AFO's for Spasticity-Responses
Richard Ziegeler
Description
Collection
Title:
AFO's for Spasticity-Responses
Creator:
Richard Ziegeler
Date:
5/6/2001
Text:
Herewith the helpful replies to my post, a copy of which follows. Thankyou all again for your assistance. I think that it will be safe to assume that there is no new approach and that the present techniques, beyond putting the tonic limb in a bucket of soft concrete, necessarily must be used in conjunction with other active treatment modalities (Physiotherapy etc) to maintain muscle length and stretch). Richard Ziegeler
1. Arizona AFO www.arizonaafo.com
2.What you use depends on what the time from injury and the range is when the patient is sitting with knee flexed at 90 degrees; ankle at R1 plus this is what and Flexible Stability AFO can control. If it is in negative dorsiflexion 4 to 8 weeks after injury than a Flexcast AFO is the best bet. It can be done in twenty minutes; the patient can ambulate on it in 4 hours. It is safe the family can take it off by unwrapping the cast. If this is long term the only choice is R-Wrap AFO since we have done over
600 of these AFO's. You can learn more at this web site; <URL Redacted>
3.I am a resident so think what you will but I would
personally use something custom made like a Oregon
Orthotics systems AFO with double adjustable ankle
joints. The anterior stops and possible even the
posterior stops but it doesn't sound like it. Clam
shell style shin portion all laminated including
footplate. So it is kind a like a floor reaction AFO.
The main reason I say this is because you need
dorsiflexion stops. SO it is hard to do that in a
thermoplastic design in my eyes. I would recommend a conventional AFO with double adjustable ankle joints but it seems to me that the one stap is a high pressure area. SO if I am totally wrong forgive me. But I gave it a shot. Do let us know what you got as a result to all the emails.
4.I have been studying this topic myself. I have run across a few intriquing articles. In case you have not already read them, they are and can be found
at: Overview of the Causes, Treatment, and Orthotic Management of Lower Limb Spasticity - www.oandp.org/jpo/21/2133.asp, Neurophysiologic Orthotic Designs in the Treatment of Central Nervous System Disorders - www.oandp.org/jpo/21/2114.asp, and Design Changes in Ankle-Foot Orthosis Intended to Alter Stiffness Also Alter Orthosis Kinematics -
www.oandp.org/jpo/113/11348.asp.
5.We have had some luck with a normal trim AFO and add a padded anterior shell . We usually use TPE as our choice of plastic.
6.try an oos laminated afo- i have some very good results
7.In my opinion, if it is fixed deformity and not correctable passively, it is the case of surgery i.e. soft tissue release and osteotomy.
8.We have had some luck doing hinged AFO with full footplate and Friddle Adjustable ankle joints.
9.I recommend a custom neuropathic walker AFO. The equinovarus position yu described will be very dificult to manage and you will need all the padding
(liner) associated with a NP walker. You may have to add a lift to the contralateral shoe to avoid hip problems. If the patient gets physical or medical therapy to combat the spasticity, then you may be able to obtain a more neutral posture of the ankle-foot complex when you take the impression.
Original question:<<Esteemed colleagues. I( would like to hear your ideas about what is your AFO of choice for a weight bearing application in a lower limb with typical extensor pattern spasm? Foot plantarflexed to billy-oh, ankle in varus and leg internally rotated? Position is correctible with a slow stretch but physios wish to have an orthosis which they can use to have this patient weight bearing in a good position. I will post the responses because I
believe that this is one of the basics.>>
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1. Arizona AFO www.arizonaafo.com
2.What you use depends on what the time from injury and the range is when the patient is sitting with knee flexed at 90 degrees; ankle at R1 plus this is what and Flexible Stability AFO can control. If it is in negative dorsiflexion 4 to 8 weeks after injury than a Flexcast AFO is the best bet. It can be done in twenty minutes; the patient can ambulate on it in 4 hours. It is safe the family can take it off by unwrapping the cast. If this is long term the only choice is R-Wrap AFO since we have done over
600 of these AFO's. You can learn more at this web site; <URL Redacted>
3.I am a resident so think what you will but I would
personally use something custom made like a Oregon
Orthotics systems AFO with double adjustable ankle
joints. The anterior stops and possible even the
posterior stops but it doesn't sound like it. Clam
shell style shin portion all laminated including
footplate. So it is kind a like a floor reaction AFO.
The main reason I say this is because you need
dorsiflexion stops. SO it is hard to do that in a
thermoplastic design in my eyes. I would recommend a conventional AFO with double adjustable ankle joints but it seems to me that the one stap is a high pressure area. SO if I am totally wrong forgive me. But I gave it a shot. Do let us know what you got as a result to all the emails.
4.I have been studying this topic myself. I have run across a few intriquing articles. In case you have not already read them, they are and can be found
at: Overview of the Causes, Treatment, and Orthotic Management of Lower Limb Spasticity - www.oandp.org/jpo/21/2133.asp, Neurophysiologic Orthotic Designs in the Treatment of Central Nervous System Disorders - www.oandp.org/jpo/21/2114.asp, and Design Changes in Ankle-Foot Orthosis Intended to Alter Stiffness Also Alter Orthosis Kinematics -
www.oandp.org/jpo/113/11348.asp.
5.We have had some luck with a normal trim AFO and add a padded anterior shell . We usually use TPE as our choice of plastic.
6.try an oos laminated afo- i have some very good results
7.In my opinion, if it is fixed deformity and not correctable passively, it is the case of surgery i.e. soft tissue release and osteotomy.
8.We have had some luck doing hinged AFO with full footplate and Friddle Adjustable ankle joints.
9.I recommend a custom neuropathic walker AFO. The equinovarus position yu described will be very dificult to manage and you will need all the padding
(liner) associated with a NP walker. You may have to add a lift to the contralateral shoe to avoid hip problems. If the patient gets physical or medical therapy to combat the spasticity, then you may be able to obtain a more neutral posture of the ankle-foot complex when you take the impression.
Original question:<<Esteemed colleagues. I( would like to hear your ideas about what is your AFO of choice for a weight bearing application in a lower limb with typical extensor pattern spasm? Foot plantarflexed to billy-oh, ankle in varus and leg internally rotated? Position is correctible with a slow stretch but physios wish to have an orthosis which they can use to have this patient weight bearing in a good position. I will post the responses because I
believe that this is one of the basics.>>
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list.
Citation
Richard Ziegeler, “AFO's for Spasticity-Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/216471.
