Results Analysis including Documentation

Check if the length of the orthosis’ foot piece corresponds to the inner shoe length.

Check if the pitch of foot piece and shoe is identical.

Check if the toe spring of foot piece and shoe is identical.

Check if the stops of all joints are reached when the orthosis is placed standing in the shoe.

AFO:
Drop the plumb line through the middle of the ap measurement at knee height. The plumb line should fall through the rear third of the front half of the supportive area, as otherwise it is not possible for the orthosis side to carry the load.

KAFO:
Drop the plumb line across the greater trochanter. The plumb line should fall through the rear third of the front half of the supportive area, as otherwise it is not possible for the orthosis side to carry the load.

Check if a dorsiflexion stop is recommended according to the configuration result.

Explain if and how you performed a visual stance analysis and decide if you can continue checking the orthosis function.

Check if a weight shift from one leg to the other is possible. If that is not the case, you cannot start checking the alignment dynamically, as the patient is not able to walk like this.  

For the following steps, you need to know where to position the body’s centre of gravity. A pressure measuring plate provides an accurate result. If you do not have one, you can assume that the body’s centre of gravity is somewhere below the navel and viewed sagitally in the middle between the abdominal wall and the back. Medical devices can be used in all cases for standing.

Drop a plumb line starting at the body's centre of gravity. 
The plumb line must fall into the area shown in the picture in order for the patient to stand safely. If this is the case, you can continue checking the orthosis function

Check if the patient is able to stand and if the line of gravity falls through the front half of the supportive area. Then, check the angles of the shank to the floor and the shank to the thigh. If the shank-to-floor angle is smaller than 90°, write down which one of the two positions shown in the picture applies.

If the shank-to-floor angle is 90°, write down which one of the two positions shown in the picture applies.

If the shank-to-floor angle is larger than 90°, write down which one of the two positions shown in the picture applies.

Check if the dorsiflexion stop is reached (exception: It has been removed or the orthosis is a KO).

If one or two joints are mounted at knee height, check if the extension stop is reached. If there are two joints, both extension stops must be reached without causing any twisting of the orthosis.

Check if the maximum lever lengths were reached:

• tibial shell at AFO and KAFO: directly below the patella, as far up as possible
• femoral shell at a KAFO: ca. two fingers below the gluteal fold

Check if the functioning muscles have sufficient space for activity. If shells or fasteners are too tight, the muscles cannot extend and reach their full functionality.

Check the fasteners with the patient standing in their individual normal posture. Fasteners should prevent the orthosis from shifting while walking or the shells from hinging down. They also fix possibly necessary covers to shells. Fasteners cannot guarantee an equal load distribution and are therefore not suited to carry the load.

Perform a visual gait analysis and document it. Write down if medical devices were employed. If a gait analysis is not possible, write down the reason and resolve the problem. Then, start checking the orthosis function again from the beginning. For checking the alignment dynamically, always examine several step processes.

Check if the load duration on both legs is the same. If it is not, you will notice a limp, although the step length can still be identical.  

Check if the step length of both legs is the same. If it is not, the step process on one side is often incomplete.

If you note a circumduction of the leg or a lifting on the contralateral side in order to be able to swing freely, a compensatory mechanism is taking place. Write down if one/several is/are existing.

Initial Contact: Foot
Check from the side if and how often the patient touches the floor with the heel first.

Loading Response: Foot
Check if and how often a (passive) plantar flexion occurs.

Mid Stance: Foot
Check if and how often the foot contact is complete.

Mid Stance: Knee
Check if the knee joint is flexed or hyperextended. If it is flexed, write down the angle.

Late Mid Stance: Foot
Check if and how often a dorsiflexion occurs. A dorsiflexion can only take place if no static dorsiflexion stop was mounted.

Late Mid Stance: Knee
Check if the knee joint is flexed or hyperextended. If it is flexed, write down the angle.

Terminal Stance: Foot
Check if and how often the heel lifts significantly from the ground. The heel should also lift significantly from the ground if the patient has height compensations and no ankle joints.  

Initial Swing: Knee
Check if and how often a flexion movement occurs in the knee joint. If there is one, write down the flexion angle.