[tri-med] Re: AFOs

----- Original Message ----- 
From: "Katy Roberts"
> Can I ask what an AFO is?

Katy,
AFO is an acronym that stands for Ankle Foot Orthosis - its a type of 
orthotic or splint that goes from below the knee joint around the back of 
the calf, the back of the anke and holds the foot. They can be used for all 
sorts of reasons. They used to be called leg braces back in the dinosaur age 
(ie when I was little :-)) Calipers is another term though they tend to 
refer to the metal rods that attach to shoes. (used much less often these 
days, but still used on occasion.)

AFO is actually a general term, Alex's AFO are actually dynamic tamaric 
joint AFO's (which simple means that the ankle part is hinged rather than 
static and tamarac describes the specific type of hinge used) They are very 
different from most of the kids on the list but they are still called AFO's. 
Alex has them because he has tight hamstrings and his ankles roll when he 
walks. Additionally Alex has very funky toes which throw his balance off 
(the big toe and the next are normal size but the remaining three are teeny 
toes) The AFO simply keeps things aligned better and give him better 
balance. Because he walks (and runs) he needs the dynamic ankle joint, but 
its a weak point for a very active kid and we usually end up getting the 
joint repaired often!!

Most orthotics have an acronym eg MAFO = Moulded Ankle Foot Orthoses, which 
is actually what most of our kids have.
WHO = Wrist Hand Orthoses
HKFO = Hip, Knee, Foot Orthoses
SMAFO = Supramalleolar Ankle Foot Orthoses
GRAFO = Ground Reaction Ankle Foot Orthoses and the list goes on and on.

Sometimes they dont have an acronym - eg Alex also uses a spica thumb 
splint, and thats what its called. And sometimes they don't have a name at 
all eg the thumb splint we used for Alex as a babe was designed by me :-)) 
and its a combination of a couple of different dynamic splints that I have 
seen and used. Also the splint wasnt made out of normal splinting material 
(thermoplastics) it was actually made out of neoprene.

In the US they tend to use prefabricated AFO's where as here in Australia 
they are still hand made from scratch for the most part though some 
hospitals are moving towards prefabricated AFO's but they are different to 
the pre-fabricated ones used in the US.

Here in Australia an orthotist usually makes leg orthoses, and OT's hand 
orthoses though physios and OT's are all taught how to make both and 
sometimes do.

When Alex's are made the orthotist takes a plaster mould of his legs (just 
as if he had a broken leg). Then in the workshop he gets a flat sheet of 
thermosplastic material (there are different types depending on the use, 
some are more flexible than others eg sansplint, aquaplast, polyform etc) 
and heats it in a warm water bath. The plastic is then moulded around the 
cast he has of Alex's legs. As the material cools it goes hard and stays in 
the shape its moulded to. In the US they use premoulded orthoses rather than 
the flat sheet and simply adjust them as necessary.

Velcro straps are added and then he goes back for a fitting. He sees if 
there are pressure points etc (areas that rub or get red and could lead to a 
sore). These areas are adjusted using a heat gun. When the material is 
heated it reverts back to the original shape (that is it has memory). So the 
orthotic can be easily adjusted by heating it.

Of course the problem with that is you cant leave them in the sun or sitting 
beside a heater. I have had to remould many splints in my day (including 
Alex's) because they have been left in his bag in the car. You get back to 
the car to find a very interesting splint or unusually shaped AFO.

There is a limit to the number of times it can be reheated however and thats 
why old AFO's have a limited re-use capability. Especially in the US because 
as I said they tend to use the pre-fabricated AFO's. But for those without 
insurance I guess there would be a use. Alex's orthotics cost around $800  - 
$900 each leg and that doesn't include the cost of the appointments.

Here in Australia old AFO's are collected and sent to third world 
countries - eg Alex's last lot went to Thailand. They are re-used by 
missions, orphanages etc. I started collecting them to send over there after 
a friend from Uni did three months in an orphanage / leper colony (Hansons 
Disease), She had all the skills to make AFO's but thermoplastic material 
was too expensive, instead their splints and artificial limbs were made by 
the children themselves out of reeds.

Demi (now on the Wings list) used to collect them to send to Peru where she 
spent many months working with the underprivelaged after her son Connor 
passed away. Not sure if she still collects and sends them over or if she 
could give you an address to send them to but I can ask if you cant find a 
local collection point. It can take Demi a little while to answer emails at 
the moment because she has just adopted a beautiful son. :-)))

Life consists not in holding good cards but in playing those you hold well.
                                            -- Josh Billings

Keep Looking For Rainbows!!
   _--_|\
 /Karen \
 \ _.--._ /
          v Karen, Mum to Alex (12 years, T-18 Mosaic)
http://members.optushome.com.au/karens



                  Building ___ooOOoo__ Rainbows
                       www.trisomyonline.org
                  Families Helping Families On-line

Other related posts: