Stance Control Knee-Ankle-Foot Orthoses
One of the biggest challenges in orthotics is to provide knee stability to a weak lower extremity, while conserving energy during ambulation. Polio, spinal cord injury, stroke, and numerous other diagnoses have difficulty stabilizing a weak or paralyzed knee. A stance control prosthetic knee joint has been available for many years in a prosthesis. The challenge was to design a joint that could fit into an orthosis and be both lightweight and strong. The orthosis of choice, until recently, was a metal or plastic knee-ankle-foot orthosis (KAFO), where the knee is locked in complete extension. In this scenario, the knee is stabilized when walking and doesn't buckle when weight is applied. The design allows the individual to walk, but at a very high energy expense and with marginal gait habits. To clear the ground, the leg must be circumducted, or excessive hip hiking must be learned to keep from catching the toe.
Mary Free Bed O&P uses two designs provided by Becker
Orthopedic in Detroit. One design, the UTX, uses a
cable system between the knee and ankle joint (enclosed
in a tubular sidebar), which allows the knee to lock at
heel strike and remain locked until a certain angle of
ankle dorsiflexion is achieved. Along with the ankle
dorsiflexion, a hip extension movement is needed to
trigger the knee to release, allowing free knee during
swing phase. The second design, the E-Knee, uses an
electronic sensor in the footplate, which activates a
magnetic locking knee joint. In this design, when the patient's foot
makes contact with the the ground, and the knee remains
locked when weight is removed, the joint then unlocks
allowing free swing phase.
These knee joints aren't for every patient. A thorough patient evaluation is required to confirm the strength, range of motion, and coordination required to operate the system. After the fitting process is complete, an intense physical therapy program is required to ensure that patients receive the full benefit of this new technology. The final hurdle to cross is payment. Although this design has been available for several years, no billing codes were assigned for reimbursement until this past January. We now have a billing code to cover one design and hope that other codes will be available soon.
For Information on Stance Control ProductsEmail Mary Free Bed Orthotics & Prosthetics or call 616.242.0315 or 800.474.0325.