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AAOS Atlas of Orthoses and Assitive Devices > Chapter 27: Lower Limb Orthoses for persons with spinal cord injury > Flashcards

Chapter 27: Lower Limb Orthoses for persons with spinal cord injury Flashcards

1
Q

What does ASIA stand for?

A

American Spinal Injury Association

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2
Q

What are the levels scored in the ASIA examination

A 
C2 to S4-5
The pinpricks are measured on a 0-2
0: absent
1: impaired
2: normal
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3
Q

how do you classify a person as an incomplete SCI?

A

Partial preservation of sensory and motor function is found below the neurological level and must include the lowest sacral segment

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4
Q

How do you classify a person as complete SCI?

A

He or she has no sensory or motor function inthe lowest sacral segment.

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5
Q

What are some possible complications in children with SCI?

A

Hip dislocation/subluxation
Scoliosis
Pressure ulcers

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6
Q

What are the different walking patterns seen in patients with SCI?

A

Step to
Step through
Swing to
Swing through

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7
Q

For a patient with SCI using an Floor reaction or Ground reactionAFO, what muscles must be present?

A

Hip flexion

quad strength of 4/5

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8
Q

For a patient with SCI using an articulated AFO, what muscles must be present?

A

Hip flexion
Quad strength of 4/5
Knee strength

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9
Q

What muscle strength is absent for a patient with SCI to use a KAFO?

A

Quads

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10
Q

What is parastance?

A

The most stable stance involving neutral ankle
Knee in extension
Hips in passive extension

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11
Q

Why would a patient with SCI require a HKAFO?

A

The level of injury is higher
Hip flexion, knee flexion, or ankle plantarflexion contractures,
Poor balance
Decreased motor control.

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12
Q

What are HGO ORLAU parawalkers?

A

Hip Guidance Orthosis
Orthotic Research and Locomotor Assessment Unit (ORLAU) parawalker
Theses are HKAFOs with free-moving hip joints that allow a reciprocal gait pattern.

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13
Q

What is a RGO?

A

A Reciprocating Gait Orthosis
An HKAFO that uses a mechanical system that connects the two sides of the brace by an isocentric bar (IRGO), double cable (LSU RGO from Louisiana State Univeristy), or single push/pull cable system (advanced RGO [ARGO])
The patient achieves a reciprocal gait by shifting body weight forward and laterally while extending the hips and upper trunk.

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14
Q

What is the HALO in regards to Lower limb SCI?

A

Hip and Ankle Linked Orthosis
It is a cable system that links both ankle joints with a medial hip joint. The linkage of the ankles by way of a pulley system results in assistance of the swinging leg when the contralateral ankle is flexed.

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15
Q

What is the SCO?

A

Stance Control Orthosis
Has knee joints that provide stability during stance but free motion during swing. It reduces the energy required during gait.

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16
Q

What are the different standers available for children?

A

L-Frame
Parapodium
Swivel standers
The Rabbit: Strapped into a stander with wheelchair like wheels for mobility.

17
Q

You have an athletic patient with a T9 injury and no significant comorbidities. Their goal is spontaneity of activities for short distances. What orthoses could work for them?

A

KAFOs

18
Q

You have a patient with a T9 injury and no significant comorbidities. The patient is interested in using an orthosis for limited function and prefers a reciprocating gait pattern. What orthoses should they use?

A

A Parawalker or RGo to be more stable.

19
Q

What orthopedic considerations might affect the patient if they want to stand?

A 
Scoliosis
Pelvic Obliquity
Hip subluxation/dislocation
Lower Limb contractures
Spasticity
History of Lower limb fractures.
20
Q

Which contractures might prevent the patient from standing?

A

30 degrees hip flexion contracture
20 degree knee flexion contracture
15 degrees of plantarflexion contracture

21
Q

What might reduce spastisity or make it worse?

A

Standing reduces spasticity

But movement may trigger a patient’s spasticity

22
Q

Which braces can be used for patients with SCI at motor level L2 or above?

A

HKAFOs (including RGOs) and KAFOs

23
Q

What are the benefits of the HGO?

A

Lateral stiffness, which prevents adduction during swing through of the free limb, and broad footplates, which encourage stability during double limb stance.

24
Q

What patient’s will benefit from an added pelvic section in a HKAFO

A

Patient’s with hip obliquity due to scoliosis or hip subluxation.
Children with pliable Y-ligaments.

25
Q

Transverse stability below the hips can be achieved how?

A

With a spreader bar, but it eliminates the possibility of a reciprocal gait.

26
Q

How can you provide reciprocal gait without transversing the hip?

A

KAFO section linked with a single medial hinge joint such as the walkabout orthosis (WO) or the primewalk orthosis.

27
Q

Patients with SCI are at risk for chronic conditions of age due to inactivity such as what?

A

Hypertension
Cardiovascular disease
Obesity
Diabetes.

28
Q

Why are orthoses prescribed for patients with SCI?

A 
Stabilization after injury
Anti-footdrop to prevent contractures
TLSOs for spine and pelvic stability
Therapeutic and functional upright mobility
independence
Decrease energy cost
29
Q

A C5 injury involves what muscles

A 
Elbow flexors
Wrist extensors
Elbow extensors
Finger flexors 
Finger abductors
Hip flexors
Knee extensors
Knee extensors
Ankle dorsiflexors 
Long toe extensors
Ankle plantar flexors
30
Q

A C6 injury involves what muscles?

A 
Wrist extensors
Elbow extensors
Finger flexors
Finger abductors
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe extensors
Ankle plantar flexors
31
Q

A C7 injury involves what muscles?

A 
Elbow extensors
Finger flexors
Finger abductors
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe extensors
ankle plantar flexors
32
Q

A C8 injury involves what muscles?

A 
Finger flexors (Distal phalanx of middle finger)
Finger abductors
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe Extensors
Ankle plantar flexors
33
Q

A T1 injury involves what muscles?

A 
Finger abductors
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe extensors
Ankle plantar flexors
34
Q

A L2 injury involves what muscles?

A 
Hip flexors
Knee extensors
Ankle dorsiflexors
Long toe extensors
Ankle plantar flexors
35
Q

A L3 injury involves what muscles?

A

Knee extensors
Ankle dorsiflexors
Long toe extensors
Ankle plantarflexors

36
Q

A L4 injury involves what muscles?

A

Ankle dorsiflexors
Long toe extensors
Ankle plantarflexors

37
Q

A L5 injury involves what muscles?

A

Long toe extensors

Ankle plantarflexors

38
Q

A S1 injury involves what muscles?

A

Ankle plantar flexors.

39
Q

At what injury site does is a respiratory tube required?

A

C4 and up

AAOS Atlas of Orthoses and Assitive Devices (40 decks)

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