Some orthoses, such as the KAFO, make it difficult for a patient to lift and clear the toe due to the added weight. What do you recommend to counteract this issue?
Answer
A KAFO is definitely going to be heavier because of the thigh component; however, the types of metal uprights that are available in today’s market are very lightweight. They are likely to be made of titanium or a similar metal. The cost of the materials varies by content with the lightest material being the most expensive.
You will also want to think about lifting the client up on the opposite side if they are using a KAFO with a locked knee. Picture a person walking with their right leg in a KAFO that is locked at the knee. This positioning makes their right leg functionally longer than their left. You really need to pay attention and raise them up on their left side by adding a lift to the left shoe. How much? I would start out with a few millimeters of Pe-Lite and use trial and error to add more height until they can swing smoothly. It is not going to be perfect.
In combination, lighter weight components and a lift on the opposite side will probably solve your problem. Another thing to consider for a functional walker with financial resources is a stance control knee. There are great stance control knees out there that use microprocessors. For the right patient, it can be a dream, but it is really expensive. Not all of them are covered by insurance.
Jill Seale, PT, PhD, NCS
Jill has been a licensed physical therapist for 24 years. She received Board Certification in the area of Neurologic Physical Therapy from the American Physical Therapy Board of Clinical Specialties in 2004 and recertification in 2014. She has practiced almost exclusively in the field of Brain Injury and Stroke rehabilitation. She has a variety of teaching experiences, in physical therapy academia as well as in the health care community at large. She is currently faculty in the DPT program at South College. In addition, she teaches in several online and onsite continuing education programs across the nation. She has taught and presented in the areas of neurological pathology, rehabilitation, gait, orthotics, mentoring, and research, and is currently involved in clinical research in stroke rehabilitation, orthotic management, and gait analysis/rehabilitation.
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