Knee-Ankle-Foot Orthotics (KAFO)

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Questions and Answers

Which of the following conditions is NOT typically an indication for prescribing a Knee-Ankle-Foot Orthosis (KAFO)?

  • Cerebral Palsy
  • Undesirable knee motions
  • Post-polio
  • Isolated ankle instability (correct)

A patient presents with genu recurvatum. In which plane of motion does this deformity occur?

  • Oblique plane
  • Coronal plane
  • Sagittal plane (correct)
  • Transverse plane

What is the primary functional requirement of a KAFO related to weight bearing?

  • Partially relieve body weight. (correct)
  • Transfer all weight to the contralateral limb.
  • Completely eliminate weight bearing on the affected limb.
  • Increase weight bearing on the affected limb.

Which of the following is a primary advantage of a conventional KAFO over a thermoplastic KAFO?

<p>Increased durability (C)</p>
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A patient with significant obesity and fluctuating edema would likely benefit MOST from which type of KAFO?

<p>Conventional KAFO (A)</p>
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Which of these features is a key advantage of thermoplastic KAFOs compared to conventional KAFOs?

<p>Greater cosmesis and ease of wearing under clothing (B)</p>
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For which patient characteristic would a thermoplastic KAFO be least suitable?

<p>Significant obesity (B)</p>
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What is a key consideration when choosing a carbon composite KAFO over other KAFO types?

<p>The patient's budget, as they are generally more expensive (D)</p>
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Which of the following is a characteristic of a KAFO with a quadrilateral top design?

<p>It primarily transmits body weight from the ischial tuberosity to the floor. (C)</p>
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In the context of KAFO design, what is the primary purpose of a cuff top design?

<p>To offer a contoured fit with single or double thigh bands, preventing impingement (C)</p>
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What is the typical placement for the metal upright of a KAFO, relative to the greater trochanter?

<p>2-3 cm below the greater trochanter (C)</p>
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What is a major factor influencing the control and stability at the ankle when using a corset top KAFO?

<p>The design of the AFO (Ankle-Foot Orthosis) portion (B)</p>
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In which plane should the orthotic knee joint be aligned with the anatomical knee joint?

<p>Both frontal and sagittal planes (A)</p>
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What is the approximate anterior/posterior positioning of the orthotic knee joint relative to the anatomical knee?

<p>Directly midline of knee thickness (without patella) (D)</p>
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Which of the following is NOT a primary biomechanical function of an orthotic knee joint in a KAFO?

<p>To initiate muscle contractions around the knee (A)</p>
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For what condition is a drop lock or ring lock knee joint MOST commonly indicated?

<p>Knee extensor paralysis or paresis (A)</p>
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An offset orthotic knee joint is primarily designed to enhance:

<p>Knee joint stability (A)</p>
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What is the primary advantage of a polycentric knee joint in a KAFO?

<p>Reduced pistoning on the leg during joint rotation (B)</p>
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A stance control knee joint in a KAFO is designed to:

<p>Prevent knee flexion under weight bearing but allow it when unweighted. (D)</p>
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How does a fan lock knee joint function in a KAFO?

<p>It allows for presetting a desired knee flexion angle. (B)</p>
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What is the primary function of a dial lock in a KAFO knee joint?

<p>To provide ROM control, locking in a fixed position or limiting motion (C)</p>
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A bar lock knee joint typically unlocks by which mechanism?

<p>Manual release or catching it on a seat (D)</p>
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Which of the following is a distinctive feature of a bale/bail lock joint?

<p>It employs medial and lateral joints that are not connected. (B)</p>
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What is the primary purpose of a knee cap component used with a KAFO?

<p>To maintain the knee in full extension (D)</p>
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In a KAFO designed to address valgum or varum, what is the function of the knee cap component?

<p>To provide corrective force via medial or lateral straps (D)</p>
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What gait deviation is MOST likely to result from a KAFO with mechanical knee locks?

<p>Circumduction (D)</p>
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What is the purpose of utilizing a 3-force system in KAFO alignment?

<p>To correct alignment (D)</p>
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According to the information provided; what would be the MINIMUM muscle strength, as measured by manual muscle testing (MMT) using the Medical Research Council (MRC) scale, required for a patient to be considered for a stance control KAFO?

<p>At least 3/5 at the hip extensors and flexors (C)</p>
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Which of the following is a CONTRAINDICATION for prescribing a stance control KAFO?

<p>Fixed plantarflexion contracture (A)</p>
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How does the Freewalk orthosis provide stability during the stance phase of gait?

<p>By utilizing a ratchet that engages when the knee reaches full extension (C)</p>
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How does the C-brace control knee flexion and extension?

<p>By regulating the hydraulic resistance using a microprocessor (A)</p>
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What is the INITIAL focus of functional training after delivery of a KAFO?

<p>Practice donning/doffing the orthosis (C)</p>
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What is the LATER focus of functional training after delivery of a KAFO?

<p>Treadmill training to improve gait speed and kinematics (B)</p>
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Which of the following is tested when assessing the general workmanship of a KAFO?

<p>The overall quality and construction of the orthosis. (C)</p>
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Why is it important to ensure satisfactory clearance between the mechanical knee joint and the patient's knee in a KAFO?

<p>To prevent pressure sores and irritation (D)</p>
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What is the significance of assessing whether the sole and heel of the patient’s shoe are flat on the floor when fitting a KAFO?

<p>To ensure stability and prevent gait deviations (A)</p>
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Which of the following best describes the rationale for evaluating whether the uprights of a KAFO conform to the contours of the leg and thigh?

<p>To optimize comfort, fit, and pressure distribution (B)</p>
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During a KAFO assessment, what potential problem is indicated by excessive medial or lateral foot contact during gait?

<p>Poorly aligned or fitted KAFO (A)</p>
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A patient with a stroke experiencing undesirable knee motions could benefit from a KAFO. What is the primary goal of KAFO intervention in this scenario?

<p>To control or eliminate unwanted knee movements. (D)</p>
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An individual presents with both muscle weakness and a combined knee and ankle flexion deformity. How does a KAFO assist in maintaining an upright posture during the stance phase?

<p>By providing external support to prevent knee flexion. (A)</p>
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Which functional requirement of a KAFO is MOST directly related to preventing hyperextension or excessive flexion of the knee?

<p>Stabilizing the knee and ankle in the sagittal plane. (B)</p>
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For a patient who requires maximum strength and durability from their KAFO, which type would be MOST appropriate?

<p>Conventional KAFO (D)</p>
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Consider a patient who works in a hot environment. What disadvantage of a thermoplastic KAFO might MOST significantly impact their comfort and compliance?

<p>Potential for heat retention. (C)</p>
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A patient requires a KAFO that provides maximum control of transverse plane motion. Which KAFO type is BEST suited for this purpose?

<p>Thermoplastic KAFO (D)</p>
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Which characteristic of a carbon composite KAFO is MOST likely to improve a patient's gait speed and overall kinematics, compared to other KAFO designs?

<p>Reduced weight (A)</p>
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Why might a quadrilateral top design be chosen for a KAFO?

<p>To transfer body weight from the ischial tuberosity to the floor. (B)</p>
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In what plane should the orthotic knee joint be aligned to the anatomical knee joint to ensure proper biomechanics and function?

<p>Frontal plane (A)</p>
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During the fitting of a KAFO, what is the significance of ensuring satisfactory clearance between the mechanical knee joint and the patient's knee?

<p>To prevent discomfort and skin breakdown (A)</p>
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A patient with knee extensor paralysis is prescribed a KAFO. Which type of knee joint is MOST appropriate to provide stability during stance?

<p>Drop lock/ring lock knee joint (A)</p>
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What is the MOST significant advantage of a polycentric knee joint in a KAFO design?

<p>Reduction of pistoning on the leg (D)</p>
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A patient requires a KAFO that will allow knee flexion during swing phase but prevent knee flexion during weight-bearing. Which of the following knee joint options would be MOST suitable?

<p>A stance control knee joint. (B)</p>
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In the context of KAFO knee joints, how does a bar lock knee joint typically unlock?

<p>By manually lifting or catching the posterior bar on a seat. (B)</p>
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A patient wearing a KAFO exhibits circumduction during gait. Which of the following is the MOST likely cause of this gait deviation?

<p>Mechanical knee locks preventing normal knee flexion in swing phase. (C)</p>
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A KAFO can be indicated for individuals experiencing unwanted elbow motions.

<p>False (B)</p>
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A primary functional requirement of a KAFO is to completely relieve a patient's body weight.

<p>False (B)</p>
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Conventional KAFOs are known for being lightweight and cosmetically appealing.

<p>False (B)</p>
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Thermoplastic KAFOs are well-suited for individuals with significant obesity due to their robust construction.

<p>False (B)</p>
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Carbon composite KAFOs may offer improvements in gait speed and kinematics.

<p>True (A)</p>
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A quadrilateral top design in a KAFO transmits weight through the ischial tuberosity to the floor.

<p>True (A)</p>
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In a metal upright KAFO design, the upright should be positioned 5-7 cm below the greater trochanter.

<p>False (B)</p>
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In the coronal plane, the orthotic knee joint should align with the mid-patellar level, assuming normal patellar alignment.

<p>True (A)</p>
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The primary function of an orthotic knee joint is to restrict any and all knee movement.

<p>False (B)</p>
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A free knee joint is typically a multi-axis joint designed for significant varus or valgus correction.

<p>False (B)</p>
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Drop lock mechanisms are designed to automatically lock the knee into flexion.

<p>False (B)</p>
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Polycentric knee joints are designed to maintain a fixed axis of rotation throughout the range of motion.

<p>False (B)</p>
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Stance control joints lock the knee during swing phase and allow free motion during stance.

<p>False (B)</p>
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A fan lock allows for presetting a desired knee extension angle only.

<p>False (B)</p>
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A dial lock allows the motion of the knee to be locked in a fixed position.

<p>True (A)</p>
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The bar lock knee joint features a spring-loaded mechanism for automatic locking.

<p>False (B)</p>
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Bale or bail lock joints are generally as strong as bar lock joints.

<p>False (B)</p>
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A knee cap is used to strictly limit hyperextension.

<p>False (B)</p>
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In the presence of valgum or varum, the knee cap may include a horizontal strap.

<p>False (B)</p>
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KAFOs with mechanical knee locks may improve normal knee flexion in the swing phase.

<p>False (B)</p>
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Common gait deviations related to KAFO use include circumduction, hip hiking, and plantarflexion of the contralateral side.

<p>True (A)</p>
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A three-force system to correct alignment in a KAFO typically includes only side bars and knee joints.

<p>False (B)</p>
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For proper KAFO fitting, the sole and heel of the shoe should be flat on the floor.

<p>True (A)</p>
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When a patient stands with weight on the braced leg, there should be minimal clearance between the knee joint and patient's knee.

<p>False (B)</p>
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A Freewalk device is stabilized during the swing phase by a ratchet mechanism.

<p>False (B)</p>
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Excessive body weight is a contraindication for stance control knees.

<p>True (A)</p>
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A C-brace allows the knee to be fully extended when stepping down with the heel.

<p>False (B)</p>
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A quadrilateral top design uses a spring-loaded mechanism.

<p>True (A)</p>
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Energy expenditure is not an issue when considering using total contact.

<p>False (B)</p>
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A single-axis knee will allow only one plane of motion.

<p>True (A)</p>
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Muscle weakness is not an indicator for using a KAFO.

<p>False (B)</p>
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Individuals with uncontrolled or fluctuating edema generally benefit from thermoplastic KAFOs due to their adjustability.

<p>False (B)</p>
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A quadrilateral top always features a spring loaded mechanism.

<p>False (B)</p>
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One advantage of thermoplastic KAFOs is enhanced durability compared to conventional KAFOs.

<p>False (B)</p>
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Offset orthotic knee joints are designed to enhance knee joint stability.

<p>True (A)</p>
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A knee cap ensures maximum flexibility of the knee joint by preventing any restriction of movement.

<p>False (B)</p>
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The term 'pistoning' in orthotics refers to the excessive vertical movement of the orthosis relative to the limb.

<p>True (A)</p>
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KAFOs are indicated for patients with undesirable hip motions.

<p>False (B)</p>
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A functional requirement of a KAFO is to completely relieve body weight.

<p>False (B)</p>
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Conventional KAFOs are lightweight and offer good cosmesis.

<p>False (B)</p>
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Conventional KAFOs are often indicated for individuals needing maximum strength and durability.

<p>True (A)</p>
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Thermoplastic KAFOs are contraindicated if control of transverse plane motion is needed.

<p>False (B)</p>
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Thermoplastic KAFOs are a good choice for individuals with uncontrolled or fluctuating edema due to the intimate fit.

<p>False (B)</p>
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Carbon composite KAFOs are heavier than conventional KAFOs.

<p>False (B)</p>
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A quadrilateral top design in a KAFO is designed to transmit body weight from the tibial tuberosity to the floor.

<p>False (B)</p>
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In a cuff top design, the distal thigh band and calf band are positioned at an equal distance from the ankle joint.

<p>False (B)</p>
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A thermoplastic thigh corset is commonly used with a conventional metal ankle joint in KAFOs.

<p>False (B)</p>
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The orthotic knee joint should be aligned with the mid-patellar level in the frontal plane.

<p>True (A)</p>
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A free knee joint is typically a polycentric joint.

<p>False (B)</p>
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A drop lock mechanism in a KAFO automatically locks during knee extension.

<p>True (A)</p>
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A KAFO incorporating a stance control joint allows knee flexion during the swing phase.

<p>True (A)</p>
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The C-brace controls knee flexion and extension by regulating electrical resistance using a microprocessor.

<p>False (B)</p>
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Flashcards

What is a KAFO?

Knee-Ankle-Foot Orthosis. An orthotic device that spans the knee, ankle, and foot to provide support and control.

What are the indications for KAFO?

Conditions such as stroke, cerebral palsy, spina bifida and trauma.

What are the specific indications for KAFO?

Undesirable knee motions, difficulty maintaining upright position, coronal/sagittal plane deformity.

What is the functional requirement of KAFO?

Partially relieve body weight, stabilize knee/ankle, control knee/ankle position.

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What are the advantages/disadvantages of Conventional KAFO?

Strong, durable, easily adjusted, but heavy and less cosmetic.

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What are the advantages/disadvantages of Thermoplastic KAFO?

Thermoplastic KAFOs are lightweight, offer interchangeability of shoes, and greater cosmesis, but can be hot.

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What are the indications/contraindications of Conventional KAFO?

Conventional KAFOs are indicated when maximum strength and durability are needed, but contraindicated when weight is a factor or transverse plane motion control is important.

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What are the indications/contraindications of Thermoplastic KAFO?

Thermoplastic KAFOs are indicated when total contact fit makes maximum limb control possible but contraindicated with obesity or uncontrolled edema.

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What are the advantages of Carbon Composite KAFO?

Much lighter than plastic or conventional KAFO, more cosmetic, improvement in gait, but expensive.

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What are the Main Proximal End Designs for KAFOs?

Cuff top, Corset top, Quadrilateral top.

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Hallmarks of Cuff Top Design

Contoured metal cuff with leather covering, with single or two thigh bands.

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What is a Corset Top?

Metal reinforced leather thigh for stabilizing forces to control valgus/varus or limit knee extension/flexion.

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What is the purpose of Quadrilateral Top?

Transmitting body-weight from ischial tuberosity to floor, partially unweighting the femur.

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What are the features of Quadrilateral Top?

Anterior opening with velcro strapping and a posterior wall to support the ischium.

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What is the Frontal plane location of Orthotic Knee Joint?

Mid-patellar level (assuming normal patella alignment).

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What is the A/P direction of Orthotic Knee Joint?

Mid-line of knee thickness (without patellar) or slightly posterior.

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What are the Biomechanical Functions of Orthotic Knee joint?

Maintain free knee flexion and extension, assist or resist joint movement, hold or lock knee, stop function.

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When would you use a Free Knee Joint?

Free motion knee joint, single-axis, for moderate genu varum or genu valgum.

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Drop Lock / Ring Lock

Manually or gravity-activated, automatically locks on extension, used for knee extensor paralysis or paresis

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What is a Polycentric joint?

Various designs that allow the axis to translate during joint rotation, reduces pistoning on the leg

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Stance control joint

No knee flexion under weight bearing, free flexion-extension when unweighted, for extensor paralysis or paresis.

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What is the functionality of Fan lock?

Preset the desired knee flexion angle by moving the position of the screw.

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What is the functionality of Dial lock?

Various types of ROM control, can be locked in a fixed position, limits motion in flexion/extension.

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What is the functionality of Bar Lock Knee Joint?

Posterior bar connected to the joint for release, elastic band between posterior bar and calf band. Unlocks manually.

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What is the functionality of Bale / Bail lock joint?

Spring-loaded locking mechanism, medial and lateral joints not connected, not as strong as bar lock.

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What is the purpose of Knee cap?

Maintains knee in full extension, prevents uncomfortable contact between the limb and the orthotic cuffs due to slight flexion.

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Goal of Knee Cap with Medial/Lateral Strap

Corrective force as necessary

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Knee extensor absence/weakness

Insecure gait, high energy consumption. Corrected by KAFO with mechanical knee locks.

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List Gait deviations

Circumduction, Hip hiking, Plantarflexion of the contralateral side

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3 force system to correct alignment

Side bars, calf and thigh bands, knee and ankle joints, with leather aprons/caps/straps.

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Prescription criteria of stance control knee

Muscle strength of at least 3/5 at hip extensors/flexors & full knee extension

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Contraindications of stance control knee

Fixed hip, knee flexion or plantarflexion contracture. Significant spasticity, leg length discrepancy or deformity.

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Freewalk KAFO features

Lightweight single upright KAFO that stabilizes for stance phase when knee reaches full extension

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Walking with c-brace

Walking without fully extend the knee, and natural rollover effect

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Functional training after delivery

Strengthen muscles, practice donning/doffing, gait training.

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KAFO Function

A KAFO helps manage undesirable knee motions during various activities.

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Ideal candidate for Conventional KAFO

Conventional KAFOs are more suitable for individuals needing maximum support.

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Thermoplastic advantages

Thermoplastic KAFOs are lighter and more cosmetic than conventional.

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Carbon composite advantages

Carbon composite KAFOs offer a lightweight design with improved gait dynamics.

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Metal upright placement

Metal uprights' proximal trimlines are measured relative to bony landmarks.

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Purpose of the Offset Orthotic Knee Joint

Offset orthotic knee joints enhance knee joint stability during the stance phase of gait.

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Purpose of knee cap.

A knee cap in KAFOs addresses slight knee flexion.

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Influence of medial/lateral strap

Adding a medial or lateral strap applies corrective force.

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Stance control definition

A stance control orthosis, allows knee flexion only during the swing phase.

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Medical Research Council (MRC)

Assesses muscle strength for stance control KAFO candidacy.

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Functional training goals

KAFOs help to strengthen muscle groups.

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Study Notes

Evaluation of KAFO

  • Evaluate gait deviations such as lateral trunk bending, hip hiking, circumduction, or vaulting

Three-Force System for Alignment Correction

  • Forces applied at F1, F2, F3 to correct alignment.

Lower Extremity Alignment Conditions

  • Visual representation of forces at K to correct alignment.

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