Term
| most commonly prescribed orthoses |
|
Definition
| lower limb orthoses, with their many variations |
|
|
Term
| large number of lower limb orthoses demonstrates: |
|
Definition
-reflects strong desire by most individuals with physical disabilities to achieve independent mobility
-present orthotic technology does a effective job restoring gross physical deficits that may impede performance |
|
|
Term
| Adaptations that can significantly enhance the effectiveness of orthotic management |
|
Definition
| -simple shoe adaptations can significantly enhance the effectiveness of lower limb orthotics |
|
|
Term
|
Definition
-confined to the foot only, do not encompass the ankle
-covers mainly the planter surface of the foot and only benefits upon weight bearing
-foot must be positioned and held on the orthosis for the device to be effective
-most commonly placed in an closed shoe |
|
|
Term
| quantification of foot orthosis effect |
|
Definition
| -has proven hard to prove the foot orthosis effect on the proximal joints |
|
|
Term
| insurance coverage for foot orthosis |
|
Definition
| currently the Medicare system will only pay for foot orthosis when they are used for treatment of diabetes |
|
|
Term
| importance of evaluation for foot orthosis |
|
Definition
| important physical findings must be collected to maximize the benefits of the FO |
|
|
Term
| aspects of examination FO |
|
Definition
examination of:
-skin condition
-foot shape
-range of motion
-muscle strength
-dynamic performance
-shoe wear patterns |
|
|
Term
|
Definition
| provides insight into the cause of the problem and assists with orthotic design selection |
|
|
Term
|
Definition
result of repetitive pressure
-location of callus signals the location of high pressure (stress)on the foot when weight bearing
-use FO to reduce stress in these areas |
|
|
Term
|
Definition
maybe the sign of a systemic condition
-delicate skin requires softer materials in the FO
-corrective forces must be limited to protect the fragile skin |
|
|
Term
|
Definition
-important factor to protecting skin, any deficit must be noted
-any deficit will require a more accommodative and protective approach |
|
|
Term
|
Definition
-cavus or planus
-good indicator of the potential problems that will present |
|
|
Term
|
Definition
-usually less flexible
-results in greatly decreased shock absorption
-results in excessive pressure on the balls of the foot and calcaneus |
|
|
Term
|
Definition
| may also result in excessive pressure on the base and head of the fifth metatarsal |
|
|
Term
| pes planus/plano valgus foot type |
|
Definition
-is usually flexible
-problems are generally more related to poor alignment of the foot and ankle joints |
|
|
Term
| pes planus foot position in weight bearing |
|
Definition
| -in pronated position the calcaneus remains everted, the talus is plantarflexed and the forefoot is abducted. |
|
|
Term
| result of pes planus positioning |
|
Definition
-causes stress to be placed on the supporting structures of the medial arch.
-severe pronation may cause stress being placed upon the lateral malleolus |
|
|
Term
| pes planus effect on late stance phase |
|
Definition
| additional effort is needed to achieve the rigid lever necessary for the later parts of stance |
|
|
Term
| foot and ankle ROM assessment |
|
Definition
hindfoot, midfoot and forefoot must be assessed in open and closed chain environments to determine limitations
-emphasis should be placed on closed chain when the roe of the foot is the most important |
|
|
Term
|
Definition
| place the patient in subtalar neutral, dorsiflex the fifth ray to lock midfoot joint and then note the alignment of the clacaneus to the long axis of the tibia |
|
|
Term
|
Definition
-note flexibility and the position of the first ray
-if the foot is viewed as a three legged stool, a flexible first ray represents an instability in the stool. |
|
|
Term
| effect of a flexible first ray |
|
Definition
-foot will have a greater tendency to pronate
-stress may/will be placed at the second metatarsal head to stabilize the foot. |
|
|
Term
| passive rage of motion of the foot |
|
Definition
-dorsiflexion is 20 degrees
-plantarflexion is 50 degrees |
|
|
Term
|
Definition
-dorsiflexion is 5-10 degrees
-plantarflexion is |
|
|
Term
| effects of limited foot and ankle ROM |
|
Definition
-changes the normal biomechanics of the foot
-results in compensatory changes
-more pressure is placed at the metatarsal heads during the late part of mid stance |
|
|
Term
| potential result of limited foot and ankle ROM |
|
Definition
| -examination of the MTP, PIP, and DIP joint ROM may reveal complications as well as the development of hammer or claw toes |
|
|
Term
| MMT of the major muscle groups surrounding the foot |
|
Definition
| -may provide important information about weakness that maybe the source of the foot complications |
|
|
Term
|
Definition
| assist with toe clearance through swing, ensure heel contact at the beginning of stance, and prevent foot slap at loading response |
|
|
Term
| roles of the plantarflexor muscle group |
|
Definition
-antagonists to the dorsiflexor muscle group
-weight acceptance during midstance
-stability of the toe lever during terminal stance |
|
|
Term
| lack of dorsiflexor strength warrants: |
|
Definition
| -requires AFO set in neutral position |
|
|
Term
| lack of platarfexor muscles warrants: |
|
Definition
| -use of an AFO with a solid ankle or dorsiflexion stop |
|
|
Term
| inversion and eversion strength |
|
Definition
-plays important role in mid and hindfoot function
-weakness results in mediolateral instability |
|
|
Term
| role of inverter and everter muscle groups |
|
Definition
-ensure good alignment and stability in preperation for initial contact and loading response
- |
|
|
Term
| role of heel wedges or posts in FOs |
|
Definition
| resist excessive varus or valgus tendencies of the foot during loading |
|
|
Term
| importance of posterior tibialis |
|
Definition
| helps to stabilize the medial longitudanal arch and plantarflexion |
|
|
Term
| Most important function of the foot: |
|
Definition
| weight bearing during ambulation |
|
|
Term
| important observations of foot in gait during evaluation |
|
Definition
-amount of time spent on each extremity
-ankle motion
-pronation
-supination
-tibial internal and external rotation |
|
|
Term
| importance of identifying phase of gait were pain occurs |
|
Definition
| this allows the clinician to isolate the problem and to examine any deficits present during that stage |
|
|
Term
|
Definition
-metatarsal pad
-lateral longitudinal arch support
-toe bed
-medial longitudinal arch support
-heel bed |
|
|
Term
| FO medial longitudinal arch support |
|
Definition
-one of the most important aspects of the FO
-prevents excessive pronation of the foot by providing external support to the medial arch |
|
|
Term
|
Definition
-common addition to an FO
-support starts at a point close to the middle of the plantar surface
-supports transverse arch of the foot used to decrease the pressure on metatarsal heads by shifting the weight to the shafts of the metatarsals |
|
|
Term
|
Definition
-used to control pronation
-can be used with pes planus condition to create a natural arch and prevent proximal stress from developing in ankle |
|
|
Term
|
Definition
| -used to reduce supination |
|
|
Term
|
Definition
-basis (base) for all lower limb orthotics
-the FO portion of any orthosis should be used to manage as many deficits as possible
-more proximal orthoses should only be used when a FO is insufficient |
|
|
Term
|
Definition
1. accomodative or soft devices
2. intermediate or semirigid devices
3.corrective or rigid devices |
|
|
Term
|
Definition
| -used to cradle the foot and protect rigid deformity, insensate or dysvascular feet |
|
|
Term
|
Definition
-can be made of different levels of material to provide graduated degrees of control
-used for mild problems like metatarsalgia |
|
|
Term
|
Definition
-made of rigid materials
-can be difficult to fit successfully
-a weaning period is recommended
-usually used for easily correctable, flexible deformities like mild ankle valgus, or slight overpronation |
|
|
Term
|
Definition
-desgined with sufficiant lever arms to control the foot and ankle complex
-can influence knee joint indirectly |
|
|
Term
| usual applications of older leather and metal orthoses |
|
Definition
-satisfied previous wearers
-unusually large or heavy individuals
-when minimal contact with leg is desired
-lower extremity volume fluctuation |
|
|
Term
| one of the most important criteria for orthosis material selection |
|
Definition
| patient preference which largely determines acceptance |
|
|
Term
|
Definition
must achieve at least one
-control of motion
-correction of deformity
-compensation for weakness |
|
|
Term
|
Definition
| extended proximal rigid anterior section accentuates knee extension moment at mid stance and prevents tibial collapse |
|
|
Term
| indications for a floor reaction AFO |
|
Definition
-weak or absent gastrocnemius soleus strength
-weak quadriceps muscles |
|
|
Term
| critical treatment principle of of orthotics management: |
|
Definition
the orthosis may indirectly affect remote body segments and this characteristic can be used therapeutically
-example: ground reaction AFO |
|
|
Term
|
Definition
| -orthosis can be prescribed based upon the biomechanical function desired |
|
|
Term
| indications for ground reaction AFO |
|
Definition
| -paralyzed ankle foot complex, with good or better quadriceps and balance. |
|
|
Term
| pathologies that maybe indicated for ground reaction AFO |
|
Definition
| myelodysplasia, spinal cord injury, peripheral nerve injury, poliomyelitis, gastro soleus trauma or dysfunction |
|
|
Term
| one of the most common lower extremity deficits |
|
Definition
| -flaccid equinaus: pretibial weakness or paralysis |
|
|
Term
| orthotic options to compensate for flaccid equinus |
|
Definition
1.bilateral 2" heel lifts
2.piano wire AFO
3.Metal alloy dorsiflexion assist AFO
4.flexible plastic AFO
5.peroneal NMES |
|
|
Term
| treatment with 2" heels for flaccid equinus |
|
Definition
-typical of cowboy boot
-prevents planterflexed foot from dragging in swing phase
-boot stabilizes foot and heel height lengthens both legs for clearence |
|
|
Term
| potential benefits from a NMES (neuro muscular electric stimulation) |
|
Definition
-strengthening of the weakened muscle group
-inhibition of spasticity in the antagonist muscle group
-short term carry-over permitting ambulation without any "orthosis" |
|
|
Term
| function of a NMES device |
|
Definition
| creates an ankle dorsiflexion force by stimulating the peroneal nerve |
|
|
Term
| reason for neutral foot position in AFO |
|
Definition
-attain neutral or balanced position in casting
-reduces floor reaction moments trying to collapse the limb segment further under weight bearing conditions
-lowers the magnitude of the stabilizing force necessary
-results in a more comfortable device enhancing long term acceptance |
|
|
Term
| correcting rigid deformities |
|
Definition
-feasible only in selected cases
-usually cause must be short term and primarily soft tissue related |
|
|
Term
| 2 important principles for orthotic treatment |
|
Definition
1. application of a low level force, tolerable forces over an extended period may result in significant physiological changes
2. the tibia to floor angle can be varied independently of the ankle foot attitude to facilitate gait |
|
|
Term
|
Definition
| due to simpler orthosis having a higher acceptance rate a KAFO should not be prescribed unless there is a compelling reason to do so |
|
|
Term
| most common justification for KAFO |
|
Definition
| the need for direct control of the knee complex that can not be accomplished in another way as well as the need for suspension or control of the ankle foot complex. |
|
|
Term
| when to use a KO over a KAFO |
|
Definition
| when knee complex alone needs to be controlled and it can be done without need for further suspension |
|
|
Term
|
Definition
pathologies of the foot
-only addresses the foot, does not address clubfoot |
|
|
Term
|
Definition
-loss of protective sensation
-arthritis of the ankle |
|
|
Term
| common pathologies addressed with the UCBL |
|
Definition
adult
-posterior tibia dysfunction
-healing calcaneal fractures
-tarsal coalition
peds
-flexible pes planus
-metatarsus abductus
-myelomeningecele (spina bifida)
-hypotonia |
|
|
Term
| posterior tibialis dysfunction |
|
Definition
4 stages
-stages 2 and 3 are orthotically managed |
|
|
Term
| UCBL biomechanical principles |
|
Definition
-total contact
-multiple three point pressure systems |
|
|
Term
| how to correct a flexible pes planus presentation in a cast |
|
Definition
1. externally rotate the tibia
2. pronate the forefoot
3. adduct the forefoot |
|
|
Term
| corrective goal of the UCBL |
|
Definition
maintain the calcaneus in a neutral position
-forefoot can then be: adducted, abducted, pronated, supinated or held in a neutral position relative to hindfoot
-forefoot adduction or abduction can be used to create a longitudinal arch
- |
|
|
Term
| objectives of lower extremity alignment and fit |
|
Definition
-flat heel/sole contact with ground
-anatomical/mechanical joint congruency
-horizontal orientation to joint axes
-conformity to anatomical contours and landmarks |
|
|
Term
| location of mechanical joint of hip |
|
Definition
| 12mm anterior and 25 mm proximal to greater trochanter |
|
|
Term
| location of the mechanical knee joint |
|
Definition
| half way between medial plateau and adductor tubercle |
|
|
Term
| location of the mechanical talocrual joint |
|
Definition
| distal tip of the medial maleolus |
|
|
Term
|
Definition
| -20-30 degrees external rotation in relation to the knee axis |
|
|
Term
|
Definition
-talus and calacaneus
-in standing allows medial/lateral shifting allowing adaption to uneven ground
-regulates tension on planter aponeurosis |
|
|
Term
| subtalar joint other functions |
|
Definition
as weight is transferred from heel forward, it absorbs shock
-compensates for differences in joint alignments, as in squatting, viewed in transverse plane |
|
|
Term
| effects of malalignment of anatomical and mechanical joints |
|
Definition
-premature joint wear
-extra stress on muscles
-uneven floor contact, pressures medial and lateral on floor
-pressures from the bands of the orthosis |
|
|
Term
|
Definition
-control motion at eh ankle and the subtalar joint
-correction of deformity
-compensation for weakness
-prevent further deformity |
|
|
Term
|
Definition
-genu recurvatum of less then 30 degrees
-ankle instability or deficiency
-influence knee stability |
|
|
Term
|
Definition
-20 mm distal to the fibular neck
-knee flexion to at least 105 degrees, no impingement on the hamstrings
-3-6 mm clearance sidebars to skin
-sidebar along the midline of the leg
-ankle joint clearance-6mm medial, 5mm lateral
-anatomical joint congruency to distal tip of malleolus |
|
|
Term
| ground reaction AFO indications |
|
Definition
-quad strength of 3-/2+
-coronal stability at the knee
-foot follows line of progression |
|
|
Term
| ground reaction AFO contraindications |
|
Definition
-hip or knee contractures
-fluctuating edema
-genu recurvatum |
|
|
Term
| axial resist AFO/ patelar tendon bearing |
|
Definition
-unloads limb distally
-loads limb proximally |
|
|
Term
| axial resist AFO indications |
|
Definition
-malunions
-fractures distal 2/3 of tibia
-heel ulceration
-painful heel conditions
-osteomyelitis of the clacaneus
-avascular necrosis of talus |
|
|
Term
| axial resist AFO contraindications |
|
Definition
-vascular impairment
-skin breakdown
-muscle atrophy or loss of soft tissue
-loss of protective sensation |
|
|
Term
| effect of the position of wedging on an AFO |
|
Definition
-wedging the heel inside of the AFO will effect foot
-wedging the heel outside of the AFO will effect the knee |
|
|
Term
| planterflexion stop does not: |
|
Definition
allow foot planterflexion without knee flexion
-stops recurvatum
- |
|
|
Term
| polymer AFO contraindications |
|
Definition
-fluctuating edema
-sensitivity to heat
-sensitivity to materials |
|
|
Term
| items in patient history assessment |
|
Definition
-reason for visit -living situation
-primary/secondary/tertiary complaints
-onset of conditions/symptoms
-concurrent medical care
-current OX management
-major medical history -patient goals
-activities of daily living |
|
|
Term
| summery of atypical clinical findings |
|
Definition
-dorsiflexion ROM=0-5 degrees
-dorsiflexion/eversion=0/5
-plantarflexion=3-/5
-quadriceps=4/5
-hamstrings=3+/5
-hip flexor=4/5 |
|
|
Term
| non normal gait foot/ankle |
|
Definition
| decreased swing clearance, lateral forefoot initial contact, wide BOS |
|
|
Term
|
Definition
| extensor thrust during stance |
|
|
Term
|
Definition
|
|
Term
| non normal gait: contralateral extremity |
|
Definition
|
|
Term
|
Definition
-control/restrict motion of femur on tibia
-protect joint
-decrease load
-prevent deformity from progressing |
|
|
Term
|
Definition
-arthritic conditions
-post operative
-ligamentous injuries-Acl, PDL, LCL, MCL
-unhappy triad
-prophylactic |
|
|
Term
|
Definition
-control motion of femur on tibia, talocrural joint, and joints of the foot
-correction of deformity
-compensate for weakness
-prevent deformity |
|
|
Term
| sagittal plane KAFO indications |
|
Definition
-quadriceps strength of 3+ or less
-genu recurvatum greater then 30 degrees
-flexion contracture |
|
|
Term
| coronal plane KAFO indications |
|
Definition
| - medial or lateral instability |
|
|
Term
| further indications for a KAFO |
|
Definition
-combined instability
-loss or decreased proprioception or awareness of limb in space |
|
|
Term
|
Definition
| bail lock, swiss lock, cam lock, french lock-hands free locking mechanisms that are possible to disengage accidentally |
|
|
Term
|
Definition
posterior offset-mechanical joint posterior to anatomical joint provides extra knee stability
-dial lock-adjustable for flexion deformities
-step lock-hands free, adjusts to available knee range. usually ratcheting |
|
|
Term
| fitting criteria for KAFO |
|
Definition
35mm distal to perinieum
-10mm clearance from trochanter
-6mm joint clearance medially and 3mm laterally |
|
|
Term
| sitting criteria for KAFO |
|
Definition
-distal thigh and proximal calf equidistant from knee center, at least 105 degrees of knee flexion
-polymer systems in total contact |
|
|
Term
| foot/ankle fitting criteria for KAFO |
|
Definition
-conventional=3-6mm sidebare clearence with skin
-conventional ankle joint clearance-6mm medially, 5mm laterally
-foot plate trim lines appropriate |
|
|
Term
| knee stability is provided by two sets of ligaments: |
|
Definition
-2 collateral
-2 cruciate |
|
|
Term
| collateral ligaments counter: |
|
Definition
|
|
Term
| cruciate ligaments counter: |
|
Definition
| translatory forces that displace the tibia on the femur. |
|
|
Term
| location of attachment of two ligament groups: |
|
Definition
| makes each of these ligaments most effective at particular places in the knees arch of motion |
|
|
Term
|
Definition
| counteracting valgus stressors when knee is slightly flexed to fully extended |
|
|
Term
|
Definition
| resists varus stressors and lateral rotation of the tibia and is most effective when the knee is slightly flexed |
|
|
Term
|
Definition
| acts to prevent forward shift and excessive medial rotation of the tibia as the knee moves toward extension |
|
|
Term
| ACL is most vulnerable to injury when: |
|
Definition
| femur rotates internally on the tibia when the knee is flexed and the foot is fixed on the ground during weight bearing activities |
|
|
Term
|
Definition
| restrains posterior displacement of the tibia in its articulation with the femur, especially when the knee moves into full extension. |
|
|
Term
|
Definition
| strongest and most resistant ligament in the knee |
|
|
Term
|
Definition
| locking mechanism of the knee as tension on the ligament produces lateral (external) rotation of the tibia on the femur in the final degrees of knee extension. it can also assist in resisting varus and valgus stresses |
|
|
Term
|
Definition
| functions as an anatomical pulley, increasing the knee extension moment created by the contraction of the quads femoris by as much as 50% |
|
|
Term
| purpose of rehabilitation KO |
|
Definition
| designed to control knee motion in order to minimize excessive loading on healing tissues |
|
|
Term
| important characteristics of rehab KO |
|
Definition
-adjustable to accommodate for changes in girth due to edema or atrophy
-must remain in desired position
-comfortable
-easy to don and doff
-durable and economical
-ability to incrementally change ROM |
|
|
Term
| assessment of knee function should never: |
|
Definition
| occur in isolation but instead be evaluated in the context of a closed chain or system |
|
|
Term
|
Definition
| the position of the knee in realation to the GRFs |
|
|
Term
| if any position or function of the hip, knee or ankle is altered or disturbed: |
|
Definition
| the entire gait "system" is thrown out of equilibrium and gait will be less efficient or compromised |
|
|
Term
| improved function due to an orthosis does not: |
|
Definition
-imply normalcy
-goals of stability and protection are to provide patients with improved function, but function cannot be restored to normal |
|
|
Term
| most common gait pattern developed by most KAFO users: |
|
Definition
-swing-to or swing through gait pattern
-some maybe able to use reciprocal pattern if they have sufficient muscle strength at the hip |
|
|
Term
| indications for conventional KAFO |
|
Definition
-max strength and durability needed
-significant obesity
-uncontrolled or fluctuating edema |
|
|
Term
| contrindications for conventional KAFO |
|
Definition
-when energy expenditure issues cause an issue with the weight of the orthosis
-when control of the transverse plane is needed |
|
|
Term
| indications for a thermoplastic KAFO |
|
Definition
-total contact gives max limb control
-energy expenditures make weight a issue
-control of transverse plane is needed |
|
|
Term
| contraindications for thermoplastic KAFO |
|
Definition
-obesity of the patient creates issue with fit
-uncontrolled or fluctuating edema |
|
|
Term
| impact of GRF on knee in KAFO with a locked knee |
|
Definition
|
|
Term
|
Definition
-no drop lock
-permits unrestricted flexion and extension to 180 degrees while providing medio lateral stability |
|
|
Term
| location of single axis knee joint |
|
Definition
| axis of the joint medially along the midline of the extended leg at a point approximately 1/2 the distance between adductor tubercle and the medial tibial plateau |
|
|
Term
| single axis knee is appropriate for: |
|
Definition
| patients with enough muscle function to ensure knee stability in stance with excessive recurvatum, structural instability, or fall into excessive varus or valgus (at knee)in stance |
|
|
Term
| goal of single axis locking knee joint: |
|
Definition
-single axis with the addition of a drop lock or ring lock
-locking the knee joint provides stability in all planes of motion |
|
|
Term
| alignment of single axis locking knee: |
|
Definition
| the same as single axis without lock |
|
|
Term
| single axis locking knee joint is appropriate for: |
|
Definition
| patients who are unable to control the knee effectively during stance phase, requiring additional external stability to prevent and restrain excessive knee flexion as body weight is transferred to limb. |
|
|
Term
| objective of the posteriorly offset knee joint |
|
Definition
alignes the axis of rotation posterior to the midline of the leg posterior to the anatomical knee axis
-reduces magnitude of external flexion moment that is acting to flex the limb |
|
|
Term
| functional outcome of using a posterioly offset knee joint |
|
Definition
| with forward progression the GRF more quickly moves anterior to joint creating an extensor force that mechanically augments stance phase stability during single limb support |
|
|
Term
| posterior offset knee joint allows orthotist: |
|
Definition
| design device that allows stability in the knee from initial contact through mid stance. |
|
|
Term
| with a posteriorly offset knee joint what must be precise to make it effective? |
|
Definition
| the alignment of the knee and ankle. |
|
|
Term
| goals of the variable position knee joint |
|
Definition
-dial lock, adjustable locking knee joint
-intended for patients who are unable to achieve full extension due to contracture |
|
|
Term
| position of the GRF with knee contracture |
|
Definition
| GRF will stay posterior to the anatomical knee joint. |
|
|
Term
| difficulty with knee contracture |
|
Definition
| will make it difficult or impossible for the patient with weakness or motor control impairment to develop or maintain the counteractive muscle force for stance stability |
|
|
Term
| goal of dial lock knee joint: |
|
Definition
| joint is locked in the most extended position possible, providing an external mechanical stability |
|
|
Term
| other uses of the dial lock knee joint: |
|
Definition
| -can be gradually adjusted into extension to assist in stretching and elongating soft tissue in order to help resolve contracture |
|
|
Term
| most commonly used locking mechanism for knee joints |
|
Definition
|
|
Term
|
Definition
-simple design
-"captures" the male and female halves of the joint when it is fully extended |
|
|
Term
| contraindications for drop lock |
|
Definition
| patients with limited hand function, significant lower extremity spasticity or contracture, or difficulty balancing |
|
|
Term
|
Definition
-essentially a lever system
-permits medial and lateral locks to be used simultaneously |
|
|
Term
| functional use of a bail lock |
|
Definition
| patient backs up to a chair and pressure against the posterior bar disengages the locks and allows knee flexion |
|
|
Term
| indications for bail lock |
|
Definition
| -appropriate for patients with enough upper body strength and coordination to control the descent into sitting. |
|
|
Term
| potential problem with bail lock |
|
Definition
| if exposed bail is accidentally bumped the locks may disengage unexpectedly and cause the patient to fall |
|
|
Term
| preventing unexpected disengaging of bail lock: |
|
Definition
| posterior edge of the bail lock can be angled downward to reduce likelihood of unexpected unlocking |
|
|
Term
| stance and swing phase knee joints |
|
Definition
-designed for patients with quad weakness
-allows knee joint to unlock at terminal stance during swing phase and locks at initial contact in stance phase |
|
|
Term
| goal of stance control knee joint |
|
Definition
| to most closely mimic a normal gait pattern |
|
|
Term
| bonuses of stance control knee joints |
|
Definition
-decreases need for compensatory strategy (hip hiking, circumduction, etc)
-reduces energy expenditure
-provides reasonable option for single limb paralysis to compensate for absent musculature
-lessens stress and strain on the patients lower back due to reduction of hip hiking |
|
|
Term
| special pediatric MD KAFO design |
|
Definition
| -a modular system has been developed to allow adjustment increase length to keep pace with growth |
|
|
Term
|
Definition
-designed for spinal chord patients
-lightweight version of a conventional KAFO
-maximizes stability in stance with minimal braceing |
|
|
Term
| how does craig-scott KAFO create stable position? |
|
Definition
| patients without active hip control are biomechanically stable in standing. assisted by dorsiflexion assist ankles and posterior offset knee joints when in a position of hip hyperextension with exaggerated lumbar lordosis |
|
|
Term
| stability with craig scott KAFO achieved with: |
|
Definition
| combination of orthosis and posture, the GRF passes just anterior to the knee and posterior to the hip so no muscular counterforce is necessary |
|
|
Term
| table for selection of different knee joints |
|
Definition
| table 11-1 on pg 249 of Lusardi |
|
|
Term
| when is a HKAFO indicated? |
|
Definition
-not as well documented
-additional control that can be achieved by going above the hips must be balanced with practical challenges patient will face |
|
|
Term
|
Definition
| -based upon biomechanical deficits and neuromuscular impairments that are independent of a specific condition |
|
|
Term
| common pathologies HKAFO is prescribed for |
|
Definition
| polio, spinal chord injury, spastic quadriplegic CP |
|
|
Term
| limiting factor in the use of a HKAFO |
|
Definition
high energy cost of gait
-this has become less of an issue with the incorporation of thermoplastics into orthosis |
|
|
Term
| use of HKAFO with spina bifida: |
|
Definition
| -used to facilitate the mental processes (motor and cognitive) to develop as normally as the neuromuscular impairments allow |
|
|
Term
| achieving goals of spina bifida development |
|
Definition
| -orthopedic and orthotic management of child's spine and lower limbs focuses on achieving a stable upright posture |
|
|
Term
| 3 goals of orthopedic and surgical management of spina bifida |
|
Definition
1. correct primary deformity, maintain correction, prevent recurrence, avoid secondary deformities or musculoskeletal impairments
2. to obtain best possible locomotor
function
3. prevent or minimize effects of sensorimotor deficiency |
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