Keys To Prescribing AFOs For Senior Patients
- Volume 25 - Issue 8 - August 2012
- 11782 reads
- 2 comments
The following additional considerations are vital in order to select the right style of AFO for those seniors at risk for falling.
• First and foremost, one must perform a biomechanical fall risk assessment to identify the specific risk factors involved. As I noted earlier, weakness, balance deficits and gait deficits are reportedly among the top causes of falling among seniors.15,16
• Senior patients who already have risk factors for falling (i.e. history of falling, weakness, joint instability) must have symmetrical treatment for the best outcome. Thus, bilateral AFO bracing is critical when addressing a severe ataxic, unstable gait.
• Any AFO used for balance must be lightweight and easy to don. While this is true for all AFOs discussed in this article, it is critical to make sure the patient receives proper training on how to put on and take off the AFO. This can make or break the success of any AFO among seniors.
• In addition to being lightweight, a balance AFO must be flexible so as to stabilize the ankle and improve postural stability, but not so solid as to limit the normal range of motion still available.
• A flexible or hinged gauntlet style AFO, like the Moore Balance Brace, is critical to maximize somatosensory contact, thereby improving proprioception around the foot and ankle. In my experience, most patients have more than ample flexibility with the non-hinged standard Moore Balance Brace, but there are some who will benefit more from the hinged version (i.e. those who need more stability but more sagittal plane flexibility).
• Lightweight, balanced footwear is critical to the success of any AFO used for the improvement of balance. This one point is probably what prevents more success when utilizing a balance AFO.
• Easy donning and doffing is critical for any AFO designed for a senior. However, ordering Velcro attachments for these patients with no loops or strings can be an easy way to improve adherence. Strings, loops and hooks, while very valuable in many styles of AFOs, can create more difficulty for a senior.
Essential Insights On Utilizing AFOs For Drop Foot
While utilizing AFOs for drop foot patients has been widely accepted and understood for decades, clinicians must carefully consider a few important factors when ordering the right style for more senior patients.
While not a disease in and of itself, drop foot is a symptom of an underlying pathology that can include a stroke, a traumatic brain or spinal cord injury, spinal stenosis, multiple sclerosis or a peroneal nerve injury.
The goal of any AFO for this condition is to promote toe clearance while limiting the speed at which the foot plantarflexes. In short, the goal is to prevent the foot from dropping during the swing phase of gait (drop foot).
Typically, the drop foot AFO will extend from distal to the metatarsal heads to just distal to the head of the fibula. In the PDAC definition of an L1960 AFO, the proximal edge cannot be higher than 1½ inches below the head of the fibula. In some cases, the foot plate may extend to the entire length of the foot. Topcover materials for the foot are optional but can be advantageous for those (the majority) who may be at risk for skin breakdown.
While most AFO manufacturers make some version of a posterior leaf style AFO, choosing between a simple posterior leaf design versus a dorsiflex assist device is critical.