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DPT 620: Neuro > Assistive Technology For Locomotion > Flashcards

Assistive Technology For Locomotion Flashcards

1
Q

what are the two assistive technologies for locomotion?

A

ADs and LE orthotics

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2
Q

t/f: we want to know what the assistive technology is going to change when we prescribe them

A

true

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3
Q

we want to try and use what kind of ADs for as long as possible as you progress to the least restrictive device?

A

bilateral

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4
Q

what do we need to consider when making a prescription for assistive technologies?

A

the interaction bw fxnal performance and personal/environment factors and how they are going to effect gait speed, endurance, and balance

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5
Q

what 3 things do we want to be aware of with prescription of assistive technologies?

A

the pt fxn, prognosis, and ambulatory status

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6
Q

with d/c disposition home, home health, or outpatient, do we prescribe assistive technologies?

A

yes

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7
Q

with d/c disposition to IFR–> home or subacute–>home, do we prescribe assistive technologies?

A

sometimes

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8
Q

with d/c disposition to ECF and or with non-ambulatory pts, do we prescribe assistive technologies?

A

no

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9
Q

what are the reasons for orthotics?

A

limited DF (BIG ONE)

pt independence

stability

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10
Q

the PT exam for LE orthotics includes what?

A

a needs assessment for assistive technologies or other supportive devices

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11
Q

who is involved in the decision making team for LE orthotics?

A

the pt

the PT

the certified orthotist

the physician/physiatrist

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12
Q

what is the role of the pt in LE orthotics prescription?

A

know their expectations, compliance, co-morbidities, health condition, expected improvement, and resources

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13
Q

what is the role of the PT in the LE orthotics prescription?

A

they do the eval of gait and documentation of their current status and potential of the pt with an orthotic

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14
Q

what setting is the PT often more involved in the prescription of orthotics?

A

inpatient

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15
Q

what is the role of the certified orthotist in the prescription of orthotics?

A

they make the final determination in collaboration with the PT

expert in both materials and kinematics

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16
Q

what is the role of the physician/physiatrist in the prescription of orthotics?

A

they sign the prescription based upon the orthotist’s recommendation and provides oversight of the medical and rehab situation

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17
Q

what are the various types of LE orthoses?

A

HKAFO/HO

KAFO

AFO

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18
Q

what does the Rancho R.O.A.D.M.A.P stand for?

A

recommendations for orthotic assessment, decision-making, and prescription

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19
Q

t/f: the Racho R.O.A.D.M.A.P is widely used and accepted but has limitations for orthotic prescription

A

true

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20
Q

what is an AFO?

A

ankle foot orthotic

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21
Q

t/f: AFOs give mechanical advantage of crossing the ankle for increased control and stability of the jt

A

true

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22
Q

t/f: FOs change the angle of the foot w/relation to the floor in the sagittal and coronal places to effect change at the ankle or sometimes even at the knee

A

true

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23
Q

are FOs accommodative or corrective?

A

they can be either

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24
Q

what are the indications for AFOs?

A

muscle weakness/paralysis

some cases of genu recurvatum (<30 deg)

ligament laxity/damage (PTTD)

post-op (stability/limit motion)

OA

anatomical deformities (Charcot)

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25
Q

what are the contraindications for AFOs?

A

when knee instability is too great, so you need a higher level or support or stability

genu recurvatum >30 deg

some cases of severe spasticity

pt is nonabulatory

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26
Q

why is it a contraindication for LE orthotics when the pt is nonambulatory?

A

bc orthotics for positional purposes will not likely be covered

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27
Q

t/f: ground reaction forces of AFOs can provide a knee moment that can produce knee stability if the knee buckles bc the AFO in terminal stance wont allow DF as much, forcing back the knee

A

true

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28
Q

how are LE orthotics typically donned?

A

in sitting/EOB using the webbed space of the hand to push the heel in first then the leg

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29
Q

should an orthotic be donned distal to proximal or proximal to distal?

A

distal to proximal

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30
Q

M/L clearance on the leg should be ___ mm for conventional, total contact for polymer

A

3-6

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31
Q

medial ankle jt clearance should be__ mm

A

6

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32
Q

lateral ankle jt clearance should be ___ mm

A

5

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33
Q

the shell/frame should have ___ mm clearance below the fibular head

A

20

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34
Q

describe the initial wear schedule for LE orthotics

A

start low and ramp up the wear schedule by an hour a day working up to all waking Horus so the skin can support the change of what has been introduced to the LE

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35
Q

t/f: the shoes worn over AFOs are important

A

true

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36
Q

often, the shoes over AFOs are ___ size(s) bigger than the contralateral foot

A

1/2

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37
Q

what shells/frames are available with LE orthotics?

A

tibial (ant)
post
med
lat

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38
Q

if a pt has fluctuant edema, should they be prescribed a total contact AFO?

A

NO

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39
Q

t/f: you need increased pressure relief when prescribing a total contact AFO

A

true

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40
Q

what are the various frame materials for LE orthotics?

A

thermoplastic polymer, carbon graphite, and others

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41
Q

if the ____ trimline is too proximal, it interferes with knee flexion

A

posterior

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42
Q

what are the various trimlines of LE orthotics?

A

proximal, anterior, ankle, and footplate

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43
Q

t/f: trimline on the polymer can determine fxn

A

true

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44
Q

what is one of the most important pieces of an AFO prescription?

A

the ankle jt

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45
Q

which type of AFO ankle jt allows no movement at the ankle?

A

solid AFO

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46
Q

which type of AFO ankle jt allows some flexibility in material?

A

semisolid AFO

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47
Q

which type of AFO ankle jt allows some ankle movement?

A

articulating jt AFO

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48
Q

if you think a pt may progress a few months or a year down the line to need an articulating ankle jt AFO, can you plan ahead to modify a solid jt to an articulating jt?

A

yes!!!

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49
Q

if you plan ahead for a modification can it be paid for rather than getting a new orthotic?

A

yes!

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50
Q

a full footplate trimline is generally chosen for what pts?

A

pts with a lot of spasticity

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51
Q

a metatarsal trimline is generally chosen for what pts?

A

when pts need more terminal stance and push off w/toe extension allowed

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52
Q

what footplate trimline allows more terminal stance and push off w/toe extension allowed?

A

metatarsal trimline

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53
Q

does a static or dynamic AFO prohibit motion in any plane in the ankle?

A

static AFO

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54
Q

does static or dynamic AFO allow some deg of sagittal plane motion at the ankle?

A

dynamic AFO

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55
Q

are posterior leaf spring (PLS) AFOs and spiral AFOs static or dynamic AFOs?

A

dynamic AFOs

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56
Q

what are SAFOs?

A

static AFOs

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57
Q

are MAFOs with solid ankle static or dynamic AFOs?

A

static AFOs

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58
Q

are articulating SAFOs and MAFOs static or dynamic AFOs?

A

dynamic AFOs

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59
Q

are tone inhibiting AFOs static or dynamic AFOs?

A

static AFOs

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60
Q

are ground reaction/anterior AFOs static or dynamic AFOs?

A

static AFOs

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61
Q

are carbon graphite AFOs static or dynamic AFOs?

A

dynamic AFOs

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62
Q

are metal DBL upright open AFOs static or dynamic AFOs?

A

dynamic AFOs

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63
Q

are Klenzak/metal DBL upright locked AFOs static or dynamic AFOs?

A

static AFOs

64
Q

are neuro-orthoses static or dynamic AFOs?

A

dynamic AFOs

65
Q

t/f: an anterior shell can provide greater knee stability

A

true

66
Q
A
67
Q

what are the characteristics of an ideal orthosis?

A

meets mobility needs and goals

maximizes stance phase stability

minimizes abnormal alignment

minimally compromises swing clearance

effectively prepositions the limbs for IC

allows for energy conservation

67
Q

what factors for comfort of AFOs need to be considered?

A

can be worn long periods w/o risk to skin or pain

can be easily donned/doffed

considered clothing, footwear and toileting needs

68
Q

what are the cosmesis characteristics of an ideal orthosis?

A

it meets the individual’s needs to fit in with peers

69
Q

what are the fabrication characteristics of an ideal orthosis?

A

can be made in the shortest period of time

uses a minimally complex design

is durable

70
Q

what are the cost characteristics of the ideal orthosis?

A

can be made with minimal initial cost

has min cost for maintenance

is w/in the pt/s available budget or funding

71
Q

if not enough DF is allowed in terminal stance, what happens at the hip and knee?

A

they will go backward and hip flexors won’t get a stretch

72
Q

what are the 5 determinants of fxnal gait?

A

stance phase stability

clearance in swing

swing phase in pre-positioning

adequate step length

energy conservation

73
Q

what are the 3 stance transitions?

A

1st heel rocker

2nd ankle rocker

3rd toe rocker

74
Q

what is stance phase stability?

A

adequate stability to support the body weight and respond to ground rxn forces during the 3 stance transitions

75
Q

t/f: it is essential to achieve adequate terminal hip extension of the involved limb to drive flexor phase of the CPG

A

true

76
Q

what is clearance in swing?

A

advancing the limb must clear the ground adequately during swing phase

77
Q

clearance in swing requires what two things?

A

level pelvis

adequate hip/knee/ankle flexion in the swing limb

78
Q

what is swing phase pre-positioning for?

A

effective IC and loading response

79
Q

what is an essential driver for the limb extensor phase of the limb through CPG?

A

swing phase pre-positioning

80
Q

what is involved in getting adequate step length?

A

adequate motor control

adequate ROM at the hip knee and ankle of both limbs

81
Q

t/f: the energy cost of walking rises substantially and is effectively compromised if there are problems with muscles fxn, coordination, postural controls, or stability during gait

A

true

82
Q

walking energy and efficiency is compromised if there are problems with what parts of gait?

A

muscle fxn

coordination

postural control

stability

83
Q

adequate ___ is the CPG driver for limb extension

A

IC

84
Q

what is the 1st heel rocker?

A

controlled lowering of the foot from neutral ankle position

85
Q

the heel rocker requires eccentric contraction of what 2 muscles?

A

the quads and ant tib

86
Q

what is the 2nd ankle rocker?

A

roll over of tibial advancement over the WB foot

87
Q

the ankle rocker requires concentric contraction of the ___ with eccentric braking of the ___

A

tib ant; GS

88
Q

t/f: we don’t want so much limb clearance (DF) that we lose knee stability in terminal stance

A

true

89
Q

how are LE orthotics a balancing act?

A

they provide some deg of external stability but can disrupt smooth transitions through the rockers and forward progression

90
Q

othotics can have a negative affect on what 3 factors in gait?

A

SLS, cadence, step length

91
Q

what does a posterior channel pin do?

A

limits PF

92
Q

what are the indications for a posterior channel pin?

A

plantar spasticity
toe drag

pain with ankle motion

93
Q

what does a posterior channel spring do?

A

assists DF

94
Q

what are the indications for a posterior channel spring?

A

flaccid foot drop

knee hyperextension

95
Q

what does an anterior channel pin do?

A

limits DF

96
Q

what are the indications for an anterior channel pin?

A

weak PFers

weak knee extensors

pain with ankle motion

97
Q

what does an anterior channel spring do?

A

assists PF

98
Q

what are the indications for an anterior channel spring?

A

none, not really ever used

99
Q

if you allow more DF, what happens to the knee/tibia?

A

there is more tibial advancement and knee flexion

100
Q

what is the most common indication for an anterior channel pin?

A

weak knee extensors

101
Q

if a pt is lacking DF ROM, will a posterior channel spring work for them?

A

no bc they simply don’t have the ROM for it do give them any DF

102
Q

t/f: an anterior channel pin produces a knee extension moment by stopping forward progression of the tibia and forcing it back

A

true

103
Q

t/f: an anterior channel spring allows forward tibial progression and provides a spring on toe off

A

true (don’t worry too much on this one bc its not commonly used AT ALL)

104
Q

t/f: a posterior pin produces a knee flexion moment by placing the ankle in relative DF stopping the posterior progression of the tibia into knee hyperextension

A

true

105
Q

what things do we need to consider when deciding on a solid, PLS, or articulating ankle jt?

A

how stability do we need? ankle? knee? hip?

how much weakness is present?

how much active motor control is present?

how much spasticity is present?

how much recovery do you expect?

106
Q

if there is a lot of weakness present, what type of AFO should be your first choice?

A

a static AFO

107
Q

if only a little active motor control is present, what type of AFO should be your first choice?

A

a static AFO

108
Q

if mod/severe spasticity or fluctuant spasticity is present, what kind of AFO is required?

A

a static AFO

109
Q

how do we decide on the type of orthosis to use?

A

what is the primary deviation you’re trying to fix? what is the underlying cause?

are there any secondary deviations/issues? is there a balance/ROM loss or edema or DM?

what therapeutic handling does it take to correct it? a lot of inhibition? facilitation? or a little? what is needed and where?

110
Q

t/f: when an AFO is set in relative DF, it eliminates the 1st heel rocker, the 2nd ankle rocker, and the 3rd toe rocker in started very early

A

true

111
Q

what is the issue with orthotics set in relative DF?

A

the eliminate the heel and ankle rockers and lack knee stability

112
Q

what are the 3 orthoses in the static orthoses (group A)?

A

double adjustable ankle jt

SAFO

GRAFO

113
Q

why would a static orthosis be chosen?

A

to prohibit motion in any plane at the ankle

significant hypotonicity, hemiparesis at the knee or ankle

foot deformities

mod/severe/fluctuant spasticity

114
Q

when is a double adjustable ankle jt orthotic indicated?

A

for significant/fluctuant edema, sensory loss, or DM

115
Q

what kind of orthotic is a ground reaction force AFO?

A

static orthotic (group A)

116
Q

t/f: GRF AFOs produce a knee extension moment via relative PF with DF stop (resists knee flexion)

A

true

117
Q

what are the indications for GRF AFOs?

A

crouched gait

weakness of the quads

knee buckling

118
Q

what condition will we commonly see crouching gait in?

A

CP

119
Q

for GRF AFOs, the pt MUST have at least ____ quad MMT and good ___ stability

A

3/5, hip

120
Q

what are the indications for articulating AFOs?

A

hemiparesis and impaired muscle performance eof DF

potential for recovery of neuromotor fxn

121
Q

what are the contraindications for articulating AFOs?

A

severe paralysis

flaccidity/hypotonicity

severe spasticity

122
Q

t/f: articulating AFOs can induce clonus in pts with severe spasticity

A

true

123
Q

what do articulating AFOs with PF stop do?

A

block PF motion (typically at 90 deg)

allow free DF

124
Q

what are the indications for articulating AFOs with PF stop?

A

weak DF or tight PF

125
Q

what do articulating AFOs with DF assist do?

A

assists toe clearance during swing phase

helps control PF at IC

126
Q

what are the indications for articulating AFOs with DF assist?

A

primarily for weak DF

limited resistance to PF

127
Q

what is the main advantage of the carbon graphite AFOs?

A

their energy storage and return capabilities

128
Q

how do carbon graphite AFOs help with push off?

A

they store energy when compressed in terminal stance

129
Q

an anterior shell carbon graphite AFO provides ___ resistance during mid-late stance and assists _____ as the limb is unloaded at toe off

A

DF; PF/propulsion

130
Q

t/f: the anterior shell carbon graphite AFO provides considerable strength and force

A

true

131
Q

when is a lateral strut used?

A

on pts w/ a pronated ankle to avoid skin integrity compromise as the ankle moves medially

132
Q

when is a medial strut used?

A

on pts w/a supinated ankle to avoid skin integrity compromise as the ankle moves laterally

133
Q

what type of orthotic is a posterior leaf orthosis?

A

dynamic orthosis (group C)

134
Q

what is a posterior leaf orthosis?

A

a narrow orthosis trimmed behind the malleoli with a flange that can be added to control excessive pro/sup

135
Q

t/f: the posterior leaf orthosis provides swing phase DF assist to permit foot clearance, but provides no stance control or frontal plane control

A

true

136
Q

what are the indications for posterior leaf orthoses?

A

drop foot

DF weakness

137
Q

what are the contraindications for the posterior leaf orthosis?

A

genu recurvatum

ML instability

mod/severe spasticity

138
Q

which has more control, a posterior leaf orthosis or a MAFO?

A

a MAFO

139
Q

what is a Saebo step device?

A

a device pts will often buy off of Amazon to attach to the ankle and shoe laces to “help DF” but doesn’t really do anything for them

140
Q

t/f: neuro-orthoses assist limb clearance during swing and improve pre-positioning for IC by the heel

A

true

141
Q

what are the indications for neuro-orthoses?

A

DF weakness

low tone

142
Q

what are the contraindications for neuro-orthoses?

A

flaccid paralysis

pt intolerance to ESTIM

143
Q

how do neuro-orthoses work?

A

electrodes stimulate a nerve based on loading/unloading of the limb

144
Q

what does the CPG for AFO vs FES post stroke tell us?

A

the efficacy of and when to use AFO vs FES post CVA

145
Q

t/f: there is no difference in QOL, gait speed, dynamic balance, gait kinematics, or walking endurance outcomes with AFOs vs FES according to the CPG

A

true

146
Q

what AFO is best for the pt according to he CPG?

A

one customized to the pt

147
Q

____ may be better for slower walker, ___ may be better for faster walkers according to the CPG

A

AFO, FES

148
Q

more meaningful improvements were observed in the CPG when AFOs/FE was combined with what?

A

skilled PT

149
Q

t/f: consistent reassessments of AFO/FES are needed to meet changing needs according to the CPG

A

true

150
Q

____ provision early in recovery enhances participation and leads to faster progress towards goals according to the CPG

A

AFO

151
Q

t/f: wearing an AFO doesn’t hinder muscles activation according to the CPG

A

true

152
Q

t/f: FES can improve muscles activation through a therapeutic effect according to the CPG

A

true

153
Q

t/f: there is evidence that AFOs/FES can reduce PF spasticity according to the CPG

A

false

154
Q

an AFO that allows ___ motion may lead to greater effects of gait speed according to the CPG

A

PF

DPT 620: Neuro (10 decks)

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