L3: HKAFOs (AKA above pelvis)

Question 1

W/ HKAFOs…we are now what?

Answer 1

ABOVE the pelvis

Question 2

Rx for HKAFO depends on:

Answer 2

1. Biomechanical deficits
2. NMSK impairments
3. Indiv’s acceptance/compliance to wear

Question 3

HKAFOs diff to don/doff, cumbersome

All leads to:

Answer 3

Poor compliance***

Question 4

HKAFOs

Traditionally rx’d for→

Answer 4

• Post-polio, SCI, Myelomeningocele (spina bifida), Spastic quadriplegic CP
• B/L use
• Tradition leather w/ metal OR thermoplastic custom-fit

Question 5

Giveaway for HKAFO

Answer 5

High pelvic band

Question 6

HKAFOs

More ex’s

Answer 6

see pics

Question 7

HKAFO’s

Control and design

Answer 7

• Primary objective→ control HIP
• Single mech. axis→ Flex/Ext
  
  • *limited abd/add and rotation
• *Mech. joint attached to pelvic band (see pics)
  
  • bw greater troch and iliac crests

Question 8

HKAFOs

SCI

Answer 8

• Lower T/S and Lumbar → use single axis HKAFO w/ swing-thru gait
  
  • exxager’d lordosis+hanging on Y ligs (ant hips)

Question 9

HKAFOs

Myelomeningocele (Spina Bifida)

Answer 9

• Goal→ Upright posture
• Flaccid paralysis→ need MAX stability
• Type of jt/amt stability==> lvl of lesion and hip/trunk strength

Question 10

HKAFOs

Myelomeningocele (Spina Bifida)

How the type of orthosis changes for this pop.

Answer 10

• Changes w/ growth/age beginning bw 12-18mos for standing
• Diff to control exxag’d APT and hyperlordosis @ L/S

Question 11

Dead giveaway for Hip Guidance Orthosis (HGO)

Answer 11

*lumbosacral support

Question 12

Hip Guidance Orthosis (HGO)

Designed for what patients?

Answer 12

• Giveaway feature: Lumbosacral support
• Designed for: paraplegics unable to advance LE
  
  • rigid in SLS==> effectively advance Contralat LE in swing
• *Reciprocal gait pattern ability

Question 13

RGOs use a

Answer 13

cable system

Question 14

HGO are more or less energy cost vs traditional HKAFOs and WHY?

Answer 14

LESS!!!

*Pt does not have to lift limb up off ground to advance

Question 15

HGO

Energy cost and patient success

Answer 15

• LESS energy cost vs trad. HKAFO→ pt doesnt have to lift limb up off ground to advance
• Successful use→
  
  • High lvl SCI: C8-T12 → excellent long term compliance

Question 16

HGO used most commonly in who?

Answer 16

School-aged children

Question 17

HGO

Difficulties

Answer 17

• Diff to don/doff IND
• Diff transfer sit→stand
• *good trunk strenght==incd success. use
• *School-aged children most common

Question 18

HGO- Para walker

Answer 18

Pics

Question 19

RGO or

Answer 19

Reciprocal Gait Orthosis

Question 20

What makes the RGO different vs. HGO

Answer 20

RGO uses cable system for hip motion

Question 21

This orthosis eliminates “jackknifing” aka fall forward bc no glute strength (cannot maintain upright)

Answer 21

RGO

Question 22

Reciprocal Gait Orthosis (RGO)

What it is/How it works

Answer 22

• Structural support→ lower trunk/limbs during stance
• *Cable system→ hip jt motion to advance LEs
  
  • one cable loosens=swing hip to flex
  • one cable tightens= allows stance limb to EXT and hold thru stance
• *eliminates simult. hip flex (jackknifing)

Question 23

RGO

3 Adjustments/configurations

Answer 23

1. Traditional→ orig cable system
2. Unlocked hip jts→ no cables, free hip flex/ext
3. Locked hip jts→ max stability, simulates HKAFO mechanism
   
   1. swing TO or swing THRU

Question 24

RGO

Drawbacks

Answer 24

• Diff don/doff, wear/tear, multiple repairs, hot

Question 25

Swivel walker, Standing frames, Parapodiums

Answer 25

• Promotes/Goals:
  
  • upright posture, postural drainage, improved trunk strength, psycho. benefits, LLPS (hip/knee flex contracts)