Friday, December 2, 2022

Responses to LE Bracing options for patient over 300 lbs

Paul Meyer

I really appreciate the info I got from everyone. Here are the responses:

Unilateral Joint System. Number 1 Size. When used in a double upright
configuration, will work for patients up to 350#.

http://ottobockus.com/cps/rde/xchg/ob_us_en/hs.xsl/3459.html

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For obese patients requiring a KO for knee instability I first consult the
the doctor’s office and always provide a custom KAFO with a knee joint that
is applicable and a PLS strut from the posterior calf section to a minimal
footplate to provide suspension and help orient the orthosis for donning.

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You’d need to get a better Rx but Townsend can build you a Rebel Extension Assist brace. I’d suggest the Rebel Pro model so it’s good and sturdy for your patient’s size

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In my opinion, it will be difficult to suspend a knee brace on a leg of a person that large. It likely will slide down. With a hip fx, the a longer leverarm likely is best to dissipate the forces as much as possible. Ethically, you need to evaluate to see if a stance control KAFO is appropriate. The pt is over the weight limit on the FreeWalk at 265#, the scokj is 220 lbs, the pt likely does not have enough quad stregnth to use the fillauer seatbelt style as it really requires more speed in swing, etc.
It may turn out that a locking KAFO is the only option…but I would keep looking. Don’t forget to check if on a part A stay.

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Again, thanks for the responses. Townsend has developed a locking version of the Rebel with spring locks. Fortunately, the X-large should fit this patient. She has a relatively well developed calf so I think suspension will not be a problem and this is what I plan to try.

A KAFO would not be accepted by the patient so it is off the table now. The Otto Bock joints are very nice and rated to 160 KG if using a double upright with 2 joints but they are expensive.

Given the functional potential of the patient, a stance control joint would be out of the question.

Hope this info helps others running into the same dilemma.

Paul Meyer, CPO

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