Lecture 2: AFOs

Question 1

CPO responsibilities

Answer 1

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

Question 2

O&P assistant vs tech

Answer 2

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

Question 3

requirements to be an orthotic fitter

Answer 3

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

Question 4

scope of practice for a orthotic fitter

Answer 4

prefabricated orthoses

evaluation of pt needs

formulate and implement treatment plan

Question 5

PT role in O&P

Answer 5

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

Question 6

level I vs II codes for documentation of P&O

Answer 6

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”

Question 7

what are the different ankle rockers

Answer 7

heel rocker = IC to loading response

ankle rocker = loading response to foot flat

forefoot rocker = terminal stance

toe rocker = preswing; MTP ext 60 deg

Question 8

purposes of foot orthoses (aka inserts)

Answer 8

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

Question 9

important pt edu for foot orthoses

Answer 9

recommend progressive increase in wear time

Question 10

fixed vs flexible/dynamic deformity

Answer 10

fixed = cant passively correct

flexible = can be partially or fully corrected
- possible causes = irregular mm activity, mm length, ligamentous deficit

Question 11

prefabricated vs custom foot orthoses

Answer 11

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)

Question 12

different lengths of foot orthoses

Answer 12

full = extends to toes

Sulcus length = proximal to toes (toe crease)

3/4 length = to met heads

Question 13

varying flexibilities of foot orthoses

Answer 13

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

Question 14

what to document related to foot orthoses

Answer 14

length
fabrication method
flexibility

Question 15

orthoses for pes planus

Answer 15

if flexible can correct with FO

posterior tibialis mm supports arch

Question 16

orthoses goal for pes cavus

Answer 16

support deformity

Question 17

causes of leg length discrepancy

Answer 17

previous injury to leg, bone infection, congenital, idiopathic

Question 18

“normal” leg length discrepancy

Answer 18

up to 3/5 inch

Question 19

leg length discrepancy that will result in gait abnormalities

Answer 19

1 and 2/3 inch

Question 20

orthotics for rear foot varus

Answer 20

medial wedge to accomodate (decreases hyperpronation)

lateral wedge to correct

Question 21

orthotics for rear foot valgus

Answer 21

lateral wedge to accomodate (decrease supination)

medial wedge to correct

Question 22

uses of AFOs

Answer 22

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

Question 23

how is a custom traditional AFO fabricated

Answer 23

pt casted

cast created

create positive mold

AFO fabricated

AFO delivered/fitted

Question 24

traditional vs 3D scan AFO

Answer 24

traditional = time consuming and poor reliability

3D scanning = faster for experience users and poor reliability

Question 25

steps of prescribing orthotic devices

Answer 25

1. identify where in gait cycle the abnormal time or mm performance is; where is the gait deviation
2. determine what factors could be compromising the particular abnormal phases of Gait cycle
3. identify what specific orthotic interventions would benefit the particular abnormal phases of gait cycle

Question 26

function of AFO during swing

Answer 26

provide external support during swing for foot clearance (positioning of foot/ankle)

optimize position of limb for IC in prep for stance stability

Question 27

AFOs during stance function

Answer 27

optimize position of ankle/foot

may also influence proximal alignment

provide external support for stance stability

depending on device, may also facilitate fwd progression

Question 28

types of AFOs

Answer 28

solid/fixed

hinged/articulating

anterior floor reaction

energy storage and return

tone inhibiting

Question 29

impact of solid/fixed AFO on gait

Answer 29

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

Question 30

solid AFO effect on hyperextended knee

Answer 30

pushes tibia forward and prevents backward movement/knee hyper ext

Question 31

what happens when an AFO is placed in 5 deg PF vs Df

Answer 31

PF = produces knee extension

Df = produces knee flexion

Question 32

hinged/articulating AFO effect on gait/function

Answer 32

allows for limited ankle ROM

provide medial lateral stability

can have DF/PF assist/stop

some rockers are preserved

Question 33

posterior leaf spring impact on gait/function

Answer 33

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

Question 34

anterior floor reaction AFO impact on gait/function

Answer 34

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

Question 35

energy return or dynamic AFOs impact on gat/function

Answer 35

assist limb clearance

positions heel for IC

assists with fwd propulsion

*not appropriate for those with mod to severe hypertonicity

Question 36

function of tone inhibiting AFO

Answer 36

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

Question 37

alternative options to AFOs

Answer 37

functional electrical stimulation; relies on stimulating common peroneal nn (anterior tibia’s)

ossur foot up

DF assist with ACE

Question 38

what should you document with gait deviations in objective portion

Answer 38

magnitude (i.e. increased, decreased, inadequate, etc)

timing

related to ROM

side

joint

direction/motion

phases of Gait

Question 39

what to include in you assessment in regard to gait deviations

Answer 39

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)