Exam 4: Orthotics Part 3, AFOs, KAFOs, HKAFOs Flashcards
6 types of AFOs that are not what was in the last deck (don’t know how to ask this question, maybe just mark it blue and get rid of it)
- Anterior Floor Reaction AFO
- Patellar Tendon-Bearing/Total Contact/Claim Shell AFO (book called it Weight Relieving AFO)
- Posterior Leaf-Spring AFO
- Spiral AFO
- Klenzak
- AFO’s with Joints
What dos an Articulating/Dynamic AFO do (very general)?
It allows or assists motion
Anterior Floor Reaction AFO
- What is it/what does it look like?
- What does it do?
- What it is used for? (2)
Anterior Floor Reaction AFO (Pg 229)
- big chunk of plastic in front
- limits tibial translation (and dorsiflexion), which promotes knee extension (keeps knee more extended)
- Often used for people with people with crouch gait (gait seen in Parkinson’s)
- Could use with knee buckling
Patellar Tendon-Bearing AFO?
- What is it/what does it look like?
- What does it doe?
- What might it be used for?
Patellar Tendon-Bearing AFO
- Total Contact along front
- Reduces the axial load of the distal limb and puts it on the tissue of leg and patellar tendon
- takes weight bearing from distal end of extremity and distributes it higher up
- Used for
- Ulcer
- non-union of fracture
**Not used very often now
**Alternate Names: Total Contact- or Clam Shell- AFO (three different names he gave for the same thing) (called Weight-Relieving AFO in book, pg 230)
What are the 2-3 alternative names for a Patellar Tendon-Bearing AFO?
- Total Contact AFO
- Clam Shell AFO
- Weight-Relieving AFO (book’s term, Dr. Bringman did not mention it)
Posterior Leaf-Spring AFO
- What is it/what does it look like?
- How does it work?
- What is it good for and 2 advantages?
Posterior Leaf-Spring (pg 232)
- Considered articulating/dynamic even though it has no joints (but it moves and stores and releases energy)
- Like rigid AFO, but doesn’t provide mediolateral stability since side trimlines are removed (so it is just relatively thin in the back)
- Allows more ankle rocker motion, and assists with spring into dorsiflexion at toe off (I think it returns from DF toward PF and then stops at neutral)
- Stores energy and provides small assist with recoil
- Will slow PF, allow DF a bit in stance, and then assist launch (but not allow DF)
- Good for foot drop
- Low visibility, and fits in shoes pretty well
**Not used as much now because of the Spiral AFO
What are the two types of Klenzak AFO?
Klenzak
and
Double Klenzak
What is another name for the Double Klenzak AFO?
BICAAL
True/False: Klenzak or Double Klenzak (BICAAL) don’t have to be on an all-metal AFO. They can also be found on a plastic AFO.
True
Klenzak or Double Klenzak referrs to the joint mechanism, so it can be incorporated in a plastic or metal AFO
What is the difference between a Klenzak and a Double Klenzak (BICAAL or Bichannel)?
Klenzak has one channel (picture on pg 237, figure 9-18)
- Channel runs diagonal anterior/superior and posterior/inferior to joint
Double Klenzak has two channels (picture on pg 236, figure 9-17)
- 2 parallel channels running vertical
- one anterior to joint
- one is posterior to joint
**Picture is of a Klenzak
Describe a (plain) Klenzak
- What does it look like?
- How does it work?
- 1 channel runs diagonal from superior/anterior to inferior/posterior to the joint
- in these channels you can put one of two things in it
- rod
- makes it a solid AFO
- spring
- it will assist with dorsiflexion, just like a spiral AFO
- rod
- When a person comes into initial contact to loading, the foot goes flat and the spring gets tension on it (gets squished).
- Spring stays squished during loading response.
- The spring is in the channel running superior/anterior to inferior/posterior, so it is coiled tightly when foot is in PF.
- The coil is the tightest at toe off (Dr. bringman said this).
- When foot lifts off after toe off, the spring releases and pushes heel down, causing toe to come up.
**The way it works is weird and people get really confused. Probably look it up again in the book until you understand.
Double Klenzak/BICAAL/Bichannel Klenzak:
- What is it/what does it look like?
- How does it work?
Bichannel is on pg 236
- 2 parallel channels running vertical (one anterior to joint; one is posterior to joint)
- It is adaptible
- you can put rods or springs in each channel
- If you put rods in both channels, the AFO will be locked in neutral
- If you put a spring in the anterior channel, it could assist PF (but that is rarely used I think)
- If you put a spring in posterior channel, it will help with DF
- Take out all the rods or springs and it will provide only mediolateral stability
- or leave both springs in there to assist with both PF and DF while providing mediolateral stability
**this can be confusing, recommend looking in book or looking for more info until you understand it
Why is it good to have AFOs with joints?
we don’t want to cause atrophy by restricting movement when a pt has some strength for a movement that would be allowed by an AFO joint
Four types of AFO joints
- Overlapping plastic to create a joint
- Oklahoma AFO (it is the type of joint in the AFO that makes it an Oklahoma)
- Gillette
- USMC
Three things about a plastic overlaping joint
Overlapping plastic to create a joint
- Two pieces of plastic overlap
- needs padding
- provides lots of stability
Couldn’t find a good picture (Dr. brinman showed us one though)
Spiral AFO
- What is it/what does it look like?
- How does it work?
- What is it for?
Spiral AFO (figure 9-14 on pg 234), Discussion is under Commercially Available DF Assist Designs
- A carbon fiber orthosis that provides dorsiflexion assistance at the appropriate times in the gait cycle.
- Straps to front of tibia and spirals around to attach to full foot plate
- Allows and supports similar movement to the leaf spring AFO, but fits in a shoe better
- Often fits in normal shoe size by putting it under the insole
- Very lightweight
- Deforms and springs back to neutral at various points in the gait cycle
- Common for foot drop now (has mostly replaced the Posterior Spring Leaf)
Oklahoma AFO?
- what is it/what does it look like?
- what is it for?
- often used when we start with solid AFO, but we think a pt may need joints when they improve in the future
- The solid AFO is made with a place for the Oklahoma joint to be installed later
- If the joint wears out, we can replace it
- The joint is a removeable
Gillette Joint
- What is it/what does it look like?
- What is it for?
Gillette (pg 235)
- Made out of a flexible material that bends (not a true articulating joint)
- wears out very quickly! (Dr. Bringman doesn’t have any that are not broken)
- Used only in pediatrics
USMC joint
- What is it/what does it look like?
- how does it work?
- Has a disk in the joint which allows different available degrees of motion (like a knee orthosis)
- different disk shapes change available degrees of motion
**not in the book
**Dr. Bringman has one for us to look at (I couldn’t find a picture that I was sure was the right one)
**Dr. Bringman said he thought the name stood for United States Marine Corps (but I can’t figure out if he was joking)
Four things to know about stops used in articulated AFOs:
Stops
- usually a plantar flexion stop is used
- limits one motion but allows another
- Some change the amount of motion we limit (a peg that skrews in and out)
- Sometimes just an itty bitty bit of foam we stick there
Three Reasons to make a KAFO
Reasons for KAFO
- If knee buckling cannot be controlled by AFO
- Genu varus
- Genu valgus
KAFOs (start on pg 239)
If for some reason we cannot control the knee at the ankle, then we move up a joint, understanding that we are now going to add a lot of weight to the orthosis and pt. Requires a lot more energy expenditure and clothings options become more difficult, cosmesis goes out window, and it costs more.
What are the vast majority of KAFOs for?
Vast majority of KAFOs is going to be to stop knee buckling
(most of the time we can control recurvatum at the ankle)
How does the KAFO control Genu valgum and Genu varum?
Genu varum Genu valgum pretty simple to think about
- rods going up sides (uprights that pretty much take the place of our ligaments)
- Need enough contact above and below to hold in place and provide stability
- The KAFO knee joint must be in pretty much in exact alignment with the knee axis. (mimic and follow the exact movement of the knee) It MUST stay in the right place.
- shoot for the middle of the traveling knee axis
- For most of gait, the axis doesn’t move that much.
- shoot for the middle of the traveling knee axis
If the KAFO joint axis is exactly aligned with the knee joint axis, what is the most likely condition the KAFO is supporting?
Genu Varum or Genu valgum
(for buckling there would be a posterior offset)
Explain how to position the KAFO to prevent knee buckling and how it works
What might be a draw back?
Prevent buckling (use posterior offset with locking)
- Offset the orthosis joint at knee ever so slightly posterior to keep someone from buckling
- it becomes their new knee joint
- We want to keep them in extension
- If we put the brace joint slightly posterior it allows GRF to exert extension force on the brace joint more quickly, (which in turn might put some extensor force on knee, but what we really care about is the brace joint because pt is now weight bearing through the KAFO)
- it might interfere with other parts of the gait cycle, but it prevents them from falling down.
KAFO: Simple Drop Locks
simple drop locks
- not that advantageous for someone using their KAFO all the time by themselves.
- Might be used just in PT (PT unlocks and make sure they lock)
- Pt with SCI that insurance doesn’t think is going to really walk again, but it is therapeutic to stand.
Scott-Craig KAFO
- A type of KAFO often used with pts with SCI where the knee is always locked and the pt is encouraged to use the Y ligament of the hip to “hang” in to stay standing
- If you have them on bilaterally, then you will have a spreader bar to keep feet from going on top of each others after swing through.
- Pt will use assistiive device
Bail Lock KAFO
Bail Lock KAFO
- Lever loop on the back of the thigh that will lock and be unlocked.
- Not the best thing for if you are around a lot of people that could bump into the lever
How does an HKAFO affect motion in gait?
Once you lock out a hip, motion is going to be limited to swing through (see picture)
- there is a lot more in the book, he is not going to kill us with
When might we use a HO?
for someone who had a hip replacement that has dislocated
**Atrocious to work with
How do HGO/RGO work?
Hip guided Orthosis and Reciprocal Gait Orthosis (pg 257)
- work differently, but have same result
- RGO is By weight shifting and loading one leg the spring loaded cables advance other limb slightly forward (RGO Is in picture).
- He showed videos of these being used by pts with paraplegia and quadreplegia.
Standing Frame HKAFO
Standing frame looking thing used for pediactrics in PT sessions
- progress to parapodium (ORLAU) when child keeps rocking and starting to move
Parapodium
Called Orthotic Research and Locomotor Assessment Unit (ORLAU in the book, but Dr. B said to just call it a parapodium
A progression for pediactric from a standing frame:
Child shifts wieght back and forth and the moving the little blocks allows them to do shuffle steps
