Hi! I tried to use the roadmap to answer this one. If I’m reading it right, the roadmap says that with PF less than or equal to 4/5 and DF less than or equal to 4/5 you use DF stop with DF assist. I get that this seems like overkill given the weight of an articulated AFO and her functionality. In practice I’d start her on a PLSO, but I didn’t think that was what the exam wanted. Am I reading the roadmap wrong?
Thanks for these questions! These are examples of coupling use of the ROADMAP with your clinical reasoning. For case 12, you are correct – the ROADMAP would indicate an articulating AFO with DF stop and assist. However, given the patient’s current level of function and prognosis, this much of a brace would likely be sub-optimal. Fatigue will likely be a concern for her, her strength is unlikely to increase, and she wants to continue exercising at a high level. Considering all of this, the lightest AFO that provides adequate support will likely serve her best.
For Case 7, the ROADMAP indicates an articulating AFO with DF stop and assist. This is not one of the options on the exam. The patient does not require a PF stop. Because he has good quad strength and we did not note any signs of buckling, he can likely get by without the DF stop.