Orthotic Decision Making

if quad strength is <3+/5 bilaterally

Depending on contractures/activity, what orthoses to assess for?

bilateral KAFO vs B AFO

if quad strength is at least 3+/5 bilaterally

depending on proprioception, what orthoses to assess for?

KAFO or AFO

if quad strength is <3+/5 in affected but >3+/5 for unaffected side

Is the knee hyperextending/buckling, what orthoses to assess for?

Unilateral KAFO unlocked or locked

KAFO Decision Tree for <3+/5 bilaterally

Depending on contractures/activity, assess for bilateral KAFO vs B AFO

if has no contracture, SLR 4/10, 50 dips parallel bars, then use a

stance control KAFO

KAFO Decision Tree for <2/5 bilaterally

Depending on contractures/activity, assess for bilateral KAFO vs B AFO such as

RGO or stance control

If pt can’t stand independently, walk in parallel bars, or walk 20 steps w/ supervision, should you give them a brace?

do not give long leg orthoses, assess them for AFO

If pt has contractures, can’t SLR to 100deg, can’t floor to WC transfer, can’t perform 50 dips in // bars, VO2 max <20ML, then they are

not appropriate for KAFO (assess for AFO, wheelie ability in w/c)

if both legs have at least 3+/5 bilaterally

depending on proprioception: in tact proprioception at knee, assess for KAFO or AFO?

AFO, unlocked KAFO if proprioception at knee is impaired

if pt has less than 3+/5 if knee is hyperextending or buckling?

KAFO, locked to prevent buckling

what are some examples of locked KAFOs?

drop locks, bail lock

if pt has 3+/5 & is hyperextending what orthotic would you assess for?

KAFO, unlocked

decided to get an articulating joint AFO, with PF <4/5 seeing excessive DF (buckling), poor PF (hyperextending), then choose a

DF stop

if BERG is < 43 then recommend the orthosis to be

locked (high fall risk)

if BERG is < 43, no severe spasticity then use a

PF stop

if pt has Ankle weakness, severe spasticity, or absent proprioception w/ BERG score <43; the orthotic to use would be a

Rigid AFO or Metal AFO w/ DAAJ locked indicated

if pt has ankle weakness, PF <4 w/ excessive knee flexion (excessive DF) or knee extension (excessive PF) in stance. Orthotic to use

AFO with DF stop

Ankle strength weakness (PF >4 w/ foot drop DF weak). Orthotic to use

PLS or AFO w/ DF assist indicated

If pt has ankle weakness, severe spasticity, PF contracture, absent proprioception, w/ score of Berg >43. Orthosis to use would be an

AFO w/ articulate ankle w/ PF stop

if a toe box is not tall enough what might you see clinically?

blisters, redness

local shoe adjuster/stretcher/layer

shoe camody

what is important element to get foot and orthotic into shoe?

top closure

what hip strength is required for use of KAFO?

at least 2/5

if hip strength is <2/5 what will the pt need?

RGO

if pt does not have intact proprioception at knee, what orthosis to assess for?

unlocked KAFO

if pt has decreased ankle strength or impaired/absent proprioception at knee/ankle or ankle PF spasticity affecting gait then what orthosis should be assessed for?

orthosis w/ articulated ankle joint