AFO Decision Making

when deciding to prescribe an AFO, PTs must identify what potential deficits?

limited ankle DF or PF

knee instability w/ extension or flexion forces during stance

poor foot clearance during swing

once you choose a brace to prescribe, contact orthotist & offer an alternative as it can take up to

4 weeks to get it

during exam for AFO prescription, joint mobility must be checked. Assess AROM and PROM to determine the type of limitation whether it is

a fixed deformity or contracture/weakness

what is important for a pt w/ sensation impairment/integrity issues?

a wearing schedule

what are these kind of indications for use of an AFO:

Prevent or correct deformity from abnormal muscle tone (including contractures)

Strengthen or simulate motion lost due to denervated muscles

Improve joint positioning for activity

Protect skin in denervated areas

Special case: electro-orthoses

NEUROLOGICAL INDICATIONS

what are these kind of indications for use of an AFO:

Orthoses intended to compensate for musculoskeletal deficits, prevent injury

Correct deformity for improved orthopedic alignment

Immobilization/rest post-injury

Joint stabilization/injury prevention

ORTHOPEDIC INDICATIONS

what are these kind of indications for use of an AFO:

Include all previously mentioned ortho and neuro indications, as seen in adults

Specialized orthoses to correct congenital defects

Growth causes special concerns for fitting

PEDIATRIC INDICATIONS

ORTHOTIC EXAMINATION AND EVALUATION Need for thorough analysis of the following:

1. Effects & benefits in terms of improved function

2. Practicality/ease of use & maintenance

3. Fit and alignment

4. Safety during use of the device

what score is when Minor faults exist; cosmesis issues; patient can utilize in instructional training without harmful effect

Provisional Pass

what kind of score when Orthosis has a major defect that would interfere w/ training

Ex: shoes that are too tight

Is this an AFO utilized in a pts standard shoe?

Typical to need a size up in shoe for accommodation

fail

Tim arrived to PT clinic w/ foot drop & having multiple falls due to his foot catching on the floor.

What phase of gait would foot drop affect?

swing phase

Tim arrived to the PT clinic w/ foot drop & having multiple falls due to his foot catching on the floor.

What AFO could you recommend and components to add to brace?

carbon fiber or PLS AFO

Pete arrives to your PT clinic after a stroke. He has knee instability, & knee hyperextends during stance phase of gait causing pain & sense of falling.

What are your biggest concerns with ongoing knee hyperextension?

LLD, posterior capsule stretching, circumduction during swing

Pete arrives to your PT clinic after a stroke. He has knee instability, & knee hyperextends during stance phase of gait causing pain & sense of falling.

What type of AFO brace would you recommend?

Hinged AFO PF stop

Carl arrives to PT w/ a referral for bracing eval & treat due to gait dysfunction. Carl suffered a brain injury a year ago. Upon eval, you found to have ankle weakness as followed R foot DF 1/5, PF 1/5, Inversion 1/5, and Eversion 1/5 & WFL for remainder of his R LE.

What gait deviations would you expect?

foot drop, trunk lean, scissoring, crouched

Carl arrives to PT w/ a referral for bracing eval & treat due to gait dysfunction. Carl suffered a brain injury a year ago. Upon eval, you found to have ankle weakness as followed R foot DF 1/5, PF 1/5, Inversion 1/5, & Eversion 1/5 and WFL for remainder of his R LE.

What type of AFO would you recommend?

solid AFO

The AFO w/ shoe insert is most easily donned by applying the orthosis to foot & leg, prior to

placing the braced limb in the shoe

If the AFO has a split stirrup, the shoe should be donned first; then the

orthosis should be fitted into the box caliper on the shoe

If the AFO has a solid stirrup, the patient will have to insert the

foot into the shoe, then fasten the calf band

what is the typical recommendation for a wearing schedule?

goal to tolerate all day w/o skin integrity issues. If redness noted: educate for pt to notify orthotist to check brace & make adj to improve fit to protect skin integrity

Donned for 1 hour, Doffed for 1 hour then add 1 hour each day

Gait training w/ brace to work on improving gait quality now that foot clearance has improved: A focus on increase step length, foot clearance, knee flexion during what phase of gait?

swing phase

Gait training w/ brace to work on improving gait quality now that foot clearance has improved. A focus on midstance & increase stance time during what phase of gait?

stance phase