Post Polio Knee Brace comments Part 2
Jim Thelen
Description
Collection
Title:
Post Polio Knee Brace comments Part 2
Creator:
Jim Thelen
Date:
8/23/2001
Text:
------------------------------------
You might want to look at Becker's Trick Knee joints. They provide an
adjustable extension moment while allowing flexion. They also come with
drop locks if needed for positive locking. I have used them very
successfully for patients/clients with polio/post polio syndrome but they
(the patients/clients) were relatively small and lightweight.
Eric Schwelke, C.P.O.
--------------------------------------
Your patient is unlikely initially to accept any orthosis. I think you are on
the right track with the ground reaction orthosis, however. There is
certainly no need to cross her knee with an orthosis! Getting her to accept
the idea of a ground reaction AFO, is the first step. Then be sure she gets
PT for gait training, as the orthosis will force her knee into a position her
mind tells her is dangerous, so she'll have to learn to trust it.
I doubt if any KO will be accepted by her. They either must exert too much
force to do the job, or they won't do the job. In the first case, she won't
comply; in the second, she won't be safe. David Hendricks, CPO, FAAOP
------------------------------------
If she has been noncompliant and/or non-orthosis wearing in the past, and her
main complaint is the 2-3 times a day of instability. - You are going to have
tough time with any thing that will go above her knee. She may do well with
a solid ankle AFO that is trimmed to her satisfaction, for cosmesis and
weight. the SA AFO will aid her with a dorsi-flexion stop and therefore a knee
flexion resist during stance - a GRF AFO may be overkill. IF you can inhibit
the anterior progression of the tibia you will in turn inhibit the ant
movement of the knee during buckling. The key is fabrication of the AFO in
such a way to allow your modified(i.e. Invisible) trimlines to give her your
intended anterior stability. Jay Murray, CO - Reno
---------------------------
You could try calling Townsend Design (800) 432-3466, and ask if the
Premiere with extension assist knee joint would be an option (I don't know
if the assist will be very helpful in stance phase), or the Premiere with
trigger lock with release (allows you to use the orthosis with free knee
motion or in a locked position). It's a place to start. If you can, try to
talk to Jeff Townsend directly or a certified orthotist there. Jim Fitzpatrick, CP
---------------------------
hAVE YOU SEEN OR HEARD OF THE UTX ORTHOSIS, LIGHTWEIGHT ORTHOSIS WHICH ALLOWS SWING THROUGH GAIT BUT LOCKS THROGH STANCE AND THEN UNLOCKS AUTOMATICALLY AT THE END OF STANCE PHASE. CHECK THE WEBSITE www.ambroise-uk.com David McGregor
---------------------------
As a starter I suggest the neoprene jointed orthosis, it will help and you will know if you must provide more security. Virgil
---------------------------
The only way to prevent the knee from buckling is a locking knee joint. Anything less will not be useful. If she is against bracing then aggressive therapy may help strengthen the quads.
Steve Mersch CPO
---------------------------
Try custom K.O. posterior off set joints free rom no locks, flex tech or
, or fab your own light weight acrylic lamination layup. this really works
as long as the foot has some dorsi flexion and is not flaccid..regards.
----------------------------------------
Jim, Sports Supports used to make a neoprene sleeve with extra stays for
use by muscular dystrophy kids. If they still make it, it might be an
option. Neal Donaldson
---------------------------
I have used Otto Bock 16 mm posterior offset knee joints with 17Y35 extension assist units (single or pair depending how much extension assist required). However, at the ISPO conference in Scotland, Basko Healthcare introduced a new knee unit called Gravity Angle Detection Technology for KOs or KAFO. The unit works a switch that locks/stabilizes the
knee unit before initial ground contact (terminal swing) and releases the lock during terminal stance. This unit works very similar to the prosthetic stance control knee units. I believe Durr Fillaur will be distributing it in the US and Canada. There is also a single or double upright KAFO available in Europe that utilizes footswitch technology to lock & unlock the knee (heel contact closes a heelswitch which activates the knee lock mechanism & heel off unlocks the knee). This is distributed by UK Ambrosie. I have heard about, yet not seen, a friction type stance phase stabilizing knee unit for KOs & KAFOs designed/fabricated in Calorado or Arizona. If you need more information email me. Steven Hale, M.Sc., C.O.(C)
--------------------------
I have also had similar problems with patients suffering from polymyelitis.
The best success I have had is with the articulated GRAFO with dorsifelxion
stop laminated with carbon fibre (very sleek, very low weight) - the KOs
thend to be very bulky and collide with the contralateral limb. The offset
joints still will not provide enough protection.
One way to show your patient the benefits of a GRAFO is to apply a fibregalss
cast to the leg using GRAFO princples - they can even test it for a few
hours. Show them the equivalent brace and see how you go.
Kind Regards, Paul Retschko Bach. Pros. Orth. (Hons.) Melbourne Orthotics
(Australia)
-------------------------------------
I don't think the posterior offset hinges would work in a KO as there is
no weight on the joint to make it work.
I think your idea of an AFO is best. Possibly a solid ankle polypro AFO
using a trimline as posterior as you think you can use and still give
her some resistance. Good luck, polio people sure seem to be set in
their opinion of what they will use. If she is a previous wearer of
braces she may be very difficult to get back into one. Don
---------------------------
Thanks again,
Jim Thelen
You might want to look at Becker's Trick Knee joints. They provide an
adjustable extension moment while allowing flexion. They also come with
drop locks if needed for positive locking. I have used them very
successfully for patients/clients with polio/post polio syndrome but they
(the patients/clients) were relatively small and lightweight.
Eric Schwelke, C.P.O.
--------------------------------------
Your patient is unlikely initially to accept any orthosis. I think you are on
the right track with the ground reaction orthosis, however. There is
certainly no need to cross her knee with an orthosis! Getting her to accept
the idea of a ground reaction AFO, is the first step. Then be sure she gets
PT for gait training, as the orthosis will force her knee into a position her
mind tells her is dangerous, so she'll have to learn to trust it.
I doubt if any KO will be accepted by her. They either must exert too much
force to do the job, or they won't do the job. In the first case, she won't
comply; in the second, she won't be safe. David Hendricks, CPO, FAAOP
------------------------------------
If she has been noncompliant and/or non-orthosis wearing in the past, and her
main complaint is the 2-3 times a day of instability. - You are going to have
tough time with any thing that will go above her knee. She may do well with
a solid ankle AFO that is trimmed to her satisfaction, for cosmesis and
weight. the SA AFO will aid her with a dorsi-flexion stop and therefore a knee
flexion resist during stance - a GRF AFO may be overkill. IF you can inhibit
the anterior progression of the tibia you will in turn inhibit the ant
movement of the knee during buckling. The key is fabrication of the AFO in
such a way to allow your modified(i.e. Invisible) trimlines to give her your
intended anterior stability. Jay Murray, CO - Reno
---------------------------
You could try calling Townsend Design (800) 432-3466, and ask if the
Premiere with extension assist knee joint would be an option (I don't know
if the assist will be very helpful in stance phase), or the Premiere with
trigger lock with release (allows you to use the orthosis with free knee
motion or in a locked position). It's a place to start. If you can, try to
talk to Jeff Townsend directly or a certified orthotist there. Jim Fitzpatrick, CP
---------------------------
hAVE YOU SEEN OR HEARD OF THE UTX ORTHOSIS, LIGHTWEIGHT ORTHOSIS WHICH ALLOWS SWING THROUGH GAIT BUT LOCKS THROGH STANCE AND THEN UNLOCKS AUTOMATICALLY AT THE END OF STANCE PHASE. CHECK THE WEBSITE www.ambroise-uk.com David McGregor
---------------------------
As a starter I suggest the neoprene jointed orthosis, it will help and you will know if you must provide more security. Virgil
---------------------------
The only way to prevent the knee from buckling is a locking knee joint. Anything less will not be useful. If she is against bracing then aggressive therapy may help strengthen the quads.
Steve Mersch CPO
---------------------------
Try custom K.O. posterior off set joints free rom no locks, flex tech or
, or fab your own light weight acrylic lamination layup. this really works
as long as the foot has some dorsi flexion and is not flaccid..regards.
----------------------------------------
Jim, Sports Supports used to make a neoprene sleeve with extra stays for
use by muscular dystrophy kids. If they still make it, it might be an
option. Neal Donaldson
---------------------------
I have used Otto Bock 16 mm posterior offset knee joints with 17Y35 extension assist units (single or pair depending how much extension assist required). However, at the ISPO conference in Scotland, Basko Healthcare introduced a new knee unit called Gravity Angle Detection Technology for KOs or KAFO. The unit works a switch that locks/stabilizes the
knee unit before initial ground contact (terminal swing) and releases the lock during terminal stance. This unit works very similar to the prosthetic stance control knee units. I believe Durr Fillaur will be distributing it in the US and Canada. There is also a single or double upright KAFO available in Europe that utilizes footswitch technology to lock & unlock the knee (heel contact closes a heelswitch which activates the knee lock mechanism & heel off unlocks the knee). This is distributed by UK Ambrosie. I have heard about, yet not seen, a friction type stance phase stabilizing knee unit for KOs & KAFOs designed/fabricated in Calorado or Arizona. If you need more information email me. Steven Hale, M.Sc., C.O.(C)
--------------------------
I have also had similar problems with patients suffering from polymyelitis.
The best success I have had is with the articulated GRAFO with dorsifelxion
stop laminated with carbon fibre (very sleek, very low weight) - the KOs
thend to be very bulky and collide with the contralateral limb. The offset
joints still will not provide enough protection.
One way to show your patient the benefits of a GRAFO is to apply a fibregalss
cast to the leg using GRAFO princples - they can even test it for a few
hours. Show them the equivalent brace and see how you go.
Kind Regards, Paul Retschko Bach. Pros. Orth. (Hons.) Melbourne Orthotics
(Australia)
-------------------------------------
I don't think the posterior offset hinges would work in a KO as there is
no weight on the joint to make it work.
I think your idea of an AFO is best. Possibly a solid ankle polypro AFO
using a trimline as posterior as you think you can use and still give
her some resistance. Good luck, polio people sure seem to be set in
their opinion of what they will use. If she is a previous wearer of
braces she may be very difficult to get back into one. Don
---------------------------
Thanks again,
Jim Thelen
Citation
Jim Thelen, “Post Polio Knee Brace comments Part 2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/217151.
