test 2, question 16

[Lauren Nidiffer]

On the AFO question where the patient has 3/5 PF and DF strength and grade 1 spasticity, if you are following the roadmap, I do not understand how you get to PF stop with DF assist. Logically, I understand this makes sense, but can you explain how you got here with the roadmap? I don’t see an option on there that is consistent with a PF stop and DF assist or stop.

Thanks,
Lauren

[Lauren Nidiffer]

Ok, rephrasing my question. I misread the correct answer on that one, but still have a question. Technically, if you follow the roadmap, the patient has spasticity, which is mild. Following the roadmap would lead you to group D, a polyarticulating AFO with a PF stop. So how did you get to a polyarticulating AFO with DF assist and DF stop, if answering yes to spasticity does not lead you down that branch?

[Chrissy Durrough Lugge]

Hi Lauren,
Thanks for this question! The pathway to lead to the correct answer is:
1. Patient has decreased ankle strength OR impaired/absent proprioception at the knee/ankle OR ankle PF spasticity –> YES
2. Spasticity, PF contracture, or absent proprioception affects foot placement during standing or gait –> NO
3. Determine if DF stop is indicated –> YES (PF strength <=4, excessive DF in stance), DF stop indicated 4. Determine if DF assist is required --> YES (DF strength <=4) The patient's spasticity is mild (MAS grade of 1) and there is no indication that it is affecting foot placement in stance or gait. Standing posture is marked by excess ankle DF. Decreased foot clearance could be due to spasticity, but it is more likely explained by weakness given the mild nature of his spasticity - especially given his knee flexes during stance phase of gait. Hope this helps! Chrissy

[Lauren Nidiffer]

This helps, thank you! I got confused in my last post about spasticity when I asked if any spasticity was a yes, I did not make clear that it was at the branch of Spasticity, PF contracture, or absent proprioception affecting foot placement, not at the point of entering the initial question entering the tree. So this clears that up!

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