DHSS (1980)
NOMENCLATURE
Like orthopaedic surgery many devices named after
individuals or places – creates confusion....
Lower limb:
H = hip
K = knee
A =ankle
F = foot
Commonly used
A.F.O………ankle foot orthosis
K.A.F.O……Knee ankle foot orthosis
T.L.S.O……Thoracic lumbar sacral orthosis
Unfortunately......
D.A.F.O…..’Dynamic’ ankle foot orthosis
S.A.F.O….Silicone ankle foot orthosis
F.F.O….. Functional foot orthosis
Ideal characteristics
Effective
Lightweight
Cosmetically acceptable
Comfortable
Aims of Lower Limb Orthoses
Correct and/or prevent deformity
Provide a base of support
Facilitate training in skills
Improve efficiency in gait
Improve FUNCTION
To improve efficiency of gait
“5 prerequisites for efficient gait” – GAGE
Stability of the stance limb.
Clearance of the swinging limb.
Appropriate position at terminal swing.
Achieving adequate step length.
Conservation of energy expenditure.
These are often limited or non existent in neurological
conditions
To correct and/or prevent deformity
Dependent upon assessment, if the joints are of a
flexible nature, then the orthosis will be used to
correct/reduce the rate of deformity as the child grows
Whereas fixed deformities can only be accommodated
within the orthosis, and require surgical intervention to
improve the position of the limb and reduce forces.
How do A.F.O.’s work
in the lower limb?
Controls or eliminates ankle and sub-talar motion
By controlling distal joints one can alter the g.r.f. and
effect more proximal joints (coupling)
Therefore if placed in a slightly dorsiflexed position
the g.r.f. moves posterior to knee joint resulting in
flexion of the knee
(ski boot)..
Coupling
Joints rarely act in a solitary fashion
But in unison
Concept of affecting one joint by position of another =
coupling
Influences stability.
Each level should be assessed, but also in conjunction
with joints above and below.
Probably best lower limb example of
coupling
Simple Ground reaction force
Mechanics of an AFO
For a fixed ankle AFO
‘Trade – offs’ using A.F.O.’s in C.P.
POSITIVE NEGATIVE
Restricts undesirable Can be cumbersome &
motion heavy
Improves ability to stand May make ramps and
and take steps stairs harder
Helps toe clearance May be uncomfortable
Draws attention
Types of A.F.O’s
Rigid Ankle
Hinged
Ground Reaction
DAFO
Rigid A.F.O.
Hinged A.F.O.
D.A.F.O’s
The debate rages on…………………..
2. The disappearance of these tonic reflexes with growth appears related to maturation
of the central nervous system.
3. These reflexes are of orthopaedic interest in that they may, by their occasional
unopposed action, cause deformity.
More FUNCTIONAL.
COSMETICALLY acceptable.
D.A.F.O construction
Foot plate shaped to provide increased pressure on
Medial Arch
Peroneal Notch
M/T pad area
Extension of the toes
Most orthoses impose a posture, therefore this
imposition needs to be realistic.
(rule of thumb, is you can only achieve with an
orthosis, what you can achieve with your hands.)
• Collaboration
• Compromise
• Communication = COMPLIANCE!
Management
“The role of the therapist is to protect patients with
cerebral palsy from orthopaedic surgeons”
J Gage, Minneapolis
Thank you