Quote Originally Posted by Orthotics View Post
Thank you very much for the info and the leads on the Kinemedic AFO. I must say I am very interested in learning more about the benefits of the this design over more traditional AFO designs. I tend to think outside the box and am very picky when it comes to the design and trim lines of the finished product. It sounds like you have used this AFO for CVA pateints? Can you describe the benefits of allowing more motion, specifically with the segmeted foot plate? Why not use a plantar flexion stop with patients that have dorsi weakness or hyperextension issues?
well, you can basically imagine the advantages and disadvantages..... this AFO is pretty good for someone who has some control of the ankle and needs some more flexibility for further advancement of self-control... one of my biggest (and possibly only) complaints about the PRO is that it doesn't have a plantarflexion stop... that to me is one of the main purposes for using an AFO... but if you're creative, you can fabricate your own... if you're really good with tools and stuff, nothing should be stopping you from creating what each specific patient needs...
thing about AFOs in general is that they're a static fix-it orthotic that does not evolve with the patient's function... i would like to see some progressive AFO that could have its resistance decreased as the patient improved their control of DF... however, the electronic AFOs kind of fall into that category... because you can use the most minimal amount of amplitude to attain the desired dorsiflexion, thereby training the patient over time to DF his own foot in swing phase...

i also believe that knee hyperextension is as much a problem of the hip/pelvis as it is at the ankle...

and i NEVER EVER EVER EVER EVER EVER EVER EVER EVER give a stroke patient a fixed-angle AFO... you TOTALLY screw them up in those things....... they don't allow any dorsiflexion and therefore disallow any phase of gait on the hemi side after midstance--- so the patient steps from midstance to heel strike on the hemi leg, and the non-involved leg only steps as far as the hemi leg is on the ground... and those habits become HARD AS HELL to break........


How do you manage ROM issues if you start to see equinus contractures developing. Nighttime bracing possibly? Stretching excersizes?
yes, exactly... progressive stretching (low-load-prolonged stretches) and bracing/orthoses to maintain the acquired range is indicated in those who have limited ROM due to spasticity...
go back to simple mobilization ideologies: if a joint is tight, you need to stretch it... just keep in mind that maintland or whatever's basic joint mobz aren't going to cut it--- you need to keep in mind we're talking about tight joints due to spasticity... so deformations can occur... realigning the tarsals, metatarsals, and maintaining proper alignment of the toes are all important concepts... it's tough though--- you see an outpatient with a stroke for 45 mins 3x/week--- it's not easy to throw 10 or 15 minutes of stretching and mobilization when you've got ambulation, balance, reaching, UE activities, and other functional stuff to work on... but you MUST do it or you won't achieve an increase in function...

i'm writing about a lot of general concepts here... i think the important things to keep in mind are that you must not forget your anatomy and basic biomechanics while preparing, facilitating (as needed) and improving function... strokes are in a world all to themselves... unique and beautiful in their recovery and potentially debilitating in the wrong hands... not to mention apraxia, aphasia, depression, and other cognitive deficits you need to work through...
my next bit of advice is to just take a lot of courses... PNF, NDT, Neuro-IFRAH, and anything else that you see on the menu at places like Rehab Institute of Chicago, Rancho Los Amigos, and kaiser vallejo--- those are courses you need to take... find out who teaches the good stuff and follow them, but don't fall into taking the kool-aid of any one style... i recently had patients who look very, very similar and i decided to use PNF at an earlier stage than i previously have--- and it worked well for one dude and not for the other...... go figure!!


good luck!!