Clinical Guidelines and Key Concepts Flashcards
What evidence is there for use of AFOs in children with CP
KAFOs and AFOs have been shown to improve balance after 3 months of use
Which is more effective according to research for improving balance in children with spastic diplegia, GRAFO or SAFO?
GRAFO
What strong evidence is there for use of AFOs in patients following a stroke?
Improve gait speed, mobility, dynamic balance
What moderate evidence is there for use of AFOs in patients following a stroke?
Increase QOL, walking endurance, muscle activation
What does the research suggest for the use of prescribing a KO for a patient following ACL reconstruction?
The effectiveness is inconclusive
What is the benefit of using a KO after ACL reconstruction?
Increased confidence in returning to sport
How do TLSOs and overcorrection orthoses compare in terms of effectiveness to correct scoliosis?
They are both equally effective
What are the two primary considerations when deciding between prescribing a KAFO vs AFO?
Quad strength and proprioception at the knee
If quad strength is 3+ or higher, are you more likely to prescribe an AFO or KAFO?
AFO
If quad strength is 3 or less, are you more likely to prescribe an AFO or KAFO?
Depends on proprioception at the knee
If quad strength is 3 or less and there is intact proprioception at the knee, are you likely to prescribe an AFO or KAFO?
AFO
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?
KAFO
Why would you prescribe a SAFO over a HAFO?
If ambulation is not a goal
What gait deviations will occur when ambulating with a SAFO?
Excessive knee flexion and hip ER
When is a plantarflexion stop indicated?
Spasticity of plantarflexors, weakness resulting in poor postural control, less than 3+ dorsiflexion strength
When is a dorsiflexion assist indicated?
< 4/5 dorsiflexion strength
What is a relative contraindication for a dorsiflexion assist?
Moderate to severe plantarflexor tone
When is a dorsiflexion stop indicated?
Lack of knee control, crouched gait, weak knee extensors, lack of proprioception at the knee
When should you prescribe a SMO over a AFO?
When plantarflexion and dorsiflexion is not an issue
When is a partial footplate indicated?
ROM is available and they have active great toe extension during pushoff and swing phase
When is a full footplate indicated?
Flaccid foot, toe clawing, hammer toe, malalignment, may benefit from a toe shelf
When is a flexible footplate indicated?
Ambulation
When is a rigid footplate indicated?
If the device is only used to standing and transfers
Why would you intentionally set an AFO in dorsiflexion?
Promote knee flexion and limit knee hyperextension. May be indicated for extensor tone or synergy
Why would you intentionally set an AFO in plantarflexion?
Crouched gait pattern, LOG is anterior to the knee, will mostly be seen with KAFOs
Why would you intentionally set a KAFO in dorsiflexion?
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
