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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Describe the types (categories) and functions of knee orthoses (KOs) and knee–ankle–foot orthoses (KAFOs).

  2. Identify and describe the parts of KOs and KAFOs, including the materials and componentry used.

  3. Discuss applications for KOs and KAFOs to improve function.

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Physical Therapy students are expected to:

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  1. Determine the need for a KO or a KAFO for a client based on examination findings.

    1. Evaluate client examination findings, including preorthotic prescription clinical examinations, lower quarter biomechanical assessment, and functional and gait analyses, to diagnose impairments that may be improved by a KO or KAFO.

  2. Develop goals for a KO or KAFO based on a client's impairments and functional requirements.

  3. Describe the biomechanical methods employed in KOs and KAFOs to achieve the orthotic goals.

  4. Prescribe a KO or KAFO to meet the orthotic goals and improve function.

  5. Develop and execute a search strategy to identify research evidence for the effects and effectiveness of KOs and KAFOs and to identify best practices for orthotic prescription.

  6. Recommend a KO or KAFO as a part of a plan of care to optimize function for an individual with impairments at the knee.

  7. Recommend shoes with appropriate characteristics for use with specific KOs or KAFOs.

  8. Examine and evaluate KOs and KAFOs for acceptable fit, function, comfort, and cosmesis.

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CASE STUDIES

Ann O'Callahan is a 55-year-old elementary schoolteacher who reports right knee pain and has been given a diagnosis of medial compartment tibiofemoral osteoarthritis by her doctor. Her history and chief complaints are described in Chapter 11. In addition to the examination findings reported previously, today she is tender at the medial joint line and has a general complaint of pain throughout the anterior knee. The pain is accompanied by minimum swelling around the joint, but there are no signs of effusion. Knee strength is graded as 3+/5 by manual resistance, but her ability to produce force is limited by pain. Varus and valgus stress tests at the knee reveal mild laxity with some pain. Because she discontinued her walking exercise, she does daily straight-leg raise exercises instead and can perform 25 consecutively without difficulty or pain. Her hip, knee, and contralateral leg show no impairments. She is motivated to get started, as she is anxious to resume her walking exercise program.

Luis Sanchez is a 12-year-old sixth grader who has cerebral palsy and spastic diplegia. Luis' history and functional problems are described in Chapter 11. When you examine him today, you note that he has some limited joint range of motion (ROM): hamstrings contractures (popliteal angle of 145° on the 90–90 straight-leg raise test) and heel cord contractures (5° plantarflexion with the knee extended). Muscle strength assessment using manual resistance tests (in the available ROM) showed selective muscle weakness, including hip extension and abduction and ankle dorsi- and plantarflexion, 3/5; knee flexion and extension, 3+/5 and hip flexion, ...

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