Clinical Guidelines and Key Concepts

Question 1

What evidence is there for use of AFOs in children with CP

Answer 1

KAFOs and AFOs have been shown to improve balance after 3 months of use

Question 2

Which is more effective according to research for improving balance in children with spastic diplegia, GRAFO or SAFO?

Answer 2

GRAFO

Question 3

What strong evidence is there for use of AFOs in patients following a stroke?

Answer 3

Improve gait speed, mobility, dynamic balance

Question 4

What moderate evidence is there for use of AFOs in patients following a stroke?

Answer 4

Increase QOL, walking endurance, muscle activation

Question 5

What does the research suggest for the use of prescribing a KO for a patient following ACL reconstruction?

Answer 5

The effectiveness is inconclusive

Question 6

What is the benefit of using a KO after ACL reconstruction?

Answer 6

Increased confidence in returning to sport

Question 7

How do TLSOs and overcorrection orthoses compare in terms of effectiveness to correct scoliosis?

Answer 7

They are both equally effective

Question 8

What are the two primary considerations when deciding between prescribing a KAFO vs AFO?

Answer 8

Quad strength and proprioception at the knee

Question 9

If quad strength is 3+ or higher, are you more likely to prescribe an AFO or KAFO?

Answer 9

AFO

Question 10

If quad strength is 3 or less, are you more likely to prescribe an AFO or KAFO?

Answer 10

Depends on proprioception at the knee

Question 11

If quad strength is 3 or less and there is intact proprioception at the knee, are you likely to prescribe an AFO or KAFO?

Answer 11

AFO

Question 12

If quad strength is 3 or less and there is not intact proprioception at the knee, are you likely to prescribe an AFO or KAFO?

Answer 12

KAFO

Question 13

Why would you prescribe a SAFO over a HAFO?

Answer 13

If ambulation is not a goal

Question 14

What gait deviations will occur when ambulating with a SAFO?

Answer 14

Excessive knee flexion and hip ER

Question 15

When is a plantarflexion stop indicated?

Answer 15

Spasticity of plantarflexors, weakness resulting in poor postural control, less than 3+ dorsiflexion strength

Question 16

When is a dorsiflexion assist indicated?

Answer 16

< 4/5 dorsiflexion strength

Question 17

What is a relative contraindication for a dorsiflexion assist?

Answer 17

Moderate to severe plantarflexor tone

Question 18

When is a dorsiflexion stop indicated?

Answer 18

Lack of knee control, crouched gait, weak knee extensors, lack of proprioception at the knee

Question 19

When should you prescribe a SMO over a AFO?

Answer 19

When plantarflexion and dorsiflexion is not an issue

Question 20

When is a partial footplate indicated?

Answer 20

ROM is available and they have active great toe extension during pushoff and swing phase

Question 21

When is a full footplate indicated?

Answer 21

Flaccid foot, toe clawing, hammer toe, malalignment, may benefit from a toe shelf

Question 22

When is a flexible footplate indicated?

Answer 22

Ambulation

Question 23

When is a rigid footplate indicated?

Answer 23

If the device is only used to standing and transfers

Question 24

Why would you intentionally set an AFO in dorsiflexion?

Answer 24

Promote knee flexion and limit knee hyperextension. May be indicated for extensor tone or synergy

Question 25

Why would you intentionally set an AFO in plantarflexion?

Answer 25

Crouched gait pattern, LOG is anterior to the knee, will mostly be seen with KAFOs

Question 26

Why would you intentionally set a KAFO in dorsiflexion?

Answer 26

LOG is posterior to the knee and hip, so it will promote extension. Allows patients with SCI to hang on their Y-ligament and stand