Spina Bifida KAFO responses
Gretchen Wellman
Description
Collection
Title:
Spina Bifida KAFO responses
Creator:
Gretchen Wellman
Date:
5/2/2013
Text:
Hi everybody!
Wow, I am overwhelmed by the number of responses to my inquiry! My original post was: Hey list,
I'd love some feedback. I'm coming in new to a spina bifida patient (active pre-teen girl) that has been getting ulcerations at the posterior calcaneus with articulated KAFOs. She presents with significant bilateral knee flexion contractures and ankle plantarflexion contractures that remain despite twice weekly physical therapy.
She's been given suggestions by her physician to use solid ankles but I wondered whether anyone else had any particular suggestions, besides that and to just relieve over the spot? Her current braces appear to fit well statically; she apparently didn't have issues before this particular pair, she's been wearing KAFOs since 4 years old.
This patient has been through enough; she and especially Mom are very anxious about the design and to proceed.
Further notes include: bilateral knee flexion contractures 20-30 degrees, ankle plantarflexion (yes, plantarflexion) of 15 and 20, into some supination. Mom swears the girl is active and receives PT twice weekly and yet still has these contractures...?!? Interesting, no? I assume things aren't quite the way she describes.
Previous orthoses are 6 months old with tamarack ankle joints with 90 degree stop (yes, I hear the alarms too) and step lock knees with knee caps (which she doesn't really wear). I understand from talking to her previous clinician that she also has night splints but refuses to wear them. Family is resistant to surgery.
I believe she is pistoning (and with good reason) inside the orthoses and developing shear-related breakdown.
Design-wise, I'm thinking solid ankles (which she has worn a couple times before) with joint capability built in (for later, just in case) and step lock knees, then to wedge either under the orthosis (difficult to fit shoes) or onto the shoe. I'm undecided about an inner boot.
RESPONSES (in summary):
Give more information.
Solid ankles
Solid with inner SMO boot
Elaine Owens style
GRAFO
Night splints
Tighten the ankle strap and relieve at the sore
Articulate at the ankle but allow additional plantarflexion to allow relative dorsiflexion during gait.
Compare and duplicate the old ones that worked
Several advised I call and speak with them over the phone, which I will as soon as I can.
Suffice it to say, there are few interesting bits going on here both brace and patient/family-wise.
This patient has worked her way through numerous clinicians in the office over the years and was really frustrated/disappointed with the last set. Needless to say, I want to knock it out of the park with her early on in our new relationship and help her get going (as well as make Mom happy).
I appreciate all the feedback, everyone.
Gretchen Wellman CO
Wow, I am overwhelmed by the number of responses to my inquiry! My original post was: Hey list,
I'd love some feedback. I'm coming in new to a spina bifida patient (active pre-teen girl) that has been getting ulcerations at the posterior calcaneus with articulated KAFOs. She presents with significant bilateral knee flexion contractures and ankle plantarflexion contractures that remain despite twice weekly physical therapy.
She's been given suggestions by her physician to use solid ankles but I wondered whether anyone else had any particular suggestions, besides that and to just relieve over the spot? Her current braces appear to fit well statically; she apparently didn't have issues before this particular pair, she's been wearing KAFOs since 4 years old.
This patient has been through enough; she and especially Mom are very anxious about the design and to proceed.
Further notes include: bilateral knee flexion contractures 20-30 degrees, ankle plantarflexion (yes, plantarflexion) of 15 and 20, into some supination. Mom swears the girl is active and receives PT twice weekly and yet still has these contractures...?!? Interesting, no? I assume things aren't quite the way she describes.
Previous orthoses are 6 months old with tamarack ankle joints with 90 degree stop (yes, I hear the alarms too) and step lock knees with knee caps (which she doesn't really wear). I understand from talking to her previous clinician that she also has night splints but refuses to wear them. Family is resistant to surgery.
I believe she is pistoning (and with good reason) inside the orthoses and developing shear-related breakdown.
Design-wise, I'm thinking solid ankles (which she has worn a couple times before) with joint capability built in (for later, just in case) and step lock knees, then to wedge either under the orthosis (difficult to fit shoes) or onto the shoe. I'm undecided about an inner boot.
RESPONSES (in summary):
Give more information.
Solid ankles
Solid with inner SMO boot
Elaine Owens style
GRAFO
Night splints
Tighten the ankle strap and relieve at the sore
Articulate at the ankle but allow additional plantarflexion to allow relative dorsiflexion during gait.
Compare and duplicate the old ones that worked
Several advised I call and speak with them over the phone, which I will as soon as I can.
Suffice it to say, there are few interesting bits going on here both brace and patient/family-wise.
This patient has worked her way through numerous clinicians in the office over the years and was really frustrated/disappointed with the last set. Needless to say, I want to knock it out of the park with her early on in our new relationship and help her get going (as well as make Mom happy).
I appreciate all the feedback, everyone.
Gretchen Wellman CO
Citation
Gretchen Wellman, “Spina Bifida KAFO responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 28, 2024, https://library.drfop.org/items/show/235195.
