Lecture 2: AFOs Flashcards
CPO responsibilities
pt assessment, formulation of treatment plan, pt follow up
select appropriate device/material s
design, fabricate, and fit orthoses and/or prostheses
demonstrate how to use to pt
O&P assistant vs tech
assistant
- practice under CPO, assist with P&O procedures and tasks related to pt management
- fabricates, repairs, and maintenance of devices
tech
- assists via technical support
- fabricates, repairs, or maintains orthoses and/or prostheses
- must be proficient in current fabricating techniques, familiar with material properties and skilled in use of necessary equipment
requirements to be an orthotic fitter
HS diploma, GED, or college
complete orthotic fitter pre-certiciation course
500-1000 hours supervised pt care
holds license in related allied health profession, includes PT
scope of practice for a orthotic fitter
prefabricated orthoses
evaluation of pt needs
formulate and implement treatment plan
PT role in O&P
assessment for indentified purposes
preparation for use
evaluation of fit
edu in fit and training in use
gait training, transfer training, high level training
assessment and quantification of functional benefits and uses
level I vs II codes for documentation of P&O
level I = current procedural terminology (CPT)
level II = codes that identify services, projects, and supplies not included in CPY codes such as P&O; “L codes”
what are the different ankle rockers
heel rocker = IC to loading response
ankle rocker = loading response to foot flat
forefoot rocker = terminal stance
toe rocker = preswing; MTP ext 60 deg
purposes of foot orthoses (aka inserts)
alignment correction
deformity accommodation
facilitate supination/pronation
pain relief
improve foot and/or proximal alignment
relieve weight bearing stress
important pt edu for foot orthoses
recommend progressive increase in wear time
fixed vs flexible/dynamic deformity
fixed = cant passively correct
flexible = can be partially or fully corrected
- possible causes = irregular mm activity, mm length, ligamentous deficit
prefabricated vs custom foot orthoses
prefabricated
- generic fit
- good for short term use; healing, function/training aid, contracture prevention
- low cost
custom
- individualized
- short or long term use
- higher cost (device and labor)
different lengths of foot orthoses
full = extends to toes
Sulcus length = proximal to toes (toe crease)
3/4 length = to met heads
varying flexibilities of foot orthoses
soft
- cushions
- absorbs shock
- may redistribute plantar pressures
semi-rigid
- provides some flexibility and shock absorption
- provides control of the foot
rigid
- stabilizes deformities
- controls abnormal motion
- provides support
what to document related to foot orthoses
length
fabrication method
flexibility
orthoses for pes planus
if flexible can correct with FO
posterior tibialis mm supports arch
orthoses goal for pes cavus
support deformity
causes of leg length discrepancy
previous injury to leg, bone infection, congenital, idiopathic
“normal” leg length discrepancy
up to 3/5 inch
leg length discrepancy that will result in gait abnormalities
1 and 2/3 inch
orthotics for rear foot varus
medial wedge to accomodate (decreases hyperpronation)
lateral wedge to correct
orthotics for rear foot valgus
lateral wedge to accomodate (decrease supination)
medial wedge to correct
uses of AFOs
provide ankle stability
correct malalignment
control foot drop
enhance mobility
deformity prevention
regulate or reduce mm tone
how is a custom traditional AFO fabricated
pt casted
cast created
create positive mold
AFO fabricated
AFO delivered/fitted
traditional vs 3D scan AFO
traditional = time consuming and poor reliability
3D scanning = faster for experience users and poor reliability
steps of prescribing orthotic devices
- identify where in gait cycle the abnormal time or mm performance is; where is the gait deviation
- determine what factors could be compromising the particular abnormal phases of Gait cycle
- identify what specific orthotic interventions would benefit the particular abnormal phases of gait cycle
function of AFO during swing
provide external support during swing for foot clearance (positioning of foot/ankle)
optimize position of limb for IC in prep for stance stability
AFOs during stance function
optimize position of ankle/foot
may also influence proximal alignment
provide external support for stance stability
depending on device, may also facilitate fwd progression
types of AFOs
solid/fixed
hinged/articulating
anterior floor reaction
energy storage and return
tone inhibiting
impact of solid/fixed AFO on gait
stance stability
medial lateral support
accelerated heel rocker
loss of ankle and forefoot rocker
assist with foot clearance
positions foot for IC
- ideal position = plantar grade and neutral ankle/subtalar
solid AFO effect on hyperextended knee
pushes tibia forward and prevents backward movement/knee hyper ext
what happens when an AFO is placed in 5 deg PF vs Df
PF = produces knee extension
Df = produces knee flexion
hinged/articulating AFO effect on gait/function
allows for limited ankle ROM
provide medial lateral stability
can have DF/PF assist/stop
some rockers are preserved
posterior leaf spring impact on gait/function
control PF from IC to loading response
allows for DF in stance
support foot during swing phase
trimlines posterior to malleoli = pt needs good M-L stability
anterior floor reaction AFO impact on gait/function
maintains proper ankle alignment
compensates for weak or absent gastroc/soleus mm
facilitates PF knee ext couple
anterior shell controls fwd tibial progression
*not appropriate for those with knee ligamentous instability or gene recurvatum
energy return or dynamic AFOs impact on gat/function
assist limb clearance
positions heel for IC
assists with fwd propulsion
*not appropriate for those with mod to severe hypertonicity
function of tone inhibiting AFO
controls ankle position
provide stance stability
inhibits reflexes induced by tactile stimulation
controls mm length (i.e. spasticity caused by stretch)
indicated for pts with significantly impaired motor control
alternative options to AFOs
functional electrical stimulation; relies on stimulating common peroneal nn (anterior tibia’s)
ossur foot up
DF assist with ACE
what should you document with gait deviations in objective portion
magnitude (i.e. increased, decreased, inadequate, etc)
timing
related to ROM
side
joint
direction/motion
phases of Gait
what to include in you assessment in regard to gait deviations
possible etiology (i.e. impaired motor control , abnormal ROM, pain, sensation)
impact and significance on functional task (i.e. weight acceptance, SLS, swing limb advancement)
