Q1&2: LL Ox Systems, Biomechanics, Recommendations (AFO) Flashcards

1
Q

4 categories of pathologic gait

A
  1. Structural Impairment
  2. Motor Unit Insufficiency
  3. Peripheral sensory and motor impairment
  4. Central Control Dysfunction
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2
Q

Self selected walking speed (Men)

A

1.43 m/s

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3
Q

Self selected walking speed (Women)

A

1.39 m/s

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4
Q

Proper fitting parameters for footwear

A
  • 3/8” to 1/2” distal to toes
  • adequate depth to accommodate foot
  • heel counter captures and suspends calcaneus
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5
Q

Imposed Impairment (ankle fusion)

A

Walking speed decreases by 84% and increases work expenditure by 3%

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6
Q

Imposed Impairment (knee immobilization)

A

Walking speed decreases and increases work expenditure by 33%
- adding a lift to contralateral side can cut this in half

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7
Q

Imposed Impairment (hip fusion)

A

Walking speed decreases by 84% and increases work expenditure by 32%

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8
Q

Ankle Joint Control [PERLS]

A

Permit free motion (in one plane)
Enhance desired motion (assist)
Resist undesired motion (resist)
Limit motion (to a specific range/adjustable)
Stop motion (lock)

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9
Q

AFO Trimlines (Solid)

A

anterior to malleolus

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10
Q

AFO Trimlines (Semirigid)

A

Bisect the apex of the malleolus

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11
Q

AFO Trimlines (Flexible)

A

Posterior to malleolus

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12
Q

AFO Trimlines (Posterior Leaf Spring)

A

Further posterior than flexible trimline

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13
Q

Owen’s Criteria for Articulation

A
  1. adequate PROM for ankle DF (10 degrees)
  2. minimal spasticity (2/5 max.)
  3. adequate strength to enable volitional control (min. 3/5 PF MMT)
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14
Q

Ankle joint options - Free Motion (Tamarack)

A

Robust design as compared to Gillette, tolerates alignment inconsistency, easily swapped out
has DF assist option

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15
Q

Ankle joint options - Free Motion (Gaffney)

A

more durable but increased weight; requires precise alignment for smooth articulation

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16
Q

Ankle joint options - Free Motion (Oklahoma)

A

More robust than a tamarack and effective in high activity users, Easily Swapped out;
Potentially bulky, difficult to adjust in patients with impingement issues

17
Q

Ankle joint options - Intrinsic Stop (Camber Axis)

A

Uses small interchangeable alloy cams to limit sagittal plane motion; Requires precise alignment

18
Q

Ankle joint options - Intrinsic Stop (Clevisphere)

A

Features an adjustable plantarflexion stop which can be revised by tightening a set screw

Designed to accommodate tibial torsion
Most individuals medial malleolus is anterior to the lateral malleolus

19
Q

Ankle joint options - Motion Assist (Tamarack)

A

Available in adult and pediatric sizes; Different durometers to achieve different degrees of DF assist
- 75 (original), 85, 95 durometer

20
Q

Design Considerations - Plantar Stop

A

Effective for plantar flexor spasticity or absent
dorsiflexor muscle group

21
Q

Design Considerations - Dorsi Stop

A

Effective for absent plantar flexor muscle group and/or
weak quadriceps

22
Q

Design Considerations - Free Motion

A

Patients requiring only coronal plane support (tibialis
posterior dysfunction, early stage 3)

23
Q

Design Considerations - Dorsiflexion assist

A

must be used in conjunction with plantar stop
unless patient has normal plantarflexor tone

24
Q

Double Action Ankle Joints

A
  • Provide considerable adjustability
  • Potentially heavy
  • Bulky Design
  • Allows for joint to change as patients presentation does
  • Joint Configuration Options
25
ADR Joint
- “The Swiss Army Knife of Ankle Joints” * DAAJ with double the channels (Quadruple Action?!) - Allows Stops, Resists/Assists for PF & DF * 240 Inch/Lbs DF Assist * 360 Inch/Lbs PF Assist - Allows comparable adjustability to endoskeletal components for prosthetics -> Limited to the sagittal plane
26
AFO Trimlines to address pronation/supination
Pronation - medial flange Supination - lateral flange *extrinisic heel post can accommodate flexible deformities *could also incorporate a T-strap if fixed
27
Floor Reaction AFOs
Rigid, laminated AFO in slight plantar flexion * Extended to mid-patella * External extension moment resists knee flexion
28
Fitting Guidelines for AFOs (adults)
- Proximal Trimline - 20mm distal to the neck of the fibula - Chaffe - D-Ring should sit at least ½” (12mm) from the prox. & ant. edge - Anterior opening Project anteriorly at muscle belly Project proximal to desired ankle trimline - Midfoot Encapsulate shafts of 1st – 5th metatarsals Fully encapsulate navicular medially Fully encapsulate base of the 5th laterally - Forefoot Terminate proximal to the 1st and 5th metatarsal
29
Fitting Guidelines for AFOs (pediatrics)
Leave proximal trimline as close to neck of fibula as possible and leave footplate long as possible to accommodate growth; Wrap trimlines anterior at the calf and dorsal to the foot to increase surface area and triplanar control (requires flexible materials)