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a polio survivor who played minor
league baseball while wearing
braces on both legs
and using crutches. A motivational
speaker
worth listening to.
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CONTENTS
January Speaker
My “Adventures”
Medicare
Dental Awareness
Seniors vs. Crime
Dues
Clinical Evaluation – Bracing
Do What I Do – Not What I Say
Special Poem for Senior Citizens
Upcoming Conferences
Welcome
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JANUARY SPEAKER
Our speaker, Dave Clark, is a
unique person who serves as a shining example for others to follow. Dave delivers a feel-good courageous story
that will motivate you to fulfill your potential.
Dave
talks about how he overcame polio as a young child to go on to have a
successful career as a professional baseball player and manager – he has been a
scout for the San Diego Padres since 1999.
Dave
was originally scheduled to be our September speaker but, thanks to the
hurricanes we went through, our September meeting was cancelled.
I heard Dave talk at a Post-Polio Conference last year and found it quite
inspirational…. Well worth your coming
to the meeting.
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MY
ADVENTURES
Well,
I’ve completed two months of physical therapy.
The shoulder is feeling much better but is still not doing what I want
it to. Funny thing is – it never really
did…. It is healing but it's a very slow
process. It's a polio arm in the sense that I've never been able to
straighten out the elbow and also I have no deltoid muscle due to the
polio. Also, they took out some lymph nodes when they did the lumpectomy
on that left breast soooooooooo, all in all - that
"poor" arm has been through the mill. My main problem with it
is lifting or stretching the arm upward. Hopefully, as time goes by, it
will get better but, if not, I've compensated all my life so I'll just do a
little more compensating....
The below website was e-mailed to me
by Carolyn Mareb – it gives you quite a bit of
information on several different polio topics.
Found it interesting – Thanks, Carolyn.
http://www.geocities.com/tvppsg/2.html
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The following was e-mailed to us right after Thanksgiving by PPSG of S
FL.
MEDICARE
Disability Rights Advocates (DRA,http://www.dralegal.org), a nonprofit law center in
were unable to get a power wheelchair or scooter because you:
-needed it for use outside the home,
-were able to walk short distances, or
-had not proven sufficient upper extremity
weakness.
Also contact them if you,
for any of the reasons listed above, had to payout-of-pocket for the wheelchair
or scooter you needed.
They can be reached at:
EMAIL: healthaccess@dralegal.org PHONE:
510-451-8644
FAX: 510-451-8511
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The following articles are reprinted
from the November/December 2004 Elder
Update Senior Dental Awareness Week.
GUM DISEASE –
The Main Cause of Tooth Loss
Gum Diseases –
sometimes called periodontal or gingival diseases – are infections that harm
the gum and bone that hold the teeth in place.
When plaque stays on your teeth for too long it forms tartar. This hard covering cannot be brushed clean
and instead must be cleared away by a dentist.
Untreated
tartar can lead to gingivitis – red, swollen gums that bleed easily – which in
turn can lead to the gums pulling away from the teeth and forming pockets that
become infected – a condition called periodontitis.
If
not treated – or for that matter, prevented – this infection can ruin the
bones, gums and tissue that support your teeth.
In time, this can cause teeth to loosen requiring your dentist to remove
them.
As
with most dental health problems, the best way to prevent gum disease is to
brush your teeth at least twice a day with fluoride toothpaste, floss once a
day and make regular visits to your dentist for checkup and cleanings.
******************
ATTACK THE PLAQUE
To Help Prevent Decay
As we age, our gums
tend to recede and in doing so, expose more of the tooth and root surface to
plaque. Plaque – the waxy build-up that
coats and collects between our teeth and gums – is the main cause of tooth
decay. If the plaque is not cleaned away
it begins to harden into a stone-like covering called tartar. It is this hard coating which dental
hygienists scrape away from teeth in an effort to save them from the damaging
effects of tartar.
The
build-up of tartar can be avoided, to do so dentists recommend the following:
·
Brush
your teeth at least twice a day;
·
Use
a soft brush and brush the teeth on all sides with small round motions and short
back and forth strokes;
·
Take
time to brush carefully and gently along the gum line;
·
Remember
to brush away the bacteria that may be hiding on your tongue;
·
Clean
between your teeth with dental floss to remove plaque where toothbrushes cannot
reach;
·
Use
mouthwash to kill the bacteria that causes plaque; and
·
If
brushing or flossing causes your gums to bleed or hurt, see your dentist.
******************
DRY MOUTH
Can Lead to Serious
Health Problems
A
dry mouth is not an abnormal if it occurs once in a while – if a person is
nervous, upset or under stress – but when it occurs on a regular basis it can
become a serious health concern. Dry
mouth is the condition of not having enough saliva to keep
your mouth wet, symptoms include:
·
A
sticky, dry feeling in the mouth;
·
Trouble
chewing, swallowing, tasting or speaking;
·
A
burning feeling in the mouth;
·
Cracked
lips;
·
A
dry, tough tongue;
·
Mouth
sores; and/or
·
An
infection of the mouth.
Dry mouth – which can be caused by disease,
radiation therapy, chemotherapy and other factors – can lead to several health
problems, including the following:
·
Dry
mouth can cause difficulties chewing, swallowing and speaking;
·
Can
increase your chance of developing dental decay and other infections in the
mouth; and
·
Can
be a sign of certain diseases and conditions.
Although dry mouth can
lead to health problems, there are things that can be done to prevent it, such
as sipping water or sugarless drinks, chewing sugarless gums or in serious cases,
prescribed medications.
For individuals
experiencing chronic dry mouth it is extremely important to remember to keep
your teeth clean by brushing – using toothpaste with fluoride – and flossing
every day, as well as avoiding sticky, sugary foods.
******************
ORAL CANCER:
Early Detection Can
Prove Lifesaving
Though
perhaps not as well known as other types of cancer, oral cancer is a fatal
disease. Currently, only half of all
patients diagnosed with oral cancer survive more than five years. However, there are things you can do to
detect oral cancer early enough to give you and your dentist the opportunity to
fight and win the battle.
What You Should Know About Oral Cancer
·
Oral
cancer often starts as a tiny, unnoticed white or red spot anywhere in the
mouth. Other signs of oral cancer
include:
·
Oral
cancer occurs mot often in those who use tobacco in
any form. Alcohol use in combination
with smoking greatly increases the risk.
·
Still,
more than 25 percent of oral cancers occur in people who do not smoke and have
no other risk factors.
Regular Checkups Are Important
·
Regular
dental checkups, including examination of the entire mouth, are essential in
the early detection of cancerous and pre-cancerous conditions. You may have a very small, but dangerous,
oral spot or sore and not be aware of it.
What to Expect During Your Oral Exam
·
Your
dentist will carefully examine all areas of your mouth. In the event that your dentist finds a spot
or sore that may pose a threat, he may opt to perform a simple test such as a
brush biopsy, which is typically painless and can detect potentially dangerous
cells when the disease is still at an early stage.
·
Be
sure to let your dentist know about any sores or spots that you have
noticed. Harmful spots or sores often
look identical to harmless spots or sores.
Know the Early Signs of Oral Cancer
The
symptoms below could be the beginning of oral cancer. Please contact your dentist if you notice:
▪ A sore
that bleeds easily or does not heal.
▪ A color change of the oral tissues;
▪ A lump, thickening, rough spot,
crust or small eroded area; or
▪ Pain, tenderness or numbness
anywhere in the mouth or on the lips.
For more information, please visit the Department of Health Public
Dental Health on the Web at http://www.doh.state.fl.us/family/dental/index.html
.
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Reprinted from
November/December 2004 Elder Update newsletter.
SENIORS vs. CRIME:
Beware of Identity Theft
Submitted by a Senior Sleuth Volunteer
Identity
theft is a serious behind-the-scenes threat with no phone call to hang up on
and no door to close in order to dissipate the risk. The perpetrators of this crime are nearly
invisible, leaving elders powerless to stop them. In fact, the best way to prevent yourself from becoming a victim of identity theft is to take
careful precautions beforehand.
Begin
these precautions by realizing that one’s identity can be easily plucked from
their trashcan. Be sure that what you
are discarding is actually trash. Trash
should only contain material of personal nature if it has been properly
shredded. It should never contain
anything containing credit card or social security numbers, actual credit cards
no longer in use, communications of a personal nature or any pertinent
information provided to you by your bank.
Also,
be careful not to throw away pre-approved credit card applications, credit card
receipts or any other financial or biographical information without shredding
it first. As silly as it seems, always
think twice before throwing something away.
Today’s prospectors don’t dig through in the dirt searching for gold,
but through trashcans for treasure on paper instead.
Postal
inspectors claim that it can be a virtual nightmare to undo the harm caused by
an identity thief. A postal inspector
offered these suggestions.
·
Remove
mail from your mailbox as soon as possible.
If you are going to be away from your home, put your mail on hold at the
post office or have a neighbor pick it up for you.
·
Do
not mail sensitive information from your mailbox. A red flag signals not only the mail carrier
that there is mail for pickup, but also identity thieves.
·
Do
not give out personal information over the phone unless you initiated the
contact.
·
Review
your account statements monthly and close any accounts that are not in
use. Do not assume that just because you
have not used a credit card in years that your account is closed, you must make
this request by contacting the issuer directly.
·
Order
a copy of your credit report at least once a year.
If you have been, or
should become in the future, a victim of identity theft, please follow the
steps listed:
·
Report
the crime to the local police or sheriff’s department.
·
Contact
the three major credit reporting services – Equifax, Experian
and Trans Union – and ask that a fraud-alert be placed on your account.
·
File
a complaint with the Federal Trade Commission (FTC) by calling their Identity
Theft Hotline at 1-877-438-4338.
·
Call
the Attorney General’s Fraud Hotline at 1-866-9-NO-SCAM (1-866-966-7226).
·
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DUES FOR 2005:- Please take a look at your
mailing label - on it you’ll see the month and year we received
your 2004 dues, i.e., 01/2004 means it was received in January 2004, so your
2005 dues was due in January 2005. If your mailing label has the year first and
then the month, i.e., 2004/01 it means that you indicated to us in January 2004
that you wanted to receive the newsletter but paid no dues. That’s OK as we still believe that anyone who
wants information should receive it – but we do need you to return the tear
sheet with either the “Dues” box checked or the “Keep me on the Mailing List”
box checked.
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The following article is reprinted
from the San Francisco Bay Area Polio Survivors Newsletter, Volume 15, Issue 2,
October 2004. Would like to thank Phyllis Hartke, once
more, for e-mailing the article over to me so as to save from retyping it. THANKS, PHYLLIS – you are a lifesaver…..
POST-POLIO SYNDROME
CLINICAL EVALUATION
Part 2 of
The Proper Evaluation, Treatment, and
Management of PPS [“Bracing” and other issues]
By
Carol Vandenakker,
MD
Director, University of
and
Howard Davis & Brian DeMain,
Orthotists, Hanger
Orthotics, Pinole, CA
Presentation at SFBAPS
Transcribed by Phyllis Hartke, SFBAPS
President and approved by Dr. Carol Vandenakker.
(Part 1 was printed in SFBAPS’ September 2004 Newsletter)
(Part 2 is printed in this SFBAPS October 2004 Newsletter)
CAROL: When I gave the first half of this
presentation in May, I showed you briefly how I do the basic muscle testing and
physical examination. We didn’t go specifically through all the muscle testing
because it’s a personal thing to do a physical exam in front of an
audience. So, what I thought was more
appropriate today would be to get into what sort of things I look at as far as
the biomechanical changes from polio that are commonly seen in polio
survivors; things that might require bracing or changes in bracing or systems
devices. This is why we have two orthotists here today, Howard Davis and Brian DeMain, so we can talk about some of those issues in
bracing and also so you know a little bit about the subject if someone tells
you “I think you need a brace”. Perhaps
you might be thinking maybe a brace will help you or that you need a change in
a brace. We’re going to discuss some of the principles behind bracing. Why
bracing might or might not be necessary. What you can expect from bracing. Take
a look at the handout on bracing (included in this SFBAPS newsletter, pg 3).
The
exercise guidelines (this
SFBAPS newsletter, pg 3) are part of the other recommendations I make at a
patient’s initial assessment. I usually
talk to patients about what sort of exercise program they are doing and make
suggestions in that area. Exercise is a
very individual thing so I’ve got guidelines spelled out in the handout but to
really be able to make recommendations on an individual basis I would have to
see you specifically. The handout on
exercise is a guideline so when you are working with a PT or someone helping
you set up an exercise program the handout might be a useful sheet to show them
as far as principles in polio.
The
complete physical assessment is an important part of bracing. Obviously we need
to know not just the status of the limb we are thinking of bracing, say if you
have a foot-drop or something like that, but also the status of the other limb;
things that might affect the area that could and couldn’t be braced, whether or
not you could use a systems device, etc. Sometimes the ideal thing is for
somebody to use a cane or a crutch but they don’t have the strength in the arm
to do it so we have to come up with alternate ways of adapting or modifying
body mechanics. When we look at bracing
we really want to use it to manage a specific problem. So whether it is a
painful joint, a joint that is becoming deformed, a muscle that’s being
overused, falls that are occurring, or instability, we’re trying to correct
something specific with the bracing that is going to help you functionally,
pain-wise, or something to that affect. So, there is a specific goal with the
treatment. What we are then going to
judge after you get the brace and are using it, is “is
that goal met?” or do we need to make modifications.
If you
have a joint where there is muscle power around that joint and you can move
that joint we try to continue to allow some movement there and not lock it
up. In some other medical problems, say
like a spinal cord injury where there is not any muscle strength and people
aren’t aware of where there limbs are, you have to do a lot more locking of
joints just for stability. In polios
that’s a different story. You have full sensation. You know where those joints
are. You can be allowed a lot more freedom of movement and remain very stable.
So we’re trying not to make you really stiff in that robot-man kind of gait if
we don’t have to.
Obviously
we want to keep the brace as light as possible. Usually there is some degree of
proximal weakness as well. Adding a
brace always adds some amount of weight to a weak limb so we want to keep that
weight minimal. We want to insure that you are safe and independent in mobility
as long as possible and that’s probably one of the main goals of bracing.
I know
for a lot of patients, psychologically, going into a brace is often a big step,
often viewed as a huge step backwards. You know, you fought to get out of
braces when you were young and having to accept that you may need a brace again
when you are older can be very difficult. But if it means you can walk safely
and continue to be independent another 10, 15, 20 years rather than fall and
break a hip and be stuck in a wheelchair, then it’s
well worth it. And everybody has to come
to terms with this themselves. Early on, when we were
first learning about PPS I met a lot more polio survivors that were very
resistant when you mentioned bracing and “no, no, no way will I ever do
that.” Nowadays, because you are all
better educated on PPS, I think most polios’ know they
might need bracing at some point and by the time I see them, they have come to
terms with the idea of wearing a brace again.
There
is a list of things I need to cover in the physical exam when I’m looking at a
patient and thinking about a brace prescription for them. How much does the person weigh? How active is
the patient? How much are they going to be using it, stressing this brace’s
materials, what type of brace are we going to use? How
strong are the other extremities? Are they able to use assistive devices? I
talked about upper extremity strength.
Will they be able to put on or take off this brace?
If you
get someone a brace that they can’t put on by themselves and they’re living
alone, it doesn’t do them much good.
Whether or not they have swelling in their legs so that the leg changes
sizes through the course of the day, that’s going to impact what type of brace
we use. Whether there is any sensory
loss. Now with polio you don’t lose sensation but if someone also has diabetes
or has had a stroke or some other medical problem where there is sensory loss
then we’ve got to take that into account as well. Are there skin problems where
we have risk of skin breakdown? And then what is their home or work environment,
as far as what kind of surfaces are they walking on, where are they going to be
using this brace?
The orthotist I am going to refer you to, (if I have any
control over that, and that’s not always the case because of insurance
companies nowadays), I want to make sure these guys really know their stuff.
And sometimes I don’t know the orthotist; sometimes
we just take what we get. If I am sending a patient somewhere that I don’t know
the orthotist, I’ll write my pager number on the
prescription and say please page me if there is any question about the
prescription. Because if the orthotist looks at the
prescription and doesn’t agree with me, I’d rather he page me and talk it over
with me on the phone than make it his way and then we figure out, “Oh! Maybe
that wasn’t right”, or make it my way and I was wrong. I’d rather have that discussion beforehand
than try to change a brace later. That’s a lot more difficult, a lot more
work. So communication between the
physician and the orthotist is very important.
Certainly
you want to have a Board Certified orthotist. Here in CA I have not had a problem with
non-certified orthotists. I saw a lot more of that in
FL. I saw braces made in peoples’
garages. That was interesting. I find
that orthotists that have years of experience tend to do better with polio patients. Polio patients in
general tend to be more difficult to brace.
Not that you are difficult people. You demand more from your brace
because you are more active than most patients who would need to wear a brace.
You use it more aggressively. And because you have sensation in your limbs, if
anything is a little off, you feel it. Most people with other medical diagnosis
who have to be braced don’t have any sensation there.
So
those two components kind of make you more difficult to fit, a more exacting
brace client for the orthotist. So we want an orthotist with patience and the kind of personality where
they are willing to assist you, talk to you and discuss things; they need to be
able to listen, talk back and forth, decide will this or will this not work,
and not just go by the book “Oh no. That’s not the way we learned. It has to be
this way.”
That’s
what I look for in an orthotist that does well with a
polio patient – one that tends to be a little more creative and think outside
the box. One with a lot of patience and
who’s willing to do modifications because any time you do a brace there is
always a little tweaking that needs to be done to make it that perfect fit and
be really functional for you. The reason
we go through all of this is to improve your function and if it’s not
comfortable and it doesn’t fit right, you’re not going to use it so we haven’t
gained a thing and spent a lot of good insurance money and our tax dollars,
etc. I also tell patients you are not to
pay for the brace until it fits right and you can use it.
Sometimes
patients were given a brace, it didn’t fit right, and they couldn’t even walk
in it. If they took it home, the orthotist would bill Medicare and then sometimes they
couldn’t get adjustments made. Then
they’d come to me with the brace “made totally wrong” and you can’t get a new
one until a year later because Medicare won’t pay for another one. So be aware that, if you take the brace home
and say that you are going to try to use it, you may well be stuck with it.
HOWARD – You
do have some rights. You basically have three months of warranty through
Medicare to go back. If you have problems with it, go back and see your orthotist.
CAROL –
Don’t be afraid to be pushy and aggressive.
There are patients who just give up. I try to get people back in to see
me shortly after they get their fitted brace.
Some are afraid to go back to the orthotist
for adjustments, feeling they are being too much of a bother. But you know
what? The orthotist wants to get it right too. And
it’s part of the process. It’s a custom made thing, fitted to you and
adjustments are just part of the process.
Let’s
start with distal problems.
The
simplest thing you would use an orthotic for is foot
deformity, by placing an orthotic in the shoe. That would be due to muscle imbalance in the
foot or in the lower leg only that would affect primarily maybe a little bit of
the ankle position, a little bit of the foot position in the shoe, but could be
corrected by modification with support inside the shoe to balance the
foot. An example is a real simple arch
support to keep a foot from proning/turning this way
where there is a weakness of the muscle that pulls the foot in. And typically
if you have a foot that turns/falls in a lot, you start to get a lot of
pressure on the first metatarsal and you might get deformity of the first
toe.
HOWARD –
Putting too much pressure on the middle part of your foot, the bone in the
middle, which is called the “meticular”, is very
painful, because it’s not intended for weight bearing. Then the foot tends to
abduct which means move away from the midline in the forefoot which can cause
many problems in shoes as well, by putting too much pressure on the outside of
your foot. They all go together.
Shoe – buy a
shoe that has extra depth to accommodate the foot and the orthotic. High top gives more control and support at
the ankle. Here the polio involvement
has a lot more collapse at the ankle, you can see the base of the foot is
affected and so the weight bearing surface is not the normal shape anymore and
so she has to have a custom-made orthotic so it’s
cushioned in the right places, supported in the right places, so there’s not a
lot of pain with every step. She can’t
walk barefoot. When she was young she could.
When you’re young you can get away with it. As you get older you wear down those fat pads
at the bottom of your feet and the ligaments stretch and you’re walking on bony
prominences and that’s when you can’t stand it anymore because it hurts too
much. Like Howard said, here small
bones in the foot have shifted position, putting all your weight on the bony
prominence there. You just can’t walk that way.
HOWARD
– If you look at this shoe, which is manufactured by Drew, notice how it
is wider over the middle part of the foot. This is a pronator
type shoe. It gives you extra support in that area so instead of rocking over
the inside of the shoe and risking injury to the ankle it stabilizes it.
CAROL –
Most insurance companies, including Medicare, won’t cover just shoe inserts.
HOWARD – Not
unless you have diabetes. There are some that do, if it’s a private
insurer. This orthotic
was covered by Medicare and Tri-care.
An AFO, or ankle-foot-orthosis is
used to control and stabilize the ankle because of instability at the ankle and
too much medial-lateral movement. There
are different types of AFOs. There are very short AFOs
that come up just over the ankle bones. They are mostly for stability,
medial-lateral stability at the ankle. You can almost accomplish the same type
thing with a good high top shoe. They’re not well tolerated in general by
adults.
Much
more common is the AFO that comes up along the back of the calf. This is
commonly used for a foot drop, where the strength of the ankle dorsiflexors, the muscles that take the foot up, is either
gone or weak. Classically in normal gait your foot just flops down; when you lift
your leg and go forward the foot doesn’t come up so you have to compensate by
lifting the leg real high, which is called the steppage
gait. If you are a polio survivor and
don’t have a strong hip flexor you may not be able to do that. So then there’s
other means of compensating.
The
main foot ankle dorsiflexor is the tibiallis anterial muscle, the
big muscle at the front of your shin.
Interestingly enough, polio affects that muscle very commonly but often
spares the toe extensors. A lot of
people pick that foot up using the toe extensors, so the toes come up every
time they pick their foot up. This will work for a while but then the toe
extensors get tired because it’s a much smaller muscle. So after a while when
you get tired, that foot starts dragging and then you start catching the toe
and that’s when you fall. You also might find that walking barefoot is a whole
lot easier because the shoe doesn’t interfere with being able to pick the toes
up real efficiently.
The foot
drop is effectively improved with use of an AFO that is designed to give you
assistance with the dorsiflexion. Now there’s a simple bracing type, a PLS
splint which is just a lightweight plastic piece that’s kind of flexible and
gives a little dorsiflexion assistance. You can kind
of push it down with your foot. I’m showing the one Phyllis Hartke
wears as an example of one of those.
If you
have a pretty strong plantar flexion and some dorsal flexion, you probably want
a hinged AFO. With the hinged joint you
can spring load it to help with the dorsal flexion. I’m showing the one Stella Cade wears as an example.
If
there is more than just the foot drop involved, the AFO can be fit more around
the ankle to add medial lateral stability as well. So if the problem at the
ankle is not just the foot dropping but turning in to the side, collapsing
inward, we’re going to make it more molded around the ankle, covering more of
the foot and adding more support, control more of the plantar movement.
HOWARD –
That would be more of a reason to go with an articulated AFO vs. a posterior
leaf spring AFO.
CAROL- the
posterior leaf spring AFO will only add a little bit of dorsiflex
assist. It won’t control anything.
HOWARD
– The trim lines end up way more in the back of the leg as opposed to
wrapping around the leg. Phyllis has a PLF and Stella has the articulated
AFO. The PLF is cut way back. It’s very
easy to fit into shoes. It’s a thinner, smaller brace. If all you need is a little help with the dorsiflexion, it’s an easy light brace to use. It has
flexibility in both wings. It does move both ways. It’s more natural. This particular brace could be flatter, but
it’s molded to have more foot control and medial lateral stability. The nice thing about the PLS vs the articulating AFO is you get what is called a
kinesthetic minder and ground reaction force from just the stiffness of the
plastic. So it will still pick up your
toes but it also will create a little bit of an extension force at the knee. If
you have a tendency for the knee to buckle forward it helps with that as well
but very minimal as opposed to some of the other ones.
ARTICULATED
AFO – This type comes more forward
around the foot as well as the ankle and so you get more sideways stability.
This particular one will allow you to dorsiflex so
you can roll over the foot but it stops so it doesn’t let her foot drop. The
thing about an articulated AFO such as this is that there is absolutely no
additional support to the knee as far as it bending forward and a lot of you
have that problem.
I’m
showing examples of bad braces an orthotist has made
for Stella in the past – basically put her in a cast, so to walk there’s no
motion at the ankle here. Sometimes you have to do that if you have a really
unstable ankle, which she doesn’t. In general because it affects the natural
movement too much, it’s not a good idea.
Also, depending on the angle the ankle is set at, if someone depends on
a little bit of recurvatum to stabilize the knee, the
quadricep is weak, and then they’re given an AFO that
does not allow them to go back a little bit, it will collapse the knee with
every step. They’ve put on the AFO and can’t walk in it; the leg gives out with
every step. Someone did not really look
at them walk and know that they need to have that AFO in a little bit of
plantar flexion so that the tibia is allowed to go back and the knee go back
and we can walk and put weight-bearing on that leg.
HOWARD – Even if you have a brace such as this, which is locked up, you need to be aware of the heel height of the shoe. If you put on a shoe with a little higher heel, that’s going to throw your knee into flexion and make your knee buckle, or if you’re out walking on the sidewalk and you accidentally hit a crack that’s raised, your knee is going to buckle. If you don’t have a strong quad, it’s very hard to walk in an AFO that’s solid. An example of a shoe that’s good for an AFO is a Rockport. It comes with an insole you can remove to give it more depth, it has a nice wide toe box (like tennis shoe, often good), and a nice