Podcast
Questions and Answers
What is the primary function of a caster cart?
What is the primary function of a caster cart?
- To prevent hip and knee contractures.
- To provide sitting mobility. (correct)
- To facilitate standing balance practice.
- To control involuntary muscle spasms.
What is the primary purpose of using a standing frame?
What is the primary purpose of using a standing frame?
- To increase the user's speed and agility.
- To improve upper extremity strength.
- To eliminate the need for orthoses.
- To prevent hip, knee, and ankle contractures. (correct)
A parapodium is designed to achieve which of the following?
A parapodium is designed to achieve which of the following?
- Limit range of motion.
- Increase muscle power in lower extremities.
- Facilitate ambulation and standing without crutches. (correct)
- Allow sitting only.
The Orlau Swivel Walker is most appropriate for individuals with spinal lesions located where?
The Orlau Swivel Walker is most appropriate for individuals with spinal lesions located where?
What is the primary mechanism by which the Orlau Swivel Walker facilitates movement?
What is the primary mechanism by which the Orlau Swivel Walker facilitates movement?
The Parawalker is characterized by which feature?
The Parawalker is characterized by which feature?
In Reciprocating Gait Orthoses (RGOs), what mechanical principle prevents both hips from flexing simultaneously?
In Reciprocating Gait Orthoses (RGOs), what mechanical principle prevents both hips from flexing simultaneously?
Which of the following best describes the primary biomechanical function of the LSU Dual Looped Cable RGO?
Which of the following best describes the primary biomechanical function of the LSU Dual Looped Cable RGO?
What distinguishes the Isocentric RGO (IRGO) from other RGO designs?
What distinguishes the Isocentric RGO (IRGO) from other RGO designs?
Which of the following is a primary indication for prescribing an RGO?
Which of the following is a primary indication for prescribing an RGO?
Which of the following conditions is a contraindication for RGO use?
Which of the following conditions is a contraindication for RGO use?
Before initiating RGO training, what type of exercise is MOST important?
Before initiating RGO training, what type of exercise is MOST important?
Following donning of an RGO, what is typically the next step in training?
Following donning of an RGO, what is typically the next step in training?
During gait training in parallel bars with an RGO, what action initiates forward movement of the opposite leg?
During gait training in parallel bars with an RGO, what action initiates forward movement of the opposite leg?
During gait training with parallel bars, a client is instructed to "TUCK bottom in by extending trunk." What is the primary purpose of this instruction?
During gait training with parallel bars, a client is instructed to "TUCK bottom in by extending trunk." What is the primary purpose of this instruction?
In the context of RGO walking mechanics, what immediately follows right crutch strike?
In the context of RGO walking mechanics, what immediately follows right crutch strike?
What is a defining characteristic of a Walkabout
orthosis compared to traditional HKAFOs?
What is a defining characteristic of a Walkabout
orthosis compared to traditional HKAFOs?
A primary disadvantage of the 'Walkabout' orthosis is described as:
A primary disadvantage of the 'Walkabout' orthosis is described as:
What is the unique design feature of the Primewalk
orthosis?
What is the unique design feature of the Primewalk
orthosis?
Following gait analysis, a prosthetist determines that a patient ambulating with a Walkabout
orthosis exhibits excessive hip abduction during swing phase. What modification would MOST effectively address this gait deviation?
Following gait analysis, a prosthetist determines that a patient ambulating with a Walkabout
orthosis exhibits excessive hip abduction during swing phase. What modification would MOST effectively address this gait deviation?
According to the gait outcome data presented, which gait parameter is significantly improved with the use of the Primewalk
orthosis compared to other devices?
According to the gait outcome data presented, which gait parameter is significantly improved with the use of the Primewalk
orthosis compared to other devices?
A physical therapist is working with a child who has paraplegia and is using a Rochester Parapodium. What is the PRIMARY advantage of this device for the child's functional development?
A physical therapist is working with a child who has paraplegia and is using a Rochester Parapodium. What is the PRIMARY advantage of this device for the child's functional development?
Which of the following best explains how swinging the arms in opposite directions contributes to propulsion when using a swivel walker?
Which of the following best explains how swinging the arms in opposite directions contributes to propulsion when using a swivel walker?
A 10-year-old child with spina bifida (L3-L4) presents with hip flexion contractures of 15 degrees bilaterally. Which ambulation device would be LEAST appropriate?
A 10-year-old child with spina bifida (L3-L4) presents with hip flexion contractures of 15 degrees bilaterally. Which ambulation device would be LEAST appropriate?
A patient with paraplegia is learning to use an RGO with crutches. They are having difficulty advancing their left leg after shifting their weight to the right. What adjustment or cue would be MOST helpful?
A patient with paraplegia is learning to use an RGO with crutches. They are having difficulty advancing their left leg after shifting their weight to the right. What adjustment or cue would be MOST helpful?
A patient with a T10 spinal cord injury is using a Walkabout orthosis. They report feeling unstable and notice that their steps are very short and require significant effort. What is the MOST likely reason for these issues?
A patient with a T10 spinal cord injury is using a Walkabout orthosis. They report feeling unstable and notice that their steps are very short and require significant effort. What is the MOST likely reason for these issues?
A patient with paraplegia who has been using a KAFO expresses interest in progressing towards a more energy-efficient gait pattern. The therapist is considering both Walkabout and Primewalk orthoses. Which of the following statements MOST accurately guides the decision-making process?
A patient with paraplegia who has been using a KAFO expresses interest in progressing towards a more energy-efficient gait pattern. The therapist is considering both Walkabout and Primewalk orthoses. Which of the following statements MOST accurately guides the decision-making process?
What factor would CONTRAINDICATE the use of a swivel walker?
What factor would CONTRAINDICATE the use of a swivel walker?
A 7-year-old child with myelomeningocele (L3) is being considered for a reciprocal gait orthosis (RGO). Which assessment finding would be MOST critical in determining the child's suitability for this device?
A 7-year-old child with myelomeningocele (L3) is being considered for a reciprocal gait orthosis (RGO). Which assessment finding would be MOST critical in determining the child's suitability for this device?
A patient with a T4 complete spinal cord injury has been using an RGO for community ambulation. Over time, they report increasing fatigue and difficulty maintaining an upright posture. What intervention would be MOST appropriate?
A patient with a T4 complete spinal cord injury has been using an RGO for community ambulation. Over time, they report increasing fatigue and difficulty maintaining an upright posture. What intervention would be MOST appropriate?
A patient with paraplegia is being fitted with a Walkabout orthosis. During the fitting, the therapist notes that the mechanical hip joint center is positioned significantly posterior to the patient's anatomical hip joint center. What is the MOST likely consequence of this misalignment?
A patient with paraplegia is being fitted with a Walkabout orthosis. During the fitting, the therapist notes that the mechanical hip joint center is positioned significantly posterior to the patient's anatomical hip joint center. What is the MOST likely consequence of this misalignment?
A physical therapist is comparing the Primewalk and Walkabout orthoses for a patient with mid-thoracic paraplegia. While both devices provide reciprocal gait, what key biomechanical advantage does the Primewalk offer?
A physical therapist is comparing the Primewalk and Walkabout orthoses for a patient with mid-thoracic paraplegia. While both devices provide reciprocal gait, what key biomechanical advantage does the Primewalk offer?
A researcher is designing a study to compare the energy expenditure of ambulation using KAFOs versus an RGO in individuals with paraplegia. What would be the MOST appropriate primary outcome measure?
A researcher is designing a study to compare the energy expenditure of ambulation using KAFOs versus an RGO in individuals with paraplegia. What would be the MOST appropriate primary outcome measure?
What is the MOST pivotal difference between a standard KAFO and a Walkabout orthosis in terms of design and biomechanical function?
What is the MOST pivotal difference between a standard KAFO and a Walkabout orthosis in terms of design and biomechanical function?
A caster cart is primarily used for sitting mobility.
A caster cart is primarily used for sitting mobility.
Standing frames are only used to prevent hip contractures.
Standing frames are only used to prevent hip contractures.
Parapodiums have joints specifically at the ankles and elbows.
Parapodiums have joints specifically at the ankles and elbows.
A parapodium allows a patient to ambulate and stand without crutches, but this feature is mandatory.
A parapodium allows a patient to ambulate and stand without crutches, but this feature is mandatory.
The Orlau Swivel Walker is designed for individuals with spinal lesions between L1 and C6.
The Orlau Swivel Walker is designed for individuals with spinal lesions between L1 and C6.
The Orlau Swivel Walker requires additional walking aids for proper use.
The Orlau Swivel Walker requires additional walking aids for proper use.
Swiveling footplates are used to inject propulsive forces during ambulation.
Swiveling footplates are used to inject propulsive forces during ambulation.
Inertial torque is produced by swinging arms in the same direction.
Inertial torque is produced by swinging arms in the same direction.
A parawalker uses a rigid body brace that only maintains relative legs adduction during swing.
A parawalker uses a rigid body brace that only maintains relative legs adduction during swing.
RGO stands for Rehabilitation Gait Orthosis.
RGO stands for Rehabilitation Gait Orthosis.
In an RGO, both hips can flex simultaneously to allow for sitting.
In an RGO, both hips can flex simultaneously to allow for sitting.
The reciprocal motion in an RGO is achieved because reciprocal orthotic hip joints are interconnected, usually with a cable.
The reciprocal motion in an RGO is achieved because reciprocal orthotic hip joints are interconnected, usually with a cable.
An Isocentric RGO (IRGO) uses a cable system to provide reciprocal movement.
An Isocentric RGO (IRGO) uses a cable system to provide reciprocal movement.
Severe, but reducible contractures are a contraindication for RGO use.
Severe, but reducible contractures are a contraindication for RGO use.
Spasticity and poor upper extremity strength are both contraindications for RGO.
Spasticity and poor upper extremity strength are both contraindications for RGO.
Calf stretches are a pre-brace treatment.
Calf stretches are a pre-brace treatment.
The first step in training for RGO use is typically walking long distances unassisted.
The first step in training for RGO use is typically walking long distances unassisted.
During gait training in parallel bars, the correct sequence involves moving the right hand forward first.
During gait training in parallel bars, the correct sequence involves moving the right hand forward first.
During the early to mid-swing phase of gait, lateral tilt and trunk rotation in the sagittal plane do not occur.
During the early to mid-swing phase of gait, lateral tilt and trunk rotation in the sagittal plane do not occur.
Walkabout devices are made up of 3 KAFOs.
Walkabout devices are made up of 3 KAFOs.
The Walkabout device is heavier than most traditional RGOs.
The Walkabout device is heavier than most traditional RGOs.
Primewalk increases gait speed, cadence, and stride length compared to other RGOs.
Primewalk increases gait speed, cadence, and stride length compared to other RGOs.
The Walkabout uses a sliding mechanism to bring the orthotic and anatomical hip joints closer together.
The Walkabout uses a sliding mechanism to bring the orthotic and anatomical hip joints closer together.
The LSU Dual Looped Cable RGO has one Bowden cable.
The LSU Dual Looped Cable RGO has one Bowden cable.
The 'KICK' action during RGO gait training refers to the activation of the cable mechanism.
The 'KICK' action during RGO gait training refers to the activation of the cable mechanism.
The primary benefit of the Rochester Parapodium is to restrict movement and ensure complete stability.
The primary benefit of the Rochester Parapodium is to restrict movement and ensure complete stability.
A significant knee contracture of greater than 20 degrees is generally acceptable for RGO fitting.
A significant knee contracture of greater than 20 degrees is generally acceptable for RGO fitting.
In the gait cycle with an RGO, the right crutch strike always precedes the right heel strike.
In the gait cycle with an RGO, the right crutch strike always precedes the right heel strike.
A key advantage of the Walkabout orthosis is that it completely eliminates horizontal hip rotation during gait.
A key advantage of the Walkabout orthosis is that it completely eliminates horizontal hip rotation during gait.
One advantage of the single looped cable RGO (ARGO) is that it is more difficult to stand up.
One advantage of the single looped cable RGO (ARGO) is that it is more difficult to stand up.
If all other indications are met, obesity will not effect RGO use.
If all other indications are met, obesity will not effect RGO use.
The 'TUCK bottom in by extending trunk' cue ensures the patients extends at the knee to not drag their foot.
The 'TUCK bottom in by extending trunk' cue ensures the patients extends at the knee to not drag their foot.
The Dual Cable LSU-RGO uses Bowden cables so that one cable can facilitate flexion in hip and the other facilitates shoulder abduction.
The Dual Cable LSU-RGO uses Bowden cables so that one cable can facilitate flexion in hip and the other facilitates shoulder abduction.
Parawalkers use hinge joints with friction to limit both flexion and extension.
Parawalkers use hinge joints with friction to limit both flexion and extension.
Lateral rockers on a parawalker are designed to help lateral truck movement.
Lateral rockers on a parawalker are designed to help lateral truck movement.
Flashcards
Caster Cart Purpose
Caster Cart Purpose
A cart with casters used for sitting mobility.
Standing Frame Purpose
Standing Frame Purpose
A device used when a person is ready for standing, providing support.
Standing Frame Benefits
Standing Frame Benefits
Aids in preventing contractures, maintaining joint ROM, controlling muscle spasms, and facilitating nervous system development.
Parapodium
Parapodium
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Rochester Parapodium Function
Rochester Parapodium Function
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Orlau Swivel Walker
Orlau Swivel Walker
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Swivel Walker Mechanics
Swivel Walker Mechanics
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Inertial Torque in Swivel Walker
Inertial Torque in Swivel Walker
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Parawalker
Parawalker
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Reciprocating Gait Orthosis (RGO)
Reciprocating Gait Orthosis (RGO)
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RGO Movement Principle
RGO Movement Principle
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RGO Prevents Jackknifing
RGO Prevents Jackknifing
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LSU Dual Looped Cable RGO
LSU Dual Looped Cable RGO
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Advanced RGO (ARGO)
Advanced RGO (ARGO)
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Isocentric RGO (IRGO)
Isocentric RGO (IRGO)
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Indications for RGO Use
Indications for RGO Use
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Contraindications for RGO Use
Contraindications for RGO Use
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Pre-Brace Stretching
Pre-Brace Stretching
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Pre-Brace Balance Training
Pre-Brace Balance Training
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RGO Training Steps
RGO Training Steps
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Gait Training with RGOs - Right Side
Gait Training with RGOs - Right Side
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Gait Training with RGOs - Left Side
Gait Training with RGOs - Left Side
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Walkabout Orthoses
Walkabout Orthoses
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Advantages of Walkabout
Advantages of Walkabout
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Disadvantages of Walkabout
Disadvantages of Walkabout
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Primewalk Orthoses
Primewalk Orthoses
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Outcome of Primewalk Orthoses
Outcome of Primewalk Orthoses
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RGO Gait Training
RGO Gait Training
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RGO Gait - Right leg
RGO Gait - Right leg
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RGO Gait - Left leg
RGO Gait - Left leg
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Walking mechanics
Walking mechanics
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Study Notes
- Reciprocal Gait Orthoses and other devices are designed for Paraplegic Walking
Caster Cart & Standing Frame
- Caster carts facilitate sitting mobility.
- Standing frames are introduced when the individual is ready for standing.
Standing Frame Use
- Standing frames prevent hips, knees, and ankles contractures.
- They maintain joint Range of Motion (ROM).
- They help control involuntary muscle spasms.
- Standing frames facilitate integrated nervous system development.
- Orthoses can be used alongside standing frames.
Parapodium
- Parapodiums feature joints at the knees and hips.
- They are suitable for patients with insufficient muscle power in the lower extremities and trunk.
- These devices facilitate ambulation and standing without crutches, though crutches are optional.
- Parapodiums allow for sitting.
- Individuals can flex their knees and hips within the parapodium to sit.
Rochester Parapodium
- Rochester Parapodiums allow paraplegic children to stand, sit, and bend over.
- These actions can be used to grab objects from the floor.
Orlau Swivel Walker
- The Orlau Swivel Walker is designed for individuals with spinal lesions between L1 and C6.
- It allows users to ambulate in an upright position without additional walking aids.
- The rigid structure of the walker stabilizes the ankles, knees, and hips.
Ambulation mechanics of Swivel Walkers
- Swiveling footplates inject propulsive forces.
- Swivel is defined as turning around a central point to face another direction.
Inertial Torque
- Active patients can swing their arms in opposite directions.
- This produces an inertial torque, which increases the rotational effect produced.
Parawalker
- The parawalker is a rigid body brace.
- It maintains relative legs abduction during the swing phase of gait.
- Lateral rockers on the brace help with lateral movement of the trunk.
- Hip joint with limited Flexion / Extension ROM
- Friction free operation.
- No linkage.
- The Parawalker Stabilizes knees and ankles.
- Simple fastening arrangements allow for easy application and removal.
RGO: Reciprocating Gait Orthosis
- RGO consists of bilateral HKAFOs or KAFOs.
- These have trunk stabilization or a pelvic band.
- Reciprocal orthotic hip joints are interconnected by a cable or other mechanisms.
- Flexion of one leg causes extension of the other through the coupled hip mechanism.
- Both hips cannot flex simultaneously, which prevents "jackknifing".
- Types includes Cord & Pulley, Gear box, Single cable, Dual cable and Isocentric.
LSU Dual Looped Cable RGO (LSU-RGO)
- Employs two Bowden cables.
- One cable attaches to the anterior of the hip joint.
- The other attaches to the posterior.
- The cables transmit forces.
- These forces enable coupling of flexion in one hip joint and extension in the other.
Single Looped Cable RGO
- An advanced RGO device (ARGO)
- It is a modification of the LSU-RGO.
- It utilizes a single push-pull cable that links hip joints.
- The design also includes a cable that connects hip and knee joints.
- It contains a pneumatic assist to aid knee extension.
- It is easier to stand up with this RGO.
Isocentric RGO (IRGO)
- Isocentric RGO does not use a cable.
- It uses a specially designed pelvic band.
- It features a centrally located pivoting bar and tie rod arrangement.
Indications for RGO
- Plantigrade foot posture can be achieved with shoes modifications.
- The knees should have no significant contracture (5~10°).
- The hips should have no contracture and should be flexible.
- Neither rigid nor spastic.
- Good upper extremity strength is required.
- The patient should be well-motivated.
- A supportive, cooperative family environment is beneficial.
- Walking aids are necessary.
Contraindications for RGO
- Severe irreducible contractures that prevent establishing normal alignment.
- Spasticity or other involuntary muscle activities that prevent free and coordinated mobility.
- Obesity
- Poor upper extremity strength
Pre-brace treatment for RGO
- Passive stretching exercises for calf muscles, hamstrings, and hip flexors.
- Balance training on bed, chair, and standing frame.
- Standing practice
Training for RGO Use
- Donning
- Standing with the orthosis
- Sitting down
- Balance
- Walking with aids
Gait Training in Parallel Bars
- Move the right hand forward
- Shift weight by leaning forward and to the right, clearing the left foot off the ground.
- Tuck the bottom in by extending the trunk.
- Push down with the arms.
- Kick: the action of the mechanism involves swinging the left leg through.
Gait Training in Parallel Bars(2)
- Move left hand forward
- SHIFT weight by leaning forward & Left
- Clear right foot off ground
- TUCK bottom in by extending trunk
- PUSH down with their arms
- KICK – the action of the cable
- Swing right leg through
Walking Mechanics
- Right heel strike.
- Right crutch strike coupled with lateral movement to the right commencing.
- Early to mid-swing of the left foot, including:
- Lateral tilt to the right
- Trunk rotation in the sagittal plane.
- Peak of right lateral tilt.
- Left heel strike.
Walkabout
- Orthotic joint with bilateral KAFOs
- Alternative to HKAFOs with laterally placed external hip joints
- Made up of 2 KAFOs
- Connected at the proximal ends of medial uprights
- The joint has a mechanism of reciprocal gait
Advantages & Disadvantages of Walkabout
- Advantages: Light weight, easy to don and doff, and easy to use with a wheelchair.
- Disadvantages: Misalignment of hip and orthotic joints can lead to short steps and excessive horizontal rotation of the hip, resulting in slow and energy-expensive gait.
Primewalk
- Uses a sliding mechanism to make the orthotic and anatomical hip joint closer.
Walkabout VS Primewalk
- Gait Outcome
- Studies show 7 patients with paraplegia achieved:
- Primewalk: Faster gait speed, higher cadence, and longer stride.
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