FOs + AFOs Flashcards by Demond Fleming

select appropriate device and materials, design/fabricate/fit orthoses & protheses, and demonstrate how to use the device. These are all responsibilities of ??

certified orthotist/prosthetist

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what kind of education does a CPO need?

Bachelor’s Degree or higher in O&P from an accredited program
OR
a degree with a post-graduate O&P certificate program from an accredited program AND clinical residency

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how many hours of continuing education must a licensed orthotist or prosthetist complete annually in TN?

15 hours
– no more than 5 hours should be completed via delivery methods using some sort of at home/online platform

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if a person is licensed in more than 1 profession (i.e., orthotist AND prosthetist), how many hours of continuing education must they complete annually in TN?

20 hours
– 6 hours shall pertain to each profession they are licensed in

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practice under guidance of CPO, assist with O&P procedures and tasks related to patient management, fabricate/repair/maintenance of devices. these are all responsibilities of ???

O&P assistant

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assists CPO by providing technical support. this is responsibility of ???

O&P technician

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what are the requirements to become an orthotic fitter?

high school diploma, GED or college education
pre-certification education course
500-1000 hours of supervised patient care
license in related allied health profession, includes PT

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what is the scope of practice for an orthotic fitter?

prefabricated orthoses
evaluation of patient needs
formulate and implement treatment plan

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what is PTs role in O&P?

assessment for identified purposes
preparation for use
evaluation of fit
education on fit and training
gait training, transfer training, high level training
assessment and quantification of functional benefits and uses

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what are the 4 rockers AND the phases of gait each fall into?

heel rocker - initial contact to loading response
ankle rocker - loading response to midstance
forefoot rocker - terminal stance
toe rocker - pre swing

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foot orthoses aka ____
what are the purposes? (6)

insert
- alignment correction
- deformity accommodation
- facilitate supination/pronation
- pain relief
- improve foot and/or proximal alignment
- relieve weight bearing stresses

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what should we recommend if our patient is going to use a foot orthosis?

progressive increase in wear time

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what is a fixed deformity?
flexible/dynamic deformity?

cannot be passively corrected
can be corrected. possible causes: irregular muscle activity, muscle length, ligamentous deficit

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prefabricated orthoses are good for ____ term use specifically helps with ____, _____, _______

short term
healing, function/training aid, contracture prevention

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custom/definitive orthotics can be used for ____ term use

short or long term

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what does the evidence say about prefabricated vs custom foot orthoses?

one is not better than another

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3/4 length FO extends to:
sulcus length FO extends to:
full length FO extends to:

– met heads
– proximal to toes
– extends to toes

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soft foot orthoses:
– provides _____
– absorbs ____
– may redistribute _____ pressures

– cushioning
– shock
– plantar

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semi-rigid foot orthoses:
– provides some ___ and ____ absorption
– provides _____

– flexibility ; shock
– control of the foot

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rigid foot orthoses:
– _____ deformities
– controls ______
– provides ______

– stabilizes
– abnormal motion
– support

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what 3 things should you include in your documentation of a foot orthoses?

length (3/4, sulcus, full)
fabrication method (custom, off the shelf)
flexibility (soft, rigid, semi-rigid)

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what two foot deformities resulting in abnormal medial longitudinal arch indicate use of a FO?

pes planus (flat foot) – posterior tibialis supports arch
pes cavus (high arch) – support deformity w/ high arch support

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which abnormal medial longitudinal arch deformity can be corrected with FO?

pes planus - if flexible can be corrected

______ inch indicates normal leg length discrepancy
______ inch difference will result in gait abnormalities
– what kind of FO would you use for leg length discrepancy?

3/5
1 & 2/3
– external shoe modification, heel lift/wedge

what two rearfoot malalignment deformities indicate FO use? -- what kind of FO would you use for each?

1. rearfoot varus -- medial wedge to accommodate ; decreases hyperpronation 2. rearfoot valgus -- lateral wedge to accommodate ; decreases supination -- medial wedge to correct

AFO types (2) & materials (3):

types: pre-fabricated or custom materials: plastic (polypropylene), carbon fiber, or metal

uses for indication of AFO: (6)

provide ankle stability correct malalignment control foot drop enhance mobility deformity prevention regulate or reduce muscle tone

traditional custom fabrication method for AFOs: -- ____ time -- ____ reliability 3D scanning custom fabrication method for AFOs: -- _____ time -- ____ reliability

more poor faster poor

a patient comes to you without an AFO and can walk without one although exhibits impaired gait. why would you choose to recommend an AFO for this patient?

safer and more efficient

when prescribing orthotic devices what three things do you need to consider?

1. where in the gait cycle is the deviation 2. factors that compromise the abnormal phases of gait (muscle, ROM, spasticity) 3. identify specific orthotic interventions would benefit

how do AFOs help during the swing phase?

- provides external support for foot clearance - optimize limb position for initial contact in preparation for stance stability

how do AFOs help during the stance phase?

- provide external support for stance stability - facilitate forward progression - influence proximal alignment - optimize position of the ankle/foot

solid or fixed AFO: -- provides ____ stability and ___-____ support -- accelerated _____ _____ -- loss of _____ and ____ rocker -- assists with _______ -- position foot for ____ -- ideal position:

-- stance and medial-lateral -- heel rocker -- ankle and forefoot -- foot clearance -- initial contact -- foot in plantigrade, neutral ankle and subtalar joint

where should the calf band of a solid AFO sit?

below fibula head to prevent impingement of peroneal nerve

Solid AFOs are utilized for a patient with _____

knee hyperextension --> pushes tibia anterior

an AFO in 5 deg PF produces ____ an AFO in 5 deg DF produces ____

knee extension knee flexion

hinged/articulating AFOs: -- _____ ankle ROM -- provides _____ stability -- can have _____ -- aids in ______ -- some _____ are preserved

-- limited -- medial-lateral -- DF/PF assist/stop -- foot clearance -- rockers

what is the most common hinged AFO combo?

DF assist, PF stop

Posterior leaf spring AFO: -- control PF from ____ to _____ -- allows DF during ____ phase -- support foot during _____ phase -- pt needs good M/L stability. Why?

-- initial contact to loading response -- stance -- swing -- trimlines of AFO are posterior to malleoli (doesn't provide much M/L support)

anterior floor reaction AFOs: -- maintains ____ -- compensates for ______ muscles -- facilitate _____ couple -- anterior shell controls _____

-- proper ankle alignment -- weak or absent gastroc-soleus -- PF knee extension -- forward tibial progression

anterior floor reaction AFOs are not appropriate for individuals with:

knee ligamentous instability or genu recurvatum

energy return or dynamic response AFOs: -- assist limb clearance in ____ -- positions _____ for initial contact -- assists with ____

-- swing -- heel -- forward propulsion

energy return or dynamic response AFOs are not appropriate for individuals with:

moderate to severe hypertonicity

tone inhibiting AFOs: -- controls ____ position -- provides ____ stability -- inhibits _____ induced by tactile stimulation -- controls ____ _____ -- indicated for patients with ____

-- ankle position -- stance -- reflexes -- muscle length -- hypertonicity with significantly impaired motor control (fixed ankle)

what are some alternate options for an AFO?

FES - rely on stimulating the common peroneal nerve (anterior tib) Ossur foot up DF assist with Ace wrap

in the objective portion of your note, be sure to document the following gait deviations:

magnitude (timing, related to ROM) side (left/right) joint direction/motion (flex/ext) phases of gait

"excessive R hip flexion mid to terminal stance" should be documented in which section of your note?

objective

in the assessment portion of your note, include the possible ____ of the gait deviation such as:

etiology - impaired motor control abnormal joint ROM impaired sensation pain

in the assessment portion of your note, you should include the etiology AND _____ on functional tasks, such as:

impact/significance -- weight acceptance single limb support swing limb advancement

in acute stroke, it is best practice to provide an AFO to improve _____

quality of life

in acute stroke AND chronic stroke, you should NOT provide an AFO for someone with ___

spasticity

in chronic stroke, you SHOULD provide an AFO to improve ______ whereas in an acute stroke, you MAY provide an AFO

endurance

in an acute stroke, it is best practice to provide FES to improve (4)

quality of life dynamic balance muscle activation gait kinematics

in chronic stroke, you SHOULD perform FES to improve ______ & _____ whereas in an acute stroke, you MAY perform FES

endurance and muscle activation

in people with DF paresis, they may benefit from ____ and ____ orthoses

circular and elastic (not as much dorsal orthoses)

in children with CP, if they ambulate with an AFO they have: -- decreased ____ __ during walking -- improved _____ -- increased ______

-- energy expenditure -- ankle position -- walking velocity, stride and step length, single support time