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RANCHO R.O.A.D.M.A.P. - Coggle Diagram

- - - - is proprioception intact in test knee?
        
        NO
        
        LE ORTHOSES: LONG LEG ORTHOSIS
        
        patient has:
        < 3+/5 quadriceps strength bilaterally?
        
        MMT TESTING
        
        NO:
        compare test and contralateral (CL) limb
        
        patient has:
        < 3+/5 quad strength in test side AND ≥ 3+/5 quad strength in CL limb?
        
        2 more items...
        
        YES
        
        patient meets PARTICIPATION CRIETERIA for AMBULATION TRIAL with BILATERAL KAFO/RGO?
        
        Participation Criteria
        
        no contractures in hip and knee flexors and ankle plantarflexors (dont have ROM to use orthosis = wont help as much)
        
        SLR 0-100 degrees (at least to 110 deg = ideal)
        
        in order to get off the floor
        
        important for other ADLs (i.e.putting on socks/shoes) = ROM to bend fwd
        
        Independent with ALL transfers
        
        including wheelchair to floor/floor to wheelchair
        
        Max VO2 ≥ 20 mL/kg/min
        
        need sufficient cardiovascular strength to use
        
        50 cts full dips in parallel bars
        
        high energy demand
        
        need endurance and strength to use B orthoses
        
        2 more items...
        
        YES
        
        LE ORTHOSES: ANKLE FOOT ORTHOSIS (AFO) / LOWER LEG ORTHOSIS
        
        LE ORTHOSIS: PATIENT INVOLVEMENT IN DECISION ABOUT INTERVENTION
        (final step)
        
        REQUIREMENTS
        patient has:
        
        significant gait deviaitons AND LE orthosis(es) recommended per AFO or Long Leg Orthoses Algorithms
        
        want pt input
        
        Discuss with patient (and family): plan to consider orthosis, including:
        
        benefits and drawbacks of orthoses
        
        Other treatment options
        
        Patient preferences
        
        4 more items...
        
        GOAL
        
        include patient in the decision about use of a lower extremity orthosis
        
        pick an orthosis that patient will use the most: if need KAFO, but want to use AFO, take that into consideration
        
        WHO
        
        Ambulatory Adult Patients
        AND/OR
        
        Caregivers
        
        CHALLENGE to Orthosis RX
        
        Insurance
        
        Kaiser --> longer to make orthosis
        
        plan and d/c need to consider the timeframe so that it is ready by the time the patient is ready to go home
        
        patient has either/or:
        
        DECR ankle strength
        
        impaired or absent proprioception at the knee/ankle
        
        ankle plantarflexor spasticity*
        
        YES (to at least one of the 3x)
        check foot placement during standing
        
        for standing tasks/ADLs/stairs
        
        spasticity/hypertonicity, PF contracture, or absent proprioception MARKEDLY affects FOOT PLACEMENT during standing or gait
        
        impairments affect patient to the point that they cant perform the task (i.e. XS INV)
        
        2 more items...
        
        NO
        
        NO ORTHOSIS REQUIRED
    - - does patient have ≥ 3/5 HIP EXT on test side?
        
        NO:
        cant stay upright with weak hip ext and quads
        
        YES:
        hip ext strong enough to make up for weak quads and impaired proprioception
        
        YES
        
        Does pt have:
        
        full hip EXT ROM
        
        quad tone
        
        pt with SCI can walk with AFO
        
        spastic response keeps knee straight
        OR
        
        proprioception intact
        
        if feel leg is flexed may be able to prevent falls b/c know its bent
        
        YES
        
        patient may not required a KAFO
    - - YES
        
        may be able to use orthosis