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Year 2: Neuromuscular > Test 2: AFOs > Flashcards

Test 2: AFOs Flashcards

1
Q

some purposes of orthotics in general

A

improve performance of functional activities
improve/enhance mobility (i.e. amputation)
prevent deformity
correct passively modifiable deformity
immobilization/control/prevention
regulate/reduce muscle tone
stabilize weak/flaccid muscles
improve quality of life

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2
Q

describe the three point (counter force) system

A

includes middle force and 2 end forces

prevents plantar flexion and inversion

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3
Q

characteristics of metal AFOs

A

strong
heavy
doesn’t work well if volume fluctuates

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4
Q

characteristics of thermoplastic AFOs

A

conforms to body when custom fitted

lightweight

easy to mold

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5
Q

characteristics of composite material AFOs

A

thin
strong
durable
store and release energy

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6
Q

ways to restrict movement to different degrees

A

how enclosed the AFO is

more material = more control

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7
Q

describe a free ankle joint

A

no control

can go through full ROM in designated plane

provides some medial lateral stability

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8
Q

describe ankle joint with assist

A

plantar flexion assist most common

assists motion using external force

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9
Q

how does a dorsiflexion assist AFO work

A

uses a spring or elastic to help with DF

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10
Q

how does a dorsiflexion plantar flexion assist (dual channel) or bi channel ankle locks (BiCAAL) work

A

joint with anterior and posterior spring that assiste with plantar and dorsiflexion to varying degrees according to settings of the spring

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11
Q

describe a plantar flexion stop

A

restricts PF but allows DF

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12
Q

describe a dorsiflexion stop

A

restricts DF but allows full PF

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13
Q

what is a limited stop motion AFO

A

limits or stops joint movement

can set specific ROM restrictions

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14
Q

describe the cinical decision making process for selecting an AFO

A
  1. identify impairments- location/type/joints
  2. functional goals- PLOF, prognostic, disease progression
  3. orthotic goals - type of impairment relates; stabilize, protect, correct, etc
  4. possible orthotic solutions to meet goal - biomechanical features
  5. develop orthotic prescription - most appropriate device for pt
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15
Q

factors to consider with orthotic Rx

A

effective but least controlling

limit interference woth normal movement of adj joints

energy efficiency

foces on adj joints

minimize negative side effects

pt satisfaction/ease of use

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16
Q

how does DF paresis compensate

A

steppage gait

increase hip and knee flexion in swing

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17
Q

how does DF paresis impact spactial temporal factors of gait

A

decreased step length
decrease time to foot flat

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18
Q

how does PF paresis compensate

A

increase stance knee flexion

increase stance phase DF

19
Q

how does PF paresis affect temporal spatial parameters of gait

A

prolonged midstance

decrease stance time

20
Q

prefabricated vs custom AFOs

A

prefabricated
- off the shelf
- generic fit
- size selection
- more accessible
- quicker/cheaper

custom
- specific to pt
- need orthotist
- more expensive/takes more time

21
Q

functions of a solid or fixed AFO

A

stance stability (ROM impeded, especially with SLS)

ML support

assists with foot clearance

position foot for initial contact

blocks DF and PF

22
Q

how to fit an AFO to avoid knee hyperextension

A

align the AFO into more DF = prevent hyperextension

opposite of patient is staying in too much knee flexion

23
Q

negative impact of solid AFO

A

cant go into DF with:
- sit to stand
- stairs
- walking up/down hill

24
Q

functions of hinged/articulating AFOs

A

allows for ankle ROM- depends on PF or DF stop

provide ML stability

can have DF assist

aids in foot clearance

25
Q

describe metal upright articulating AFOs

A

utilize bichannel adjustable ankle locks (BiCHAALs)

highly adjustable to limit and/or assist ankle motion

can be for DF assist with PF stop or PF assist with DF stop

26
Q

describe posterior leaf spring

A

flexible thermoplastics

trimline posterior to malleoli; doesnt provide much ML support

27
Q

functions of posterior leaf spring

A

control PF from initial contact to loading response

allows for DF during stance

support foot during swing

28
Q

what does a posterior leaf spring not work well for

A

individuals with moderate to severe hypertonicity

29
Q

metal upright articulating AFOs dont work well for

A

those with limb volume fluctuations

abnormal foot position

30
Q

anterior floor reaction AFOs are not appropriate for

A

individuals with knee ligamentous instability or genu recurvatum

31
Q

functions of anterior floor reaction AFOs

A

maintain proper ankle alignment

compensates for weak or absent gastroc soleus muscles

facilitate plantar flexion knee extension couple

anterior shell controls forward tibial progression

32
Q

what are the coupling movements for the knee and ankle

A

DF and knee flexion

PF and knee extension

33
Q

describe energy return or dynamic response AFOs

A

typically made of carbon fiber

inappropriate for individuals with moderate to severe hypertonicity

34
Q

functions of energy return or dynamic response AFOs

A

assist limb clearance in swing

position heel for initial contact

assist with forward propulsion

35
Q

what is the rancho ROADMAP

A

recommendations for orthotic assessment, decision making, and prescription

36
Q

what is a factor that can indicate a pt needs an orthoses more involved than an AFO

A

if the pt has <3+/5 quad strength or impaired proprioception on test limb

37
Q

what types of AFOs does medicare cover that are not used during ambulation

A

PF contracture

reasonable expectation of ability to correct contractire

contracture interferes with functional abilities

uses a component of therapy program, including active stretch

plantar fasciitis

38
Q

what are reasons AFOs are covered by medicare when used during ambulation

A

individuals with weakness or deformity of the foot and ankle who:

require stabilization for medical reasons

have potential to benefit function

39
Q

advantages of functional electrical stimulation, FES and how it works

A

cosmesis

less bulky

less restrictive

rely on stimulating common peroneal n (anterior tibialis)

sensor used to detect lower leg position

40
Q

describe the ossur foot up

A

light weight
easily adjusted
low maintenance
affordable

must be used with shoes

assists with foot clearance

41
Q

benefits of AFOs for adults with hemiplegia

A

prevent or reduce PF or IV contractures

improve balance

enhance gait

reduce genu recurvatum if PF stop

facilitate weight shift to involve limb if DF stop

42
Q

effects of AFO on people with DF paresis

A

improve energy efficiency

improve exercise tolerance

improve DF during swing

circular/elestic = more comfy than dorsal AFO

circular/elastic increase walking speed more than dorsal

43
Q

benefits of FES for post stroke pt

A

improve DF
improve balance
improved functional mobility
increase gait speed when combined with PT

44
Q

describe importance of prescribing proper AFO

A

providing an AFO too early or with too much support could impede neuroplasticity/recovery

if ankle is fully supported, normal muscleactivation may not occur = learned nonuse

insurance only reimburses for AFO every 2 years

Year 2: Neuromuscular (20 decks)

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