Ankle-Foot Orthosis AFO Theory and Critique  | Assignment Help

Part A: Content, Biomechanics and Theory 

Ankle-Foot Orthosis, also abbreviated as AFO, is a device used for the purpose of supporting a weak foot or repositioning the limb into a normal position after some sort of contraction. Orthosis is an externally applied device used for the repositioning of the neuromuscular and skeletal systems into place for the proper functioning. This may include controlling or guiding the movement of the limb as well. These devices are usually made of polypropylene-based plastic which is lightweight. They may be of a few types and often used for the patients suffering from a variety of ailments. They are often used for patients suffering from Cerebral Palsy as in the current scenario. The Ankle Foot Orthosis is optimized in accordance with their gait and the deformity in the limbs. It is usually used in patients of cerebral palsy to reduce muscle contractures and improve stance position (Stott, 2015). Overall, AFO can be used to correct a variety of gait deformities (Pongpipatpaiboon et al., 2018). 

Cerebral Palsy is one of the most common causes of physical deformity, and it is imperative to understand the biomechanical gait patterns of the patients to properly do the fitting of the Ankle Foot Orthosis. The common Gait patterns can be clarified into spastic hemiplegia, which includes drop foot and equinus with variable positions of the knee, as well as spastic diplegia, which includes true equinus, apparent equinus, jump, and crouch (Armand, Decoulon & Bonnefoy-Mazure, 2016).  

True equinus can be described by the ankle remaining in plantarflexion all through the stance and the considerable extension of hip and knees (Armand, Decoulon & Bonnefoy-Mazure, 2016). An Ankle-Foot Orthosis can be used on patients with this gait pattern to prevent plantarflexion. This improves the stability of the person during the act of walking or repositioning the foot and corrects the swing of the leg during gait. This, in turn, helps in conserving energy during walking and increases the speed and length of each step (Physiopedia, 2020). A solid AFO can be used in this case because it tends to block the movement of the ankle (Icrc.org., 2020). In the current study, Mr C has a true equinus gait and is used bipedal solid AFOs, the right AFO is new, while the left AFO is old. It is essential that the AFO is well-fitted, otherwise, they might cause further damage to the gait of the patient. The gapping and contour of the device has a very high influence on the gait of the patients. If there are problems with the fit or the texture of the AFO, it can have severe effects on the gait of the patient. The potential problems may include the discrepancy between the tone of the muscle and the mould, wrong angles and ill-fitting devices (Children’s Health Queensland, 2020). In the present scenario, the AFOs are fitted, and the critique has been done. Mr C may have some potential problems with the AFO and the carer being inexperienced is unable to assess them. The critique has been done in the AFO Critique Sheet.  

Place your Order Now

Page Break 

Part B: AFO Fitting Critique Sheet 

 

3	2	1	0
Clinically proficient level with minor aesthetic flaws that do not impede function.	Appropriate to be provided to the client after minor aesthetic/fit issues are rectified.	Appropriate for diagnostic dynamic inhouse fitting but would need major revision before delivery to client.	Unsafe/inappropriate to fit to client in current state.

 

Technical finish	Score AFO 1	AFO 1 Feedback	Score AFO 2	AFO 2 Feedback
Plastic finish:   All edges are polished.   No rough patches or scuffs.  Trimlines are continuous without any bumps or waves.	3	The edges mostly polished proficiently. There are no major rough patches or jagged ends visible.  The trimlines are neat and seems to be well made.	2	The edges are polished but there are some areas that require minor fixing.  There are few rough patches in the AFO.  The trimlines are more or less okay.   The edges and the patches must be fixed.
Straps:  Stitching is neat.   Equal distance from edge of material.  Straps are correct length.   Hook isn’t contacting skin.  Appropriate padding.  Placement applies appropriate forces.	3	The stitching is neat.  The distance is correct The straps seem to be in correct length. The hook is not contacting the skin and the stitch is provided with appropriate padding. The placement likely applies proper force.	1	The stich is not very neat and needs major revision. The straps seem to be of longer than the correct length but appropriate padding has not been provided. The placement seems to be applying proper force but this AFO needs major revision before use.
Rivets:   Rivets are firm.  Internal rivet is flush with plastic of AFO.   External rivet doesn’t have unnecessary hammer marks.	3	The rivets seem to be firm and does not contain unnecessary hammer marks. The internal rivet is flush and in line with the plastic.	2	The rivet seems to be firm and no hammer marks are visible. The internal rivet seems to be a little raised above the plastic level.
Footplate:   Toes don’t overlap edges.   ¾ footplate is appropriate length.	2	The toe overlaps over the edges lightly when the straps are undone. This must be fixed before delivering.	3	The toes overlap the edges very slightly but it does not interfere with the fit.
Plastic mould:   Smooth inside and out.  No folds in plastic.	3	The plastic mould appears to be smooth inside and out without any bumps	3	The plastic mould appears to be smooth inside and out without any bumps
Contours and fit:
Calf shell:   Matches contour of limb.  Minimal gapping <4mm each side with strap loose.  Doesn’t dig into limb.	3	It does not appear to dig into the limb. It has minimal gapping with the strap loose and more or less follows the contour of the limb.	1	The calf shell seems to be digging into the skin of the patient. The shell appears to have considerable gapping when the straps are loose.
Malleolus:  Matches contour of limb.   Minimal gapping of plastic (3-4mm) with strap loose.  Doesn’t dig into limb.	2	It does not appear to be digging into the limb, but does not follow the contour of the limb either. There appears to be slight gapping in the plastic in the malleolus area.	0	The shell does not match the contour of the limb properly. There is a large amount of gapping when the straps are closed or open.
Trimlines:  Don’t dig into limb at any areas.  Don’t rub or gap over navicular.  Don’t rub or gap 1st an d 5th MTH (Metatarsal head)	3	The AFO seem to be snug and well-fitting on the limb. It is also well-fitted over the navicular and the metatarsal head.	1	The AFO is very ill-fitted. It seems to be digging into the skin in the calf area while it is loosen and has a gap around the ankle. This AFO seems to be unfit for use and must be replaced in terms of fit. In such case, it is possible that it may have left red marks on the leg as the carer had noticed. The red marks may be caused by the fit of the AFO (Children’s Health Queensland, 2020).
Alignment:
Sagittal:   AFO angle (DF/PF) matches intended position.  If AFO doesn’t match intended position – gait outcomes?	3	The AFO angle seems to be matching the intended position.  If the AFO does not fit snugly for the patient, this will not correct the plantarflexion of the patient’s angle. Hence the patient’s gait will not be corrected and the patient will continue walking in true equinus.	3	The AFO angle seems to be matching the intended position.  If the AFO does not fit snugly for the patient, this will not correct the plantarflexion of the patient’s angle. Hence the patient’s gait will not be corrected and the patient will continue walking in true equinus.
Coronal:   Calcaneal inversion/eversion matches intended position.   AFO in controlling inversion/eversion	3	The Calcaneal inversion/eversion matches intended position in this AFO. There does not seem to be any gapping or fitting issues.	1	The Calcaneal inversion/eversion matches does not match the intended position. It appears to be more than five degree evereted.
Transverse:   Toe-in/toe-out matches intended position.  Forefoot adduction/abduction matches intended forefoot position.	3	The AFO enables the matching of both toe-in/toe-out position as well as forefoot adduction/abduction to the intended position.	3	The AFO enables the matching of both toe-in/toe-out position as well as forefoot adduction/abduction to the intended position.

Reference 

Armand, S., Decoulon, G., & Bonnefoy-Mazure, A. (2016). Gait analysis in children with cerebral palsy. EFORT open reviews, 1(12), 448–460. https://doi.org/10.1302/2058-5241.1.000052 

Children’s Health Queensland. (2020). Ankle Foot Orthosis – R-wrap fact sheet | Children’s Health Queensland. Retrieved 9 April 2020, from https://www.childrens.health.qld.gov.au/fact-sheet-ankle-foot-orthosis-r-wrap/. 

Children’s Health Queensland. (2020). Ankle Foot Orthosis fact sheet | Children’s Health Queensland. Retrieved 9 April 2020, from https://www.childrens.health.qld.gov.au/fact-sheet-ankle-foot-orthosis/. 

Icrc.org. (2020). Retrieved 9 April 2020, from https://www.icrc.org/en/doc/assets/files/other/eng-afo.pdf. 

Physiopedia. (2020). Classification of Gait Patterns in Cerebral Palsy. Retrieved 9 April 2020, from https://www.physio-pedia.com/Classification_of_Gait_Patterns_in_Cerebral_Palsy. 

Pongpipatpaiboon, K., Mukaino, M., Matsuda, F., Ohtsuka, K., Tanikawa, H., Yamada, J., Tsuchiyama, K., & Saitoh, E. (2018). The impact of ankle-foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study. Journal of neuroengineering and rehabilitation, 15(1), 41. https://doi.org/10.1186/s12984-018-0382-y 

Stott, N. (2015). Cerebral Palsy. Management Of Chronic Conditions In The Foot And Lower Leg, 214-250. https://doi.org/10.1016/b978-0-7020-4769-5.00008-x