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Helen Carey

Response to: “My question is, how do you know they will need AFOs over KAFOs? For this question, are you basing AFOs on 3+/5 strength?”
Yes, we were basing this on 3+/5 strength, assuming that the adolescent could sustain anti-gravity posture for household distances with the additional support of an assistive device. The key here is household distances vs community distances (where AFOs might not be realistic due to muscle fatigue). Your quote from the Campbell text includes short community distances (in addition to household), which definitely changes the demands of the task. KAFOs are very cumbersome, especially for an adolescent or adult, therefore, the least restrictive orthotic device that supports function would be the best option. Obviously, in a real practice scenario, a PT might start with AFOs and then evaluate function to make sure they are providing sufficient support.