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

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Over the past several years, ankle foot orthoses (AFOs) have evolved in form, function, and complexity. They are no longer simple plastic devices that are beneficial only during the swing phase of gait. The newer designs incorporate the biomechanical principles of closed-kinetic chain to enhance joint and muscle function for improved gait and mobility.

Recent scientific evidence has demonstrated the advantages of AFOs for improving functional outcomes in patients with stroke, cerebral palsy, multiple sclerosis, and more. As therapists are constantly looking for ways to maximize patient function and increase revenue, it is critical to keep up with the recent developments in the field for optimizing outcomes. 

This course will provide effective strategies for clinical management of AFOs. You will delve into the biomechanics of closed-chain gait, and to understand its effect on joint motion and muscle function. You will learn how to integrate gait biomechanics with muscle function and AFO design to enhance outcomes in adult and pediatric patients. Explore the different types of AFOs and become well-versed on the most recent evidence covering intervention strategies and clinical management of AFOs.

Discuss the appropriate outcome measures to detect clinically meaningful differences in patients following an intervention. Learn the tips for billing and documentation to maximize returns. The information obtained in this course can be easily implemented in the clinic immediately for enhanced outcomes.

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1. Articulate biomechanics of closed-chain functional gait, in terms of ground reaction forces and muscle function at the foot, ankle, knee, and hip.
2. Integrate recent research in functional gait biomechanics and outcomes for effective AFO rehabilitation strategies.
3. Analyze the changes in gait biomechanics with pathologies, and the impact of AFOs on biomechanics and muscle function.
4. Evaluate appropriate AFOs for optimizing patients’ gait and function in a variety of pathological conditions.
5. Assess strategies for effective evaluation, measurement, fitting, and delivery of AFOs, as well as follow up procedures.
6. Anticipate the billing codes and documentation requirements for providing AFOs and related services. 

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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

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