1. Alterations SL support (^ knee & hip flex., ankle dorsiflexion)
1.1. dec NM control dist or prox: weak PF, hip, trunk ext, knee ext
1.2. dec hip ext ROM: hip flexor contracture, spasticity
1.3. dec knee ext ROM: contracture, hamstring hypertonicity
2. Purposes
2.1. improve performance of functional activities
2.2. improve/enhance mobility
2.2.1. ambulation
2.2.2. Transfers
2.3. limb/trunk support
2.4. deformity prevention
2.4.1. 1 + 2 degrees
2.5. correction of passively modifiable deformity
2.6. immobilization/control/protection
2.7. regulating or reducing muscle tone
2.8. stabilizing weak/flaccid mm
3. Temporary vs Definitive
3.1. Definitive
3.1.1. permanent benefit
3.1.2. mechanically & physiologically stable
3.1.3. custom fit
3.1.4. more costly
3.2. Temporary
3.2.1. short term use
3.2.1.1. healing
3.2.1.2. Function/training aid
3.2.1.3. Contracture prevention
3.2.2. assess practical applications
3.2.3. generic fit
3.2.4. less costly
4. Control Systems
4.1. GRF Control System
4.1.1. stance phase only
4.1.2. shoe structure
4.1.3. influence control over prox joints
4.1.4. less stability on various terrain
4.1.5. more energy efficient
4.2. 3-point (pressure) Control
4.2.1. stance + swing phase
4.2.2. not as dependent on shoe structure
4.2.3. controls motion of joints inside ortho
4.2.4. stable on all terrain
4.2.5. reduce gait + energy efficiency
4.2.5.1. restriction of joint motion
5. Goals
5.1. limb/trunk control
5.2. improve gait
5.3. reduce pain
6. Single-Joint
6.1. FO
6.1.1. Reduce patho loading forces
6.1.2. Optimize locomotion, WB functions
6.1.3. Prevent secondary injuries
6.2. SMO
6.2.1. used in pediatrics to help reduce tone and foot positioning
6.3. UCBL
6.4. KO
6.4.1. useful for malalignment
6.4.1.1. Genu Valgum
6.4.1.2. Genu Varum
6.4.1.3. Genu recurvatum
6.4.2. Useful to protect knee structures
6.4.2.1. undue loading or stress
6.4.2.2. inadequate neuromuscular function
7. Neuro etiologies impacting gait cycle
7.1. Forefoot first initial contact
7.1.1. PF contracture
7.1.2. Dorsiflexor weakness
7.1.3. dec. ankle/knee proprioceptive feedback
7.1.4. dec dynamic knee ext control
7.2. Alterations with weigh acceptance
7.2.1. dec ecc knee ext control
7.2.2. dec ecc hip ext control
7.2.3. dec hip ext ROM, hip flex contracture
7.2.4. hamstring contracture
7.3. Alterations SL support (lim. BCOM progression)
7.3.1. compensation for dec hip and knee ext control
7.3.2. compensation for dec PF control
7.3.3. dec ankle and forefoot rocker funct.
7.3.4. PF spasticity
8. AFO
8.1. Solid
8.1.1. fixed position
8.1.2. close to neutral ankle
8.1.2.1. control PF from IC to LR
8.1.3. preposition foot for IC
8.1.4. immobilization in 3 planes
8.1.5. promote ankle & knee stability in stance
8.1.5.1. sub for weak PF
8.1.5.2. sub for weak IV/EV
8.2. Dynamic
8.2.1. Articulated
8.2.1.1. need 5 deg of ankle DF
8.2.1.2. stops
8.2.1.2.1. PF
8.2.1.2.2. allows PF or DF
8.2.1.2.3. DF
8.2.1.3. control knee hyperext in midstance w/ PF stop
8.2.1.4. control knee flex in TS
8.2.1.4.1. limit DF with DF stop
8.2.1.4.2. if weak ankle PF
8.2.1.5. provide medial lat stability at ankle & STJ
8.2.1.6. Flexible/Posterior Leaf Spring
8.2.1.6.1. trimlines posterior to malleoli
8.2.1.6.2. set in DF
8.2.1.6.3. allow DF
8.2.1.6.4. support forefoot during swing
8.2.2. Metal Single/Double Upright
8.2.2.1. upright stirrups
8.2.2.2. spring loaded DF/PF assist
8.2.2.3. assist in swing foot clearance
8.2.2.4. assist in transition from IC to LR
9. KAFO
9.1. neuro pt
9.1.1. CVA
9.1.2. TBI
9.1.3. SCI
9.1.4. post polio
9.2. posture knee into ext and disallow flexion during ambulation
9.3. excessive mvmt at knee not controlled by AFO
9.4. types
9.4.1. conventional
9.4.2. thermoplastic carbon fiber
9.5. knee joints in KAFO
9.5.1. conventional non-locking
9.5.1.1. reduction of genu recurvatum
9.5.2. locking
9.5.2.1. LE kept in extension (control buckling) unless manually unlocked by patient to allow for knee flexion
9.5.2.2. (+) : Maximum stability
9.5.2.3. (-): gait deviation involving contralateral hip hiking or ipsilateral circumduction
9.5.3. stance control (SCKAFO)
9.5.3.1. Success with SCKAFO: adequate quad strength, intact proprioception and minimal LE spasticity
9.5.3.2. LE kept in extension for stance phase (control buckling), release made for knee flexion in swing phase
10. HKAFO
10.1. Reciprocal Gait Orthosis (RGO)
10.1.1. rigid stability for stance
10.1.2. cable-coupling system
10.1.2.1. hip movement during swing
10.1.2.2. coupled hip flex & ext
10.2. most often in children
10.2.1. Myelomeningocele
10.2.2. SCI
10.3. Conventional
10.3.1. pelvic band
10.3.2. orthotic hip joints & locks
10.3.3. proximal & distal thigh bands
10.3.4. orthotic knee joints & stabilization pads
10.3.4.1. usually locked in ext
10.3.5. proximal & distal calf bands
10.3.5.1. force over a wider thigh/calf band
10.3.6. ankle joints
10.3.6.1. solid ankle AFO
10.3.6.2. DF assist AFO
10.3.7. stirrups
10.4. blocked hip abduction, adduction & rotation
10.5. Material:
10.5.1. Metals
10.5.2. Thermoplastics
10.5.2.1. lighter than conventional
10.5.3. Carbon composites