Orthotics and FES Flashcards
What are advantages of a MAFO?
Light weight
Easy to don/doff
Cosmetic
Able to wear in any shoe
What are disadvantages of MAFO?
Only a little knee stability
Concern about plastic if swelling, sensory loss
Why are considerations when using MAFOs?
Narrow trim lines to adjust ankle flexibility
Wide trim lines to adjust stability
Options for posterior leaf spring, articulating ankle
Initiate gradual wearing schedule and monitor skin
What are advantages of AFO (double upright)?
More knee stability
More options with ankle joint (assist/stop/etc)
Easiest to don/doff
What are disadvantages for AFO double upright?
Heavier
Uglier
Can only wear with one shoe
When is a upright AFO used?
Can’t use MAFO because of fluctuating edema
Knee very unstable (buckling or hyperextended)
If unilateral weakness, this should be enough for knee control
What are advantages and disadvantages of KAFO? when might it be used?
Advantages: most knee stability, some hip stability
Disadvantages: Too heavy, very difficult to don/doff
Use as last resort if nothing else works OR if significant bilateral weakness
What is decision algorithm for prescribing orthotics?
Do they need a brace: presence of foot drop, days post stroke
AFO or MAFO?
Ankle joint considerations:
more PF = more knee extension in stance, toe clearance difficult
more DF = more knee flexion; toe clearance easier
Usually 5 degrees DF is happy medium
What are other orthotic options?
Swedish knee cage: helps temporarily with recurvatem
Knee immobilizer: buckling
Air stirrup/ankle brace: inversion or eversion problem in late stance
Supramalleolar AFO: used in peds, helps with PF and eversion in kids with CP
What are Medicare guidelines for orthotics?
Prefabircated AFO: temporary, for evaluation and early mobilization
Custom MAFO or AFO: ambulatory/potential for functional benefit; foot/ankle weakness expect > 6 months; goals are to improve walking speed, control knee stability, improve balance/stability/weight bearing
When will Medicare replace or modify an AFO?
If it’s been lost, damaged, or there is a change in patient’s condition
What is EMG biofeedback used for?
Augmented feedback: general principles, improve active movement, decrease hypertonicity (relax: at rest, with distraction, use of other muscles; decrease activity during passive stretch; relax during isometric contraction of antagonist)
Where are electrodes placed for EMG biofeedback?
Electrode size big and place far away: activate larger muscle area
Electrode size small and close together: smaller muscle activation
What is FES used for?
Use of estim for orthotic substitution/enhance function
Reduce shoulder subluxation, ankle DF during gait, LE cycle ergometry, full gait cycle, reaching activities
What is research for using FES and biofeedback?
Shoulder subluxation: treatment to supraspinatus and posterior deltoid, reduces shoulder pain, low risk intervention that can be used any time after stroke
Use EMG triggered NMES to increase wrist and finger extension. experimental group had improved ability to move blocks and generate force
What are indications for foot drop stimulation?
Provide ankle DF in individuals with foot drop following an UMN injury or disease (stroke, TBI, SCI, MS)
Can improve user’s gait, facilitate muscle re-education, prevent/retard disuse atrophy, maintain or increase joint ROM, increase local blood flow
What is electrode placement for L300?
Electrode 1: over commone peroneal nerve, posterior and distal to fibular head
Electrode 2: over tibialis anterior muscle
Muscles: co contraction of peroneus longus, brevis and extensor digitorum longus with tibialis anterior
What were results of L300 study?
Primary outcome: gait velocity improved in both groups, no significant difference between groups
Secondary outcomes: consistent improvement in both groups
Use satisfaction was superior in L300 group
What are conclusions for using L300?
More active people do well with L300
Low functioning people did not have huge impact using the device
If you have it in clinic and the person has the money just try it out and see how it works
