Thank you so much for the kind replies from many subscribers.
Hereby, I submit the summary of the replies.
At 10:18 PM 7/11/97 +0900, you wrote:
Could anybody tell me the fabrication process for the “floor reaction
orthosis (AFO)”? I remember that once I have seen it on this
discussion group, but I can not find it now.
I have to make one pair of it for my patient.
>Thank you in advance for your concern.
—
Sang-hyun Cho MD.(Rehabilitation Medicine Specialist)
Lecturer of Dept. of Rehabilitation Therapy, College of Health Science
Yonsei University, Wonju, Rep. of KOREA, FAX:+82-371-760-2427
Home page
http://www.interpia.net/~davinci
Dr. Sang-hyun Cho,
There are several designs of floor reaction orthoses. I have included
part
of the biblography that was part of my paper at the ISPO Concenses
Conference on CP in 1994. Hopefully this will help your orthotist. You
could also get the report from the conference from ISPO through the
University of Strathclyde.
All designs have a larger pretibial section with a rigid anterior ankle
to
prevent anterior motion of the tibia over the talus. This gives you a
larger surface area for the knee extention forces below the patella and
prevents dorsiflexion of the foot.
For larger adults I use laminated designs with dual channel ankle joints
with anterior pins for an adjustable anterior stop. “Oregon Orthotic
System
style.”
For lighter people I will use an anterior polypropylene design with
reinforce ankles, either extra layer of pp or carbon. Plastic is
vacuumformed with the seam running down the back and planter surface of
the
cast. Material on the back of the cast is removed for entry of the foot
and leg but covers the front of the leg and wraps around the mid foot
and
under the full sole. Plastic is trimed at MTP level, posterior to the
ankles and just posterior to the heel. The plastic is thinned under the
toes for flexibility, covers the dorsum of the foot down to the
tarsalmetatarsal joint line, and to the met heads medially and laterally
like a UCBL. If free planterflexion is desired, ankle joints can be
added.
For smaller children (under 2) I use a regular AFO design with a
larger/wider anterior strap.
I hope this all helps.
Terry Supan, CPO
2. Bleck, EE: Current concepts: Management of the lower extremities in
children who have cerebral palsy, JBJS, 72-A:140-144, 1990.
4. Carlson MJ, Berglund G: An effective orthotic design for
controlling
the unstable subtalar joint, Orthot Prosthet 33:39, 1979.
7. Fish DJ, Nielsen JP: Clinical assessment of human gait, J
Prosthet
Orthot 5(2):39-48, 1993.
8. Gage, J: Gait Analysis in Cerebral Palsy, London, 1991, Mac Keith
Press. pp 63-67.
9. Gage, J: Gait Analysis in Cerebral Palsy, London, 1991, Mac Keith
Press. pp 104 & 180-181.
10. Glancy J, Lindseth RE: The polypropylene solid-ankle orthosis,
Orthot
Prosthet 26:14-26, 1972.
11. Hanson, CJ, Jones, LJ: Gait abnormalities and inhibitive casts in
cerebral palsy, J Am Podiat Med Assoc 79:53-59, 1989.
12. Harrington ED, Lin RS, Gage JR: Use of the anterior floor reaction
orthosis in patients with cerebral palsy, Orthot Prosthet 37(4):34-42,
1983.
16. Knutson LM, Clark DE: Orthotic devices for ambulation in children
with cerebral palsy and myelomeningocele, Phys Ther 71:947-960, 1991.
17. Lehneis HR: Plastic spiral foot-ankle orthoses, Orthot Prosthet
28:3-13, 1974.
19. Rosenthal RK, et al.: A fixed-ankle below-the-knee orthosis for
the
management of genu recurvatum in spastic cerebral palsy, J Bone Joint
Surg
57A:545-547, 1975.
20. Saltiel J: A one-piece laminated knee licking short leg brace,
Orthot
Prosthet 23:68-75, 1969.
21. Shamp JK: Neurophysiologic orthotic designs in the treatment of
central nervous system disorders, J Prosthet Orthot 2(1), 14-32, 1989.
24. Sutton R: Thermoplastic elastomer (TPE): the TPE ankle-foot
orthosis
and the TPE biomechanical -foot orthosis, J Prosthet Orthot 2(2):
164-172,
(Winter) 1990.
25. Taylor CL, Harris SR: Effects of ankle-foot orthoses on functional
motor performance in a child with spastic diplegia, Am J Occup Ther
40:492-494, 1986.
27. Weber D: Use of the hinged AFO for children with spastic cerebral
palsy and midfoot instability, J Assoc Child Prosthet Orthot Clin
25:61-65, 1990/91.
Terry Supan, CPO
Associate Professor
Director, Orthotic Prosthetic Services
SIU School of Medicine, Springfield, IL.
Hello. I am an ABC Registered Prosthetic technician who does orthotics
as well. To the best of my knowledge a floor reaction AFO is a standard
AFO
that encompasses the anterior of the tibia. IF you are vacuforming
plastic
over your molds one needs to pad the proximal anterior aspect of the
mold
with aliplast or plastizote, seaming the ends of the padding on the
posterior
of the mold. Pull the plastic over the mold as you would a normal AFO
paying
close attention to the seam on the proximal section. Ideally the
plastic
should be seamed straight without any gaps or holes. While the plastic
is
still hot cut the seam as close to the mold as you can. After the
plastic
has cured place the standard trimlines on the AFO. Paying close
attention
to the anterior surface mark a line perpendicular to the tibia 3/4″
distal to
the head of the fibula in a circumferential manner. Place another
perpendicular line three to four inches distal to that line in a
circumferential manner as well. These two lines represent the anterior
aspect of the brace. The distance between these to lines should be
realitive
to the size of the mold/leg. Flow these anterior lines into the lines
that
you have already drawn on the sides of the mold. The posterior aspect
of
this brace at this level should resemble the posterior aspect of a
transtibial prosthesis, allowing room more for the gastrocnemius than
the
hamstrings at this level. A safe starting point at this stage would be
half
the distance between the proximal and distal anterior trimlines. It
will be
necessary to chisel the plaster of paris out of the plastic once the
trim
lines have been cut since the anterior shell will not let the plastic
slide
over it.
I hope this information will be helpful and not confusing, please
let
me know what the results of these braces were.
Sincerely,
K.C.Carlson RTP
North Carolina, USA
Hi there –
I do nto know about fabrication techniqyes, but I must suggest that if
you
intend to use this device on a child with significant hamstrings and/or
knee capsule contracture, expect little effet.
Most children who use it successfully have NO heel cord contracture, NO
hamstrings contracture, and have calcaneus deformtiy – hyperdorsiflexion
in
standing or stance – due to tricep surae weakness.
Furthermoer, if you articulated this device so it would allow
plantarflexion, you woulc be aboe to contribute to resolutionof teh
problem
by allowing the individual with available innervation to work to reduce
triceps surae muscle weakness.
This is an orthosis which is frought with limitations as well
asposibilities. The solid ankle distresses me most, and so I NEVER use
it
for children with CP. I always allow them to plantarflex at propulsion
and
at first rocker. If DF-assist is needed, t is easily provided for with
an
elastic connector strap between shaft and foot sections.
Beverly Cusick, MS, PT [email protected]
http://www.tellword.com/tellword/bcusick.htm
Dear Sir,
The requested fabrication process is easy if made from sheet
polypropylene
with the use of an oven. The oven tray is lined with some PTFE
impregnated
fabric, so that the 6-7 mm poloprop sheet does not stick to it. I
believeat
225C the sheet is heated until transparent. The cast is prepared and is
mounted with the shin horizontal and foot down. A protective layer of
padding may be nailed onto the cast for where the pt bar is located. A
thin
nylon stocking over the entire cast acts like a wick for the vacuum. A
vacuum is connected to the post, and if required a roll of plastacine is
wrapped round the post, so that a good seal is acchieved when the hot
polypropylene pulls close around it.
The sheet is removed from the oven with two pairs of hands (and gloves!)
and the sheet is draped over the model, whilst the vacuum is on.
Wrinkles
are worker to where the waste is going to be. Press the edges of the
draped
sheet together to create a vacuum seal, and squeeze around the
plastacine.
If all is well the sheet should pull close to the cast. Cut excess off
with
scissors.
Done.
If this is not sufficient, ask my friend Ron Hulshof at [email protected]
Regards Jacob Boender,
Prosthetist
Bristol UK
In brief:-
Cast to mid patella tendon or above.
Cast in slight plantar flexion.
Modify cast as needed to enable passing foot through from rear
usually involves flaring out the front and back edges
A full foot AFO is preferable to get maximum leverage.
DUPLICATE THE CAST. until you ar comfortable that you dont need to.
If you havent made these before, duplicate and save some later greif.
Prominat Maleoli are a particular problem with this AFO.
If you are bracing for a crouched gait Spina bifida, or CP, you may
immobilise them with this AFO. as the crouch is used for balance.
Sometimes you need to leave some crouch, ie make AFOs in
a dorsiflexed position , but less than they are used to. 8-(
You may need to reinforce the ankle area either with carbon fibre
inserts
or whatever, or good ridging. USE thicker plastic than for Standard
AFO.
Use Pelite or similar material for anterior padding. If moulding over
this
feather off bottom edge only.
Drape mould, and seal along front edge, special
attention to mid patella tendon down 50 – 100 mm
as this area will be load bearing.
Trim front top height at mid patella tendon, curving down just behind
the
midline of the leg, (like a standard AFO backwards) and going down
far enough to provide the opening to don the AFO/. Can go down as
far as the origin of achilles tendon, but strength reduces. Curve around
at this distal point (use a hole saw for ease), and up other side.
Anterior trim. Begin 50mm to 100mm distal to MPT depending on client
size and weight. for the anterior shell. A hole saw of the appropriate
size is handy here too. Center the hole saw on the tibial crest,
and cut in.
Once this hole is cut, extend trim lines down as per standard AFO, with
anterior trim.
Finally If it comes off the cast it will go on the leg!.
If the cast has to be broken it still may be possible to get the foot
in.
Trim back the seam from moulding but do not grind it flush as this
seam needs strength.
I leave about 6mm extending.
Finish with a 50mm strap posteriorly.
Hope this helps.
Mark Holian
Director of Orthotics and Prosthetics
Royal Brisbane Hospital
Australia.
END OF SUMMARY.
