IMOs/SMOs, Hinged AFOS, KOs & KAFOs Flashcards
What motions are controlled by plastic AFO and HAFOs?
- PF
- pronation
- Supination
How is PF controlled by plastic AFO & HAFO?
- A force directed posterior/inferior originating from the top of the shoe or a calcaneal strap is balanced by an anteriorly directed force originating from the posterior superior portion of the plastic shell and a superiorly directed force from the bottom of the orthotic in the area of the metatarsal heads
How is pronation controlled by plastic AFO & HAFO?
A laterally directed force originating medially in the area of the talus and navicular is balanced by medially directed forces originating laterally at the lateral superior portion of the plastic shell and lateral portion of the brace/shoe in the area of the 5th metatarsal head
How is supination controlled by a plastic AFO & HAFO?
A medially directed force originating laterally at the lateral malleolus and talus is balanced by laterally directed forces originating medially at the medial superior portion of the plastic shell and the medial portion of the brace/shoe in the area of the 1st metatarsal head
Describe an overlap joint
- inexpensive but strong and relatively simple in construction
- drawback to this joint is that it is very wide and if the patient adducts and walks with a narrow BOS, they may trip
Describe the Gaffney joint
single axis metal joint which is not as durable as some of the other choices
Describe the Oklahoma joint
- plastic joint but designed and reinforced in a more streamlined manner compared to the overlapping joint
- It is frequently used
Describe the tamarack & Gillette hardware
- they allow for a simple hinged articulation
- depending on design/shape, may provide the ability to assist with motion at the ankle (typically DF)
- These joints are made of rubber composite and are commonly used
- A spring assist in a joint is contraindicated anytime there is spasticity
Describe the wafer joint
- metal joints designed to be durable and adjustable into both PF and DF range depending on the assist may be incorporated into either of these joints
- They are more durable than the plastic and rubber joints
- heavier and more expensive than plastic joints
What is the function of a PF stop?
used to decrease PF
When is a PF stop indicated?
- whenever there is a lack of active DF or control of DF necessary for adequate swing clearance
- A plantarflexion stop could be set at 0 degrees or varying degrees of plantarflexion.
T/F: If any PF is allowed, that motion is not controlled
True
Where is a check strap typically positioned? What is its function in this position?
- posteriorly or laterally
- Used to restrict the amount of DF
When is a check strap indicated?
patient is demonstrating a flexed gait
Why might a hinged AFO be preferred over a SAFO?
- allows varying degrees of movement at the ankle providing the opportunity for greater ease and efficiency in functional movements
- It is indicated if the patient has a fair amount of control at the trunk/ hip and at least emerging control at the knee
Why might a SAFO be preferred over a hinged AFO?
- when trunk/hip/and knee control is compromised but yet upright function may still be the goal
- A solid ankle provides a good deal of stability at the ankle and biases the hip and knee towards a desired position depending on the angle at which the ankle joint is set.
- The SAFO may also be used to maintain alignment
If a post is present where is it found? What is it made out of and what is the function?
- it is found on the inferior surface of the orthosis
- It may be made out of plastic or foam
- functions to hold the orthosis steady in the shoe
T/F: Posting should add height to the orthosis
False- It should not
what is the difference between SMOs & IMOs in regards to trim lines?
Trimlines of the SMOs typically extend up above the malleoli where as IMOs are trimmed below the malleoli
What motions might an IMO control?
Supination or pronation
How is pronation controlled in an IMO?
laterally directed force originating medially in the area of the talus/navicular with medially directed forces originating laterally in the area of the calcaneous and the 5th metatarsal head (maybe from the brace if it extends out that far or from the lateral part of the shoe)
How is supination controlled?
a medially directed force originating laterally in the area of the talus combined with laterally directed forces originating medially in the area of the calcaneous and the 1st metatarsal head (maybe from the orthotic if it extends out that far or from the medial part of the shoe
What is the calcaneal relief function?
greater stability of the subtalar joint by “saddling” the calcaneous in the heel cup
What function may metatarsal relief be used for?
It may be tone inhibiting
Why may a toe shelf be incorporated into the footplate?
Toes should be horizontal (not hyperextended or clawed)
What is the difference between reliefs & buildups?
- Reliefs allow those areas to “sink into” or “drop into” the orthosis by saddling of the calcaneous
- Build ups are raised and support the corresponding anatomy in those areas
What is the difference between use of IMO vs shoe modifications?
- With an IMO, the corrections made are closer anatomically to the foot and may have greater impact
- The IMO may be more cosmetically acceptable and occasionally can be interchanged in different shoes.
- When a shoe is modified it typically can accommodate changes in foot volume to a greater degree
What motions might a SMO control?
- Supination
- Pronation
- possible PF
How might a SMO control supination?
medially directed force originating laterally from the orthosis in the area of the lateral malleolus/talus and laterally directed forces originating medially from the orthosis in the area of the medial malleoli/superior trimline of the orthotic and the 1st metatarsal head(maybe from the orthosis if it extends out that far or from the medial part of the shoe)
How does a SMO control pronation?
a laterally directed force originating medially from the orthosis in the area of thetalus/navicular and medially directed forces originating laterally from the orthosis in the areaof the lateral malleoli/superior trimline and the 5th metatarsal head (maybe from the orthotic ifit extends out that far or from the lateral part of the shoe)
How might a SMO control PF?
diagonal force directed inferiorly and posteriorly originating from the calcaneal (ankle) strap or the top of the shoe, a superiorly directed force originating from the base of the orthosis near the metatarsal heads, and an anteriorly directed force originating from the superior posterior trimline of the brace.
When comparing an IMO vs SMO which would demonstrate a greater triplanar (supination/pronation) control?
SMO because with the increased vertical construction/dimension there is greater leverage to control supination/pronation
Which would demonstrate PF control an IMO or SMO? Why?
SMO because high poster trimline is essential to set up a 3 point pressure system to control PF
How does height of posterior trimline affect PF control?
- one of the counterbalancing forces.
- The longer (higher) the posterior trimline (lever arm), the greater the leverage to control PF
When would you recommend an SMO over an IMO?
- SMO would be recommended when medial and lateral control is not adequately obtained using an IMO
- An SMO is also warranted when there is a need for PF control
How do you know if an SMO is designed to correct a flexible deformity or support a rigid one?
- If the orthosis is aligned to neutral, then the orthosis was used to correct a flexible deformity
- If the orthosis is not aligned to neutral; then most likely the orthosis was used to support a rigid deformity.
Which movement are controlled by a supracondylar shell KAFO or a Floor Reaction Orthosis (FRO)?
- At the knee, hyperextension, valgus, and varus
- Some amount of control is provided at the foot and ankle for PF, DF, supination and pronation.
How is hyperextension controlled by supracondylar shell KAFO or a Floor Reaction Orthosis (FRO)?
an anterior directed force originating at the posterior/superior margin of the orthosis is balanced by posterior directed forces originating at the anterior superior and inferior portions of the orthosis.
How is valgus controlled by the Supracondylar Shell KAFO or Floor Reaction Orthosis (FRO)?
a laterally directed force originating from the central portion of the medial aspect of the orthosis near the knee is balanced by medially directed forces originating from the superior and inferior lateral aspect of the orthosis.
How is varus controlled by a supracondylar shell KAFO or Floor Reaction Orthosis (FRO)?
a medially directed force originating from the central portion of the lateral aspect of the orthosis near the knee is balanced by laterally directed forces originating from the superior and inferior medial aspect of the orthosis
How is PF controlled by a supracondylar shell KAFO or Floor Reaction Orthosis (FRO)?
an inferior/posterior directed force originating at the anterior inferior trimline of the orthosis (on the dorsum of the foot) is balanced by a superior directed force from the bottom of the shoe and an anterior directed force from the posterior superior margin of the orthosis
How is DF controlled by a supracondylar shell KAFO or Floor Reaction Orthosis (FRO)?
an anterior/superior force originating from the heel portion of the shoe is balanced by an inferior directed force originating from the anterior inferior trimline of the orthosis (on the dorsum of the foot) and a posterior directed force originating from the superior anterior portion of the orthosis
How is supination controlled by a supracondylar shell KAFO or Floor Reaction Orthosis (FRO)?
a medially directed force originating laterally in the area of the lateral malleoli and talus is balanced by laterally directed forces from the anterior medial distal portion of the orthosis and the shoe in the area of the 1st metatarsal head and the medial superior portion of the orthosis
How is pronation controlled by a supracondylar shell KAFO or Floor Reaction Orthosis (FRO)?
a laterally directed force originating medially in the area of the talus and navicular is balanced by medially directed forces originating from the anterior lateral distal portion of the orthosis and the shoe in the area of the 5th metatarsal head and the lateral superior portion of the orthosis
T/F: A supracondylar shell KAFO is unique because the ankle joint is set in DF
False- Ankle joint is set in PF
How does the Supracondylar joint KAFO being set in PF influence biomechanics alignment?
With the ankle set and then supported in PF, the weight is shifted anteriorly towards the ball of the foot
- This shifts the ground reaction force more anteriorly as well
- The knee is biased towards extension and the hip towards flexion
What are the advantages of the supracondylar KAFO being set into PF?
This orthosis biases the knee toward extension without having to extend the orthosis much higher than the femoral epicondyles
What are the disadvantages of the supracondylar KAFO being set into PF?
- The patient prescribed this orthosis must have adequate hip extensor strength to control and overcome forces biasing it towards flexion
- For this reason, many have felt that this orthosis may actually be destabilizing
- Cosmetically, when the patient sits with this orthosis it extends up past the knee and for this reason may be awkward when wearing pants
What are the typical indications for supracondylar shell KAFO?
patient demonstrates a crouched (flexed) gait pattern
Describe the general guidelines to assess optimal fit of a double metal upright KAFO
- Superiorly brace extends to the upper third of the thigh with adequate clearance 3-4” in the groin area.
- Superior, lateral portion of the brace should fall below greater trochanter.
- Knee and ankle joints should correspond anatomically to the knee and ankle respectively.
- Condylar pads should be positioned over the condyles
- shoe should be comfortable in weightbearing and non- weightbearing positions
- Calf band should be placed 2-3” below popliteal fossa posteriorly and lie inferior to the fibular head
Which motions are restricted by a double metal upright KAFO?
When the knee joint is locked in the orthosis: knee hyperextension, flexion, valves & varus are controlled
How is hyperextension controlled in a double upright metal KAFO?
a combined anterior directed force originating posteriorly from a combination of the inferior thigh band and the calf band (work together as primary force) is balanced by posterior directed forces originating anteriorly from the thigh strap and the inferior leg strap
How is flexion controlled by a double upright metal KAFO?
a posterior directed force originating anteriorly from the knee pad (or a combined force from the supra and infra patellar straps) is balanced with anterior directed forces originating posteriorly from the superior thigh band and the calf band