This document summarizes evidence on the use of Knee-Ankle-Foot Orthoses (KAFOs) and Hip-Knee-Ankle-Foot Orthoses (HKAFOs) for ambulation. KAFOs brace the knee and ankle, while HKAFOs also brace the hip. They are used to treat conditions like muscular dystrophy, polio, and stroke. The evidence shows that KAFOs and HKAFOs can improve mobility for individuals with spinal cord injuries or paraplegia when used with gait training or electrical stimulation. However, more research is still needed due to the heterogeneity of patient populations and devices. Cost can also be a limitation, with K

1. Bangladesh Health Professions
Institute (BHPI)
Presenter
MD. Nayeem Hasan

2. Evidence Note
The Use of KAFOs and HKAFOs
for Ambulation

3. Acknowledgments
• Writer- Stefania Fatone
• Data-Kathy Dodson
• Drawings- Scott Magis
• Award Number H235K080004
This Evidence Note was made possible by
the Academy from the U.S. Department
of Education

4. STEFANIA FATONE,PhD,BPO(Hons)
Professor of Physical Medicine and Rehabilitation
Northwestern University Feinberg School of Medicine
Academy Annual Meeting Clinical Content Committee

5. Objective
How a person walk with KAFOs and HKAFOs
Provide a summary of the available evidence
Limitation of the KAFOs and HKAFOs
Facilitating access to knowledge
Patients requirements

6. Introduction
An externally applied device used to modify the
structural and functional characteristics of the
neuromuscular and skeletal system
Solution given by the (ISO)
International Standards Organization
Previously the Orthotic Devices were non by
Splint, Brace, Device etc

7. Device overview
KAFO (Knee Ankle Foot Orthosis)
 Encompass the knee and ankle
 whole foot or part of the foot.
HKAFO (hip-knee-ankle-foot
orthosis)
 Mainly KAFOs that extend across
the hip joint connecting to a
pelvic band
 Trunk stability is required,
lumbar or thoracic spinal
support

8. Indication
KAFO
• KAFO users include
children Duchenne
muscular dystrophy
(DMD)
• polio,
• post-polio syndrome
• stroke
HKAFO
• HKAFOs include adults
with
• SCI or paraplegia
• children with
myelomeningocele
A literature review of KAFOs and HKAFOs

9. Epidemiology
Direct control Knee
Ankle & Foot
Maintain alignment
Unilaterally or
bilaterally
KAFO HKAFO
Positioning the “Y”
Ligament
Maintain alignment
Rare Unilaterally

10. “Y” Ligament Positioning
Hip stability is not provided by the Orthosis
Shift the trunk center of mass posteriorly
GRF is oriented posterior to the hip joint.
tension in the Y ligament
internally stabilizing the hip joints
allows for stable standing in adults
Children is not recommended

12. Posterior off set
All knee-joint components are
 Provide coronal-plane
stability
 Accommodate knee-flexion
contractures
 Biomecanical control in
sagittal plane
Drop lock
Bail lock

13. Locked KAFO
 Provide stability during the
stance
 Doesn’t allow flex/ext
 So patient need Vault, Hip
Circumduct & Hiking
 Provide stability during the
stance
 Allow flex/ext
 So patient doesn’t need Vault,
Hip Circumduct & Hiking
Stance control KAFO

14. Walkabout Orthosis
 Stand in an upright position
 move independently with only the use of
crutches
longer-term injuries

16. Clinical Effectiveness
 14 studies that reported the effects of gait
training with KAFOs and HKAFOs in people
with complete and incomplete SCI
 7 studies that examined the combined effect
of RGOs and functional electrical stimulation
(FES)
 12 comparative trials of HKAFOs with and
without FES for adults with complete thoracic
lesions

17. Ensure safety
• Assessment and prescription of orthoses
• Responsible for manufacture and delivery
A certified orthotist is the best person to ensure
safe provision
An orthotist is an health professional
trained ,educated can make a custom-designed, fabricated,
modified device.

18. Future Research
The effect of KAFOs and HKAFOs on ambulation is challenging
Heterogeneous populations
And
The heterogeneity within each population
diagnosis
time since injury
lesion level
muscle function
experience with orthosis
type of gait pattern used

19. Economic Implications
(Unilateral)
KAFO $734–$3,289
RGO was approximately $8,306
No published studies examining the cost
effectiveness of KAFOs and HKAFOs were identified
A review of Medicare payment data for 2007