- This topic has 2 replies, 3 voices, and was last updated 1 month ago by
.
-
Posts
-
-
Hi Chrissy,
For exam one, question 33. Can you explain to me why a plantarflexion stop is not indicated for this patient with grade 1 spasticity in the knee flexors? (question listed below). I thought only severe spasticity (MAS >3) would indicate the plantar flexion stop as not appropriate. Is the general rule of thumb that if there is any spasticity, the patient is not appropriate for an articulating AFO? Thanks for your help!
exam 1, question 33: “A patient with hemiparesis post-stroke is exhibiting excessive knee flexion during stance phase on the affected side. Examination reveals 4/5 quadriceps strength, 2/5 ankle dorsiflexor and plantarflexor strength, and grade 1 spasticity in the knee flexors. Which type of orthosis would be best for this patient?”
▪ a. KAFO with drop locks
▪ b. KAFO with stance control knee joint
▪ c. Articulating AFO with dorsiflexion assist and plantarflexion stop
▪ d. Floor reaction AFO -
Hi Kristina – I was also confused on this question and I dug into the ROADMAP:
When I was looking at this question, I went through the ROADMAP and was able to eliminate a and b as 4/5 quadriceps will not need KAFO. Even though ankle DF is weak, in function they don’t say anything about foot drop in swing. There’s also no mention of ankle PF spasticity causing knee hyperextension. I can rule out DF assist and PF stop with that last two points. The only item left is floor reaction AFO which is supported because there is excessive knee flexion in stance which can cause knee buckling – the floor reaction AFO will create a knee extensor moment to increase stability at the knee in stance.
I think the spasticity referred to in the ROADMAP for AFO is specifically for ankle PF spasticity. And it says severe ankle PF spasticity impacting foot placement at IC requires rigid AFO only. So if it’s not impacting foot placement I continue on the algorithm. Hope that helps!
-
-
- You must be logged in to reply to this topic.