Orthotics & FES Flashcards
Type of Orthotic: Advantages
- Lightweight
- Easy to don/doff
- Cosmetic
- Able to wear in any shoe (in theory)
MAFO
Type of Orthotic: Disadvantages
- Only a little knee stability
- Concern about plastic if swelling, sensory loss
MAFO
Type of Orthotic: Comments
- Most common choice
- Narrow / wide trim lines to adjust ankle flexibility / stability
- Options: Post leaf spring, articulating ankle
- Initiate gradual wearing schedule and monitor skin
MAFO
Type of Orthotic: Advantages
- More knee stability
- More options with ankle joint (assist / stop / etc)
- Easiest to don / doff
AFO
Type of Orthotic: Disadvantages
- Heavier
- Uglier
- Can only wear with 1 shoe
AFO
Type of Orthotic: Comments
- Choice if can’t use MAFO because of fluctuating edema OR if knee very unstable (buckling or hyperextend)
- If unilateral weakness, this should be enough for knee control
AFO
Type of Orthotic: Advantages
- Most knee stability, some hip stability
KAFO
Type of Orthotic: Disadvantages
- TOO HEAVY
- Very difficult to don / doff
KAFO
Type of Orthotic: Comments
- Only use as last resort if nothing else works OR if significant bilateral weakness
KAFO
Describe the effect of the weight of an orthotic on gait
The orthotic provides stability in stance but can hender swing due to the increased weight of the orthotic
Describe the decision algorithm for determining the correct orthotic (3)
- Brace vs. no brace
- AFO vs. MAFO
- Ankle set up (PF vs. DF)
Describe the purpose of a swedish knee cage
It sets the knee in ~ 5 degrees of knee flexion and prevention extension in attempt to prevent knee hyperextenstion during stance
Type of Orthotic: temporary, for evaluation and early mobilization
Pre-Fabricated AFO
Type of Orthotic: weakness expected for > 6 mo; improve balance/stability/WB
Custom MAFO or AFO
Describe Medicare’s Guidelines for AFO modification/replacement
If the orthotic is lost, damage, or there is a change in the pt.’s condition
NO time frame restrictions
Term: Use of estim for orthotic substitution and ehance function
FES
List the uses for FES (5)
- Reduce shld subluxation
- Ankle DF during gait
- LE cycle ergometry
- Full gait cycle
- Reaching activities
Describe the effect of FES on shoulder subluxation
Tx to supraspinatus and posterior deltoid mm is beneficial for reducing hemiplegic shoulder pain. This low risk tx can be used any time after stroke
List the indications for use of FES foot drop stimulation
Use foot drop following an upper motor neuron injury or disease: Stroke, TBI, SCI, MS
List when FES stimulation for foot drop is turned on and off turning gait?
Heel off: stimulation on
Heel strike: stimulation off
Describe the possible operating modes for FES for foot drop (3)
Gait mode: ultilized for walking
Training mode: utilized for therapeutic mm training
Clinician’s mode: utilized to enhance clinical training
List the electrode placement for FES for foot drop (2)
1: over common peroneal nerve; posterior and distal to fibular head
2: over tibialis anterior mm
