Hi Harriet,
I think the key here is that the ROADMAP recommends KAFOs for individuals with <3+/5 quad strength *bilaterally*. So, this recommendation pertains more for someone with SCI than CVA.
The completion criteria on the ROADMAP is WITH KAFOs. They recommend completing a trial with sample braces to ensure the patient will be able to learn how to successfully use KAFOs before ordering them for a specific patient.
For my case quiz and the question I think you are referring to, the patient is walking without braces and you are being asked to score him on the WISCI. It's not an orthosis/ROADMAP question.
I wrote this recently in response to another question and it holds up here: 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). 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