Floor Reaction Orthosis: Clinical Experience Gai-Fu W. Yang, M. D., R. P. T. Dong S. Chu, M. D. Jung H. Ahn, M. Hans R. Lehneis, Ph. D., C. O. Richard M. Conceicao, B. A., C. In clinical practice, the knee-ankle-foot orthosis (KAFO) with locked knee joint and limited ankle motion has been used for patients with paraplegia or paraparesis due to various etiologies. Patients who use such an orthosis walk with a rigid knee and an unphysiologic gait. Several attempts were made to design an ankle-foot orthosis (AFO) which would stabilize the knee joint with weak quadriceps femoris muscles and facilitate a near normal gait. In 1969, a supracondylar knee-ankle orthosis 3 (SKO) and, in 1979, a Saltiel Brace 4 (SB) were introduced and were characterized by free knee flexion, limited knee extension, and a solid ankle. Both orthoses were difficult to don. In addition, the SB did not provide adequate mediolateral stability to the knee joint. In 1973, after many modifications, a Kumamoto University short leg brace5 (KU-SLB) became available primarily for poliomyelitis patients who had residual paraparesis.
... Published on Sep 22, 2018 1. Floor Reaction Orthosis Presented by INDRA VIJAY SINGH (Lecturer P&O) PDUNIPPD, NEW DELHI 9/22/2018 INDRA VIJAY SINGH( LECTURER P&O) 2. Objectives Define floor Reaction Orthosis Biomechanics /Mechanical Principle Indications Advantage /Disadvantage Discussion 3. Floor Reaction Orthosis is revolutionary orthosis: Custom fabricated, moulded plastic device that supports the ankle and foot area of the body and extends from below the knee down to and including the foot. 4. • It was described by Saltiel for the use of weak quadriceps or plantar flexors in 1969. • It holds the ankle in equinus to prevent the heel from touching the ground. As the body weight brings the heel downwards, the supra patellar band will press the knee back preventing knee from buckling during stance phase. It allows the knee to flex during swing phase when the foot is off the ground. 5. Stage in evaluation of FRO Salitial FRO Pressing over the sensitive patella. PTB contours Provided by differentiating between pressure sensitive & pressure tolerance zone or areas.
Background: The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. The purposes of this study were to evaluate the efficacy of this orthosis objectively and to identify clinical parameters that may compromise its function. Methods: All children with cerebral palsy who had comprehensive gait analyses in both barefoot and braced walking conditions during a single visit to our Motion Analysis Laboratory between January 2001 and August 2007 were identified. Kinematic study parameters included mean sagittal dynamic range of motion of the ankle in stance, peak ankle dorsiflexion in stance, peak knee extension in midstance, and mean foot progression angle in stance. The minimum sagittal knee moment in midstance was also examined in this study for subjects who walked without assistive devices. Range-of-motion and skeletal alignment data obtained from the physical examination record of each subject included knee flexion contracture, popliteal angle, hip flexion contracture, and thigh-foot angle.
Since weight bearing is not a consideration, the popliteal area and contour of the posterior calf need not be disturbed. The negative impression is removed and filled in preparation for modification. Modification follows standard procedures with plaster buildups over all bony prominences for pressure relief. The footplate is fully modified for support of the medial and lateral longitudinal arches. In addition, a slightly more aggressive modification is made under the sustentaculum tali and transverse metatarsal arch to provide a stable base for the calcaneus in a slight plantar flexion position and comfortable distal reaction point under the metatarsal heads. The patellar tendon is now isolated. Although not an area covered by the orthosis, the patella was included in the negative impression so that the tendon modification could be properly oriented with respect to natural toe out. If this is not done, the orthosis will tend to rotate medially or laterally and begin to impinge on the femoral condyles.
Functions of FRO This orthosis is used to create an extension moment at knee, generally in cases where patient is walking with hand to knee gait. This extension moment is generated when ankle is locked in a position of plantar flexion. Prevents knee flexion in weight bearing Gives medio lateral support and roatatory stability to Helps to maintain the upright position in stance and stabilized gait Other functions are similar to that of a solid ankle AFO 16. Indication of FRO • Lower limb weakness eg. Post polio paralysis • Neurological conditions • For assist knee extension at mid stance and compensate for weak / absent gastro soleus (places extension forces close to knee) • Generally all the previous conditions with quadriceps having a fair muscle power. • – 17. • Indication- Management of a crouch gait, which is characterized by excessive ankle dorsiflexion, increased knee flexion, and increased hip flexion in mid stance. 18. – spina bifida – cerebral palsy – brain injury – spinal cord injury 19.
progressed to walking with a right Zimmer splint/posterior leaf spring AFO, left "handy standy"/toe strap, and rolling platform walker. As soon as the strength of the right quadriceps femoris muscles reached fair minus, an FRO was made for the right lower limb (Figure 4). A plastic KAFO with metal knee and ankle joints was prepared for the left lower limb. All three patients described above were found to be excellent candidates for FROs. They were well motivated and the strength of their quadriceps femoris muscles was improving to at least a fair minus level. If they had one AFO, they met almost all of the requirements for functional community ambulation. 2 After a short period of rehabilitation training, they walked well with their FROs and accepted the FRO as an assistive functional device for ambulation. CASTING AND FABRICATION The patient is seated in a casting chair, and all bony prominences are identified with an indelible pencil. A latex rubber tube is run anteriorly over the dorsum of the foot along the tibial crest to the level of the fibular neck.