Test 1: Bracing Flashcards
KAFO vs HKAFO vs RGO
KAFO = knee ankle foot orthoses
HKAFO = hip knee ankle foot orthoses
RGO = Reciprocating gait orthoses
factors to consider with orthotic Rx
ease of use/ donning/ doffing
cost/insurance
pt goals/daily life
UE dexterity
cognition
leg length discrepancies
home environment
community involvement
energy efficiency
proprioception
caregiver knowledge
deficits in strength, ROM, sensation, pain, spasticity, tone, contractures, etc
when to use KAFO
pts with:
- poor frontal plane knee control
- excessive knee recurvatum
- weak hip extensors
quad strength usually less than 3+ and/or they have impaired proprioception
can be used in clinic, home, or community
conventional/non locking knee joint in a KAFO
reduces kneee hyperextension
controls mild to moderate valgus/varus
knee can go through entire ROM at any point in gait cycle
locking knee with KAFO
controls knee buckling
causes pt to walk with stiff knee gait
usually locked in full knee ext
stance control KAFO knee joint
control knee buckling
assists with knee ext
free ROM during swing but locks ext during stance
single axis vs posterior offset axis
posterior offset is good for people with excessive hyper extension; joint is slightly posterior to anatomical knee joint compared to the single axis which is at the anatomical knee joint
if a patient has a need to stabilize a “flail” knee but still needs some knee extensor moment and free knee motion what KAFO is recommended
offset unlocked
if a patient needs stabilization of flail knee without use of knee extensors or free knee motion what knee joint design is appropriate
single axis locked
or
offset locked (with contracture)
if pt needs control of genu recurvatum what knee joint design is best
single axis locked
offset unlocked
offset locked
all will work for this
if pt needs reduction of knee flexion contracture what knee joint design is best
variable position locked
if pt needs control of genu valgum/varum what knee joint design is best
single axis locked or unlocked
offset locked or unlocked
when may a person not need a KAFO even if their quad strength is <3+/5
if hip ext mm strength is >3+/5 and he/she has full knee ext ROM or quad tone or intact proprioception
what hip flexor mm strength is required to advance leg in swing
> or = 2/5
not fully going against gravity until hip flex is at 90
what are stance control KAFOs
mechanical stance control AFOs are gait activated by:
- ankle ROM
- inclination of the limb
- internal pendulum
allow for free knee in swing while preventing buckling in stance
can also be microprocessor controlled but that increases weight
what is a HKAFO and when is it appropriate
appropriate for pts with extreme hip weakness
can include a pelvic band
usually seen in PT setting
must have at lest 2/5 hip flexor strength to advance limb fwd
types of hip joints
free
variable ROM
flexion
extension
abduction
fixed/locked
off-set
what is a THKAFO
for pts who require more stability than HKAFO or KAFO
cubersome
difficult to don
heavy
typically only worn in PT
what is an RGO used for
weakness of trunk
hip joints are unlocked and connected by a posterior cable
knee joints are locked with a solid AFO
slow pace
RGO walking procedure
- shift weight ti R
- extend trunk
- unweight L leg through crutches
- swing L leg fwd
what are some reasons a pt might not wear an orthosis all the time
hard to do ADLs
hard to wear
believe it is unneeded
causes pressure
environmental conditions
presence of pressure sore
device is aging
benefits of standing
prevent bone breakdown/contractures
blood flow increases
reduce spasticity
psychological benefits
pressure relief
improve respiration, GI/GU function
