Orthotics & FES

Question 1

Type of Orthotic: Advantages

• Lightweight
• Easy to don/doff
• Cosmetic
• Able to wear in any shoe (in theory)

Answer 1

MAFO

Question 2

Type of Orthotic: Disadvantages

• Only a little knee stability
• Concern about plastic if swelling, sensory loss

Answer 2

MAFO

Question 3

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

Answer 3

MAFO

Question 4

Type of Orthotic: Advantages

• More knee stability
• More options with ankle joint (assist / stop / etc)
• Easiest to don / doff

Answer 4

AFO

Question 5

Type of Orthotic: Disadvantages

• Heavier
• Uglier
• Can only wear with 1 shoe

Answer 5

AFO

Question 6

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

Answer 6

AFO

Question 7

Type of Orthotic: Advantages

• Most knee stability, some hip stability

Answer 7

KAFO

Question 8

Type of Orthotic: Disadvantages

• TOO HEAVY
• Very difficult to don / doff

Answer 8

KAFO

Question 9

Type of Orthotic: Comments

• Only use as last resort if nothing else works OR if significant bilateral weakness

Answer 9

KAFO

Question 10

Describe the effect of the weight of an orthotic on gait

Answer 10

The orthotic provides stability in stance but can hender swing due to the increased weight of the orthotic

Question 11

Describe the decision algorithm for determining the correct orthotic (3)

Answer 11

• Brace vs. no brace
• AFO vs. MAFO
• Ankle set up (PF vs. DF)

Question 12

Describe the purpose of a swedish knee cage

Answer 12

It sets the knee in ~ 5 degrees of knee flexion and prevention extension in attempt to prevent knee hyperextenstion during stance

Question 13

Type of Orthotic: temporary, for evaluation and early mobilization

Answer 13

Pre-Fabricated AFO

Question 14

Type of Orthotic: weakness expected for > 6 mo; improve balance/stability/WB

Answer 14

Custom MAFO or AFO

Question 15

Describe Medicare’s Guidelines for AFO modification/replacement

Answer 15

If the orthotic is lost, damage, or there is a change in the pt.’s condition

NO time frame restrictions

Question 16

Term: Use of estim for orthotic substitution and ehance function

Answer 16

FES

Question 17

List the uses for FES (5)

Answer 17

• Reduce shld subluxation
• Ankle DF during gait
• LE cycle ergometry
• Full gait cycle
• Reaching activities

Question 18

Describe the effect of FES on shoulder subluxation

Answer 18

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

Question 19

List the indications for use of FES foot drop stimulation

Answer 19

Use foot drop following an upper motor neuron injury or disease: Stroke, TBI, SCI, MS

Question 20

List when FES stimulation for foot drop is turned on and off turning gait?

Answer 20

Heel off: stimulation on

Heel strike: stimulation off

Question 21

Describe the possible operating modes for FES for foot drop (3)

Answer 21

Gait mode: ultilized for walking

Training mode: utilized for therapeutic mm training

Clinician’s mode: utilized to enhance clinical training

Question 22

List the electrode placement for FES for foot drop (2)

Answer 22

1: over common peroneal nerve; posterior and distal to fibular head
2: over tibialis anterior mm