ORTHOTIC ANKLE JOINTS.pptx

In this presentation, I have added evidence based practice ankle joints which are frequently used in orthotic treatment. Hope it reaches to every person out there seeking information regarding the same.

1. ORTHOTIC ANKLE JOINTS - RUSHIKESH RAJGUDE MPO, BATCH(2023-24) DSMNRU Lucknow-226017

2. WHAT IS AN ORTHOTIC ANKLE JOINT ? It is a mechanical articulation that is incorporated into a solid AFO, KAFO and HKAFO design. It enables a specific range of motion to be achieved, mimicking the movement of the anatomical ankle.

3. TYPES

4. A) Free motion Provides M-L stability that allows free motion in dorsiflexion and plantarflexion. Indications: Mild mediolateral instability Flexible Varus/Valgus position and foot drop

5. B) Solid It restricts movement in both planes. Indication: Tibial \ foot fractures. Severe stroke (early intervention post stroke) Weight reliving orthosis (PTB-AFO)

6. C) Limited motion Allows motion to be restricted in one or both the directions Popular examples are Bi- caal ankle joint, Camber axis ankle joint.

7. 1. Bichannel adjustable ankle lock (BICAAL): An ankle joint with the anterior and posterior channels that can be fitted with pins to reduce motion or springs to assist motion. Indication: . Excessive plantar flexion deformity S pasticity or ankle instability in a flail limb .

8. CONTD: R od/pin in anterior channel limits DF ROM R od/pin in posterior channel limits PF ROM.

9. Kinematic Comparison of the Bi- Caal Orthosis and the Rigid Polypropylene Orthosis in Stroke Patients. AIM AND OBJECTIVE To find a Kinematic Comparison of the Bi- Caal Orthosis and the Rigid Polypropylene Orthosis in Stroke Patients. METHEDOLOGY Patients already fitted and accustomed to a Bi- Caal AFO were fitted with a rigid ankle polypropylene AFO. DATA COLLECTION Kinematic gait analysis .

10. Results: *The only statistical difference (Pt.05) in ankle posture between the two AFO's existed at toe-off. *Ambulation in the rigid ankle polypropylene AFO yielded an average of 4± 5 degrees of plantar flexion, while in the BiCAAL orthosis the average was 1± 5 degrees of dorsiflexion.

11. Conclusion of the study: The rigid polypropylene AFO provided the same ankle stability as the Bi- Caal AFO and had similar gait characteristics in terms of velocity , cadence , and stride length . The majority of stroke patients in this study preferred the rigid polypropylene AFO due to its light weight, cosmesis , and ability to interchange shoes.

12. 2. Anterior stop (DF stop) ankle joint It determines the limit of ankle dorsiflexion. Mechanism : If the stop is set to allow slight dorsiflexion (~5 dorsiflexion), it results in knee flexion. Indications: Weak plantar flexion. Calcaneal deformity - flexible or stretchable.

13. 3. Tamarack ankle joint It determines the limits of ankle plantar flexion. Made of plastic thus it is light in weight. Mechanism : In an AFO if the stop is set to allow slight plantar flexion (~5degrees), it results in knee extension. Indication : Foot drop deformity. Equinus deformity (Flexible). Spasticity of plantarflexion. *Can be used to control for an unstable knee that buckles.

14. A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy AIM AND OBJECTIVE To compare the GAIT analysis between solid and hinged ankle foot orthoses. METHEDOLOGY Six females and six males with an average age of 7.5 years with spastic diplegic CP were recruited to participate in the study from the outpatient clinic at Shriners Hospital for Children in San Francisco, CA. DATA COLLECTION Descriptive statistics including group means and standard deviations for the subjects were calculated for the test periods with solid and hinged AFOs. GAIT of individual patient was tested under Vicon motion capture settings.

15. Results:

16. Conclusion: Hinged AFOs further improved ankle dorsiflexion and ankle power generation compared to solid AFOs. No significant differences were observed in other aspects such as muscle timing, knee and ankle motions, and peak powers during stance. Both types of AFOs effectively reduced excessive ankle plantar flexion without affecting knee position in children with spastic diplegic CP. Data availability is limited as there were only 12 patients were taken into consideration.

17. 4. TRIPLE ACTION ANKLE JOINT This Joint is designed to provide highly adjustable active ankle control of the lower extremity during all phases of the gait cycle. INDICATION: S troke, Mu ltiple sclerosis, cerebral palsy. Ankle alignment, plantarflexion / dorsiflexion spring stiffness. Mechanism: R ange of motion are independently adjustable to help simplify optimization.

18. The effects of an articulated ankle-foot orthosis with resistance-adjustable joints on lower limb joint kinematics and kinetics during gait in individuals post-stroke. AIM & OBJECTIVE : To determine whether the triple action ankle joint is beneficial in post stroke cases. METHADOLOGY: Gait analysis was performed on 10 individuals with stroke. DATA COLLECTION: 8 resistance settings were used (4 plantarflexion and 4 dorsiflexion). Vicon motion capture system and a Bertec split-belt instrumented treadmill.

19. RESULTS: The study found significant main effects on the peak ankle and knee flexor angles at initial contact and peak ankle positive power in stance were observed with adjustments of resistance. The resistance generated from an AFO is key mechanical characteristics that can influence kinetics of lower-limb joints during walking .

20. CONCLUSION: Triple Action joints allow for independent adjustment of plantarflexion and dorsiflexion resistance. Adjustments in resistance had significant effects on ankle and knee angles at initial contact and peak ankle positive power in stance. Resistance generated from an AFO is a key mechanical characteristic that can influence lower limb joints during walking. Customary practice in orthotics relies heavily on clinician experience and clinical intuition to specify and adjust orthotic design to the specific needs of the patient. Further work is necessary to investigate the long-term effects of AFO on gait.

21. 5. OKLAHOMA ANKLE JOINT It provides articulation at the ankle and free motion in sagittal plane by assisting dorsiflexor muscles. Made of plastic therefore it is light in weight as compared to other heavy joints. Patient acceptance is high. INDICATIONS: Foot drop. Cerebral palsy. Stroke.

22. 6. CAMBER AXIS ANKLE JOINT CAM’s ensure variable locking positions in this joint. It provides limited amount of Range of motion. The components are interchangeable. A durable stainless steel joint that eliminates the need for posterior stops.

23. Gillette Dorsiflexion Assist Ankle Joints This system provides a full range of options for thermoplastic orthoses. The Flexible Ankle Joints are available in four different sizes: infant, pediatric, child and adult. These joints are designed for applications that require maximum functional stretch.

24. 8. SPRING ASSISTANCE (KLENZAK HOUSING) JOINT This joint has a coil spring in the posterior channel of the stirrup to counteract plantar flexion and aid dorsiflexion during the swing phase. It is indicated when muscle function allows a normal range of plantar and dorsiflexion, but dorsiflexor muscles are inadequate. Spring

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