KAFOs for ambulation: An orthotist's perspective

Knee-ankle-foot orthoses (KAFOs) are frequently considered "orthoses of last resort," based on the limited initial and long-term acceptance rates of these devices, particularly by persons with complete spinal cord injury (SCI). Combining bilateral KAFOs with various hip control methods, such as the reciprocating gait orthosis variants, has not been shown to dramatically improve the ability to ambulate in the community for adults. The weight and bulk of KAFOs and hip-knee-ankle-foot orthoses (HKAFOs), combined with the energy-consuming gait that they provide, are believed to be factors leading to patient rejection of such ambulatory aids. Paradoxically, some persons with physical disability use a KAFO successfully for many decades. The reasons for this discrepancy are not well documented. The recent advent of stance control orthoses (SCOs) providing excellent stance phase stability at the knee without blocking knee flexion during the swing phase may overcome some of the inherent deficiencies of earlier orthoses that immobilized the knee in full extension throughout gait. Preliminary research is encouraging, but many unanswered questions remain. This report highlights KAFO design considerations from the orthotistg's perspective and points out the potential value of a classification system that would help busy practitioners categorize, discuss, and study the plethora of individualized KAFO configurations currently in clinical use.