Hi Austin!
Orthoses are tricky and it’s difficult to find hard and fast rules (likely because they don’t really exist). I work with lots of orthotists and there are exceptions to every rule. I used the Rancho ROADMAP to provide evidence-based justification for my orthoses questions (though, admittedly, you could make a strong case for deviations from this algorithm for specific patients). Following the ROADMAP, this patient qualifies for a solid AFO based on his absent proprioception.
I’ll add this one to my list to consider revising to give him more spasticity to make that answer a clearer choice.
If I saw this patient in the clinic, I’d work with my orthotist and consider a solid AFO that could be converted to an articulated AFO with a PF stop. The PF stop will be key because of his ankle PF during swing phase, absent heel strike, and knee hyperextension (ankle PF) during mid-stance. My only concern is that knee hyperextension during stance phase. I would assume it is stemming from his profoundly weak hamstrings rather than his mildly weak quads- but, on the off chance his 4/5 quads are contributing to him seeking that stable position, the knee flexion moment created by a PF stop could lead to knee buckling.
As long as you can justify your reasoning, I think you will find you are in great shape for the NCS and clinical practice. Obviously, you can’t make your case on the NCS exam, but there won’t be enough orthoses questions for them to make or break whether you pass – and being able to defend your answer means it wasn’t a wild guess and that increases your chances of being correct.
Hope this helps!
Chrissy