I have the same question with #65 — the notes above from Campbell: “Children with grade 3 quadriceps strength usually require KAFOs and forearm crutches to ambulate for household and short community distances and a wheelchair for long community distances”,
65. you determine that the child has strength of at least 3/5 muscle grade in the following muscle groups: hip flexion, hip adduction, knee extension and flexion; and 2/5 muscle grade in the following muscle groups: hip abduction, ankle dorsiflexion, foot inversion, and toe extension.
65. Based on this child’s motor function level, which type of lower extremity orthosis will most likely be prescribed to provide lower extremity support during standing and ambulation tasks?
a. Ankle-foot orthosis (AFO)
b. Knee-ankle-foot orthosis (KAFO)
c. Hip-knee-ankle-foot orthosis (HKAFO)
d. Reciprocating gait orthosis (RGO)
Because the child likely has weak ankle stability and dorsiflexion, AFOs will be preferred to support the distal limb (medial-lateral ankle movement) and facilitate toe clearance (ankle dorsiflexion) during the swing phase of gait. If the child’s knee extensor muscles are weak, a crouched gait posture may be present. An RGO or HKAFO would be most appropriate for a young child with absent knee extension (absent knee and ankle muscle function) and only limited active hip flexion. A KAFO is most appropriate for a young child with weak knee extensor strength but functional hip flexion activity. Because orthoses add weight to the lower limb and influence energy expenditure, careful consideration should be made for the least restrictive device possible.