Course Description
Research indicated that for the treatment of stroke in inpatient rehab “The largest percentage of time in physical therapy sessions was spent on gait activities.” (Jette, et al., Physical Therapy, 2005; 85(3): 238-248, p. 241) In this study, gait training was the most frequently addressed activity at 31.3% during physical therapy sessions and equipment used most often during gait activities were the four wheeled rolling walker at 22.9%, ankle foot orthosis (AFO) at 17.0%, and straight cane at 20.2%. Research also indicated that traditional AFOs block forward progression of the body (Lima, Journal of Prosthetics & Orthotics, 1990; 2(1), p. 33-39). If the goal of physical therapy is to facilitate efficient and effective functional mobility during gait, then the therapist should be able to articulate to the physican and orthotist the best AFO intervention based on impairment level.
The purpose of this course is to teach the therapists what and how to assess the lower extremity for AFO intervention. Two different clinical case studies which are the low tone floppy foot and a foot in equinovarus (plantarflexed and inversion) will be presented. A review of lower extremity anatomy and kinesiology as it particularly relates to the leg and ankle will be reviewed and the implications for gait impairment. Therapists will learn how to differentiate between spasticity and tone as well as the indication for R1 versus R2 values for range of motion at the ankle joint. Examples of compensatory strategies at the midfoot, forefoot, knee, and hip will be discussed when the heelcord or other musculotendinous structures and neuromuscular manifestations impede lower extremity mobility. In addition to specific physical therapy techniques, serial casting, botox injections, and tendon releases will be discussed as treatment options.
Course Level (As defined by the APTA): Intermediate – Assumes that participants have a general familiarity with topic (gait). The focus is on increased understanding and use of AFOs to alleviate antalgic gait patterns.
Participants
Physical Therapists and Physical Therapist Assistants; Occupational Therapists & Certified Occupational Therapist Assistants
Course Objectives
After completing this course, the participant will be able to:
- Articulate specific reasons why and how a traditional AFO decreases cadence.
- Analyze and describe compensatory strategies seen with ankle and foot immobility during hemiplegic gait.
- Develop strategies to alleviate or reduce antalgic gait patterns associated with AFO wear.
- Justify appropriate evaluation measures to assess tone versus spasticity.
- Demonstrate appropriate technique to thoroughly measure R1 and R2 values for ankle range of motion.
Continuing Education Units
A certificate of attendance will be issued denoting eight (8) contact (clock) hours or .8 CEUs of continuing education competence. The contact hours or CEUs will vary in each state according to licensure boards, state associations, or sponsoring entities.
| Day One |
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8:00 am - 8:15 am |
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Introductions & Pre-test |
8:15 am - 9:00 am |
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Lower Extremity Anatomy Review |
9:00 am - 9:45 am |
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Kinesiology: Open Versus Close Chain and Muscle Activity |
9:45 am - 10:15 am |
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Dynamic AFOs |
10:15 am - 10:30 am |
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Break |
10:30 am - 11:15 am |
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Compensatory Gait Patterns as a Result of Limited Ankle & Foot Mobility |
11:15 am - 12:00 noon |
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Lower Extremity Evaluation: Sensation, Motor, ROM, Pathological Reflexes |
12:00 noon - 1:00 pm |
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Lunch on your own |
1:00 pm - 1:30 pm |
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Spastcity versus Tone: Definitions & Objective Measurements |
1:30 pm - 2:00 pm |
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Low Tone Foot |
2:00 pm - 2:30 pm |
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Equinovarus (Plantarflexed and Inverted Foot) |
2:30 pm - 2:45 pm |
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Break |
2:45 pm - 3:45 pm |
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Treatment Interventions |
3:45 pm - 4:30 pm |
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Lab Demonstrations |
4:30 pm - 4:45 pm |
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Serial Casting |
4:45 pm - 5:00 pm |
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Botox Injections |
5:00 pm - 5:15 pm |
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Tendon Releases |
5:15 pm - 5:30 pm |
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Questions & Answers; Post-test
Course Evaluation; Door Prize |
Recommended Items
Non-toxic markers
Goniometer
Reflex hammer
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