Orthotics

Question 1

Factors to consider when prescribing an Orthosis…

Answer 1

• Cognitive Level
• Functional mobility level
• Level of stability
• Endurance/energy level
• Does there condition limit

them from using heavy/bulky

devices?

Question 2

Solid AFO (SAFO)

Answer 2

• Solid AFO (SAFO) – standard
• Restrictive in all planes
• Doesn’t allow for many functional

activities that require ankle mobility

(i.e., STS, stairs)

• Uses
• Patient’s with excessive PF spasticity

and knee hyperextension

• Cerebral Palsy
• Stroke (PF Spasticity)
• Multiple Sclerosis

Question 3

Ankle-Foot Orthoses

Answer 3

Ankle Foot Orthosis (AFO’s)

• Hinged AFO (Hinged-AFO)
• Articulated foot plate and calf plate
• Doesn’t allow medial/lateral motion

but allows for DF or PF

• Uses
• A patient who needs medial/lateral

control but are limited functionally

by the SAFO

• A patient who has at least 3/5 or

greater quad strength

*A posterior stop prevents excessive PF

Question 4

Ground-Reaction Ankle-Foot Orthotic (GRAFO)

Answer 4

• Three points of contact which restrict

dorsiflexion and create extensor

moment at knee

• Prevents knee buckling during stance

phase

Used for:

• Patient who needs ankle and knee

control

• Patient who buckles in stance because

of weak quads (3/5 or greater)

• Cannot be used with 3-/5 or less!!!!

**Not great for medial-lateral stability

Question 5

Posterior Leaf Spring (PLS)

Answer 5

Posterior Leaf Spring (PLS)

• A plastic or carbon fiber AFO that stores

energy as it is deformed in stance

• Assists with foot drop
• Uses
• Significant foot drop/dorsiflexor

weakness BUT the patient must have

3+/5 or greater peroneal MMT

• BUT WHY?

Question 6

Knee-Ankle Foot Orthosis

Answer 6

Knee Ankle Foot Orthosis (KAFO’s)

• A combination of a plastic thigh

component and an AFO with two

metal uprights along the sides

• Metal uprights are used to lock knee

into extension!! So you walk like a penguin

• Uses
• Individuals who have significant

weakness in the ankle including the

quads (quads MMT <3/5)

*Usually L2 SCI

*THIS IS NOT USED FOR COMMUNITY AMBULATION

Drawbacks to using KAFO’s-

• High energy usage (Application checkpoint)
• Can cause gait deviation if knee remains

locked

• Can cause secondary complication (hip

pain, LBP)

Question 7

Hip-Knee-Ankle Foot Orthosis

Answer 7

• Hip-Knee-Ankle Foot Orthosis

(HKAFO’s)

• A combination of a KAFO with a

hip/pelvic component for hip

stabilization

• Similar metal uprights as KAFO

to restrict hip flexion/extension

• Uses
• Higher level SCI, Spina bifida

(T10-L1 ASIA A)

Question 8

RGO’s

Answer 8

• Hip-Knee-Ankle Foot Orthosis

(HKAFO’s)

• A combination of a KAFO with a

hip/pelvic component for hip

stabilization

• Similar metal uprights as KAFO

to restrict hip flexion/extension

• Uses
• Higher level SCI, Spina bifida

(T10-L1 ASIA A)

**ONLY FOR HOUSEHOLD AMBULATION