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

Outline

FUNCTIONAL GAIT BIOMECHANICSFUNCTIONAL GAIT BIOMECHANICS

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

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

• StrokeStroke
• Sensory perception lossSensory perception loss
• Cerebral palsyCerebral palsy
• Charcot-Marie-Tooth diseaseCharcot-Marie-Tooth disease
• Other neuromuscular conditionsOther neuromuscular conditions

OUTCOME MEASURESOUTCOME MEASURES

• Review of the existing outcome measures Review of the existing outcome measures
  • 6MWT6MWT
  • 10 meter walk test10 meter walk test
  • Functional Independence MeasureFunctional Independence Measure
• Scandinavian Stroke ScaleScandinavian Stroke Scale
• Minimal detectable change with AFOMinimal detectable change with AFO
• Minimal clinically important difference in these measuresMinimal clinically important difference in these measures

ABCs OF AFOsABCs OF AFOs

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

AFO CASE STUDIESAFO CASE STUDIES

• STROKESTROKE
• CPCP
• MSMS
• Selecting the appropriate AFOSelecting the appropriate AFO

AFO MANAGEMENTAFO MANAGEMENT

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

BILLING AND DOCUMENTATIONBILLING AND DOCUMENTATION

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