Vibhor Agrawal – AFO (Ankle-Foot Orthosis) Management: Optimizing Functional Gait Biomechanics & Outcomes

Outline

FUNCTIONAL GAIT BIOMECHANICS

• Current gait terminology
• Open-chain vs. closed-chain muscle function
• Four foot rockers
• Ankle joint and muscle function during gait
• Gravitational and ground reaction forces at the foot, ankle, and knee

AFO USE IN VARIOUS PATHOLOGIES
Review of the most current scientific literature of the following pathologies:

• Stroke
• Sensory perception loss
• Cerebral palsy
• Charcot-Marie-Tooth disease
• Other neuromuscular conditions

OUTCOME MEASURES

• Review of the existing outcome measures
  • 6MWT
  • 10 meter walk test
  • Functional Independence Measure
• Scandinavian Stroke Scale
• Minimal detectable change with AFO
• Minimal clinically important difference in these measures

ABCs OF AFOs

• Review of the different types of AFOs
  • Solid-ankle AFOs
  • Articulated AFOs
• Biomechanical influences of AFOs on a patient’s gait
• The impact of AFOs on joint and muscle function
• Indications and contraindications of each type of AFO
• Differentiating between over-the-shelf and customfabricated AFOs

AFO CASE STUDIES

• STROKE
• CP
• MS
• Selecting the appropriate AFO

AFO MANAGEMENT

• Patient evaluation
• Taking appropriate measurements
• Ensuring a good fit
• Do’s and Don’ts of AFO fitting
• Signs and Symptoms of incorrect fit
• Providing instructions at delivery
• When to refer the patient to a specialist
• Follow-up
  • Biomechanical evaluation at subsequent visits
  • Knowing when to change the AFO treatment plan

BILLING AND DOCUMENTATION

• CPT codes for billing for time and expertise
• L-codes for reimbursement for the AFO
• Documentation requirements
• Maximizing revenue with AFOs