Tuesday, July 23, 2024

Answers to my question regarding the Dynamic Walk AFOs

Keith Vinnecour

My original email:

I have a client who did very well with the dynamic walk on his right leg only for 6 months, then he said that it did not work as well. He continued to use it for two years, but he fell when using the AFO.

His diagnosis is Inclusion-Body Myositis, IBM. He is in his 70s and walks with a walker. He now needs some braces bilaterally.

What is the groups’ experience with this device as far as its longevity and not loosing function over time?

This patients muscle test is:
Right Left
Hip Flexion 2+ 2+
Hip Extension 5 5
Knee Extension 5 5
Knee Flexion 1 2
Dorsi Flexion 0 2
Plantar Flexion 5 5
It would seem like the perfect orthosis, as his needs to use his plantar flexion strength for push off and I would prefer to have free plantar flexion range of motion.

Your thoughts?

Keith E. Vinnecour, C.P.O.(E
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The answers.
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When you are fighting hip flexor and knee flexor weakness you are going to need to assist more through a stronger lever arm to assist his 5/5 plantar flexors to create enough support to allow more knee flexion. Did you test the PF through a single leg rise under full body weight with the knee straight? Many test this against their own hand and have the patient push against them, this is an inadequate measure of PF strength. Just curious.
_________
What are you up to these days?

I am working on a big study of carbon AFOs. Would you be willing to share with me why you selected Dynamic Walk over an Ypsilon®, ToeOFF®, or BlueRocker AFO®?

FYI, We have added a new AFO®, it is called Ypsilon® Flow? I have attached a PDF.

I hope to hear from you soon!

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Have determined the cause of his falls? Muscle failure or out of alignment balance issues?

Is it the unbraced side giving out? Does his good muscles fatigue after short, medium, long walks?

Does he fall in the mornings, afternoons or evenings? Inside outside?
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Keith, I have been involved with a couple dozen of these cases. At this point of progression we have used the UTX SCO from BECKER.

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I would look further into the proximal strength in his lower limbs. IBM will present its weakness in quads and proximal muscle groups first and the Myositis progress distally

________
That seems appropriate to me, but I have a similar patient that tried the Becker hip flexor assist. I think it was called the HAP. It helps with hip and knee flexion as well as dorsiflexion, but is a little bulky. Hope this helps.

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Done ton of them and it never happened. Check his hip flexors. He may have developed leg lift deficiency and then no matter how many degrees you dorsiflex the forefoot, he will still catch from mid to hindfoot.

_____
I have had great success with Otto Bock Walk on carbon afo

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I just saw a patient with significant drop foot who had been using her Dynamic Walk for past 2 years. Says that she’s had more foot slap lately. I didn’t fit the first one, so I’m not sure what she looked like after first receiving the Dynamic Walk, but she feels that brace function has changed over time. Sounds like a similar case. (I ended up fitting her with a SpryStep by Townsend, and she is walking beautifully.)

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