Use of KAFOs for Patients with Cerebral Vascular Accident, Traumatic Brain Injury, and Spinal Cord Injury

A summary is presented of the current North American clinical applications of knee-ankle-foot orthoses (KAFOs) in the cerebral vascular accident (CVA), traumatic brain injured (TBI), and spinal cord–injured (SCI) patient populations. North American orthotists avoid the use of locked-knee KAFOs for CVA and TBI patients. There is a feeling that they are too heavy and cumbersome for patients' weakened hip musculature, are difficult to don, and require increased energy costs due to the resulting stiff-legged gait. Locked knee KAFOs also raise safety concerns related to falls. The recent introduction of stance control knee joints requires re-evaluation of the possibility of KAFO use with this patient population, although the presence of knee spasticity interferes with release of this type of joint. The use of numerous KAFO designs for paraplegics is well documented. SCI patients with low level or incomplete lesions may be more likely to use KAFOs for functional ambulation at least part of the day, whereas patients with higher level and/or complete lesions will find KAFOs more useful for stationary standing activities and therapeutic exercise. In either case, the long-term use of KAFOs by patients with SCI seems to diminish over time, and a wheelchair becomes the preferred method of mobility, with KAFOs being used only for “special occasions.” Stance control technology may offer some spinal cord–injured patients a practical alternative to locked knee KAFOs—an alternative that might decrease or delay the use of a wheelchair. Further research on the benefits of stance control KAFOs, coupled with education of clinicians, should increase third-party acceptance and increase utilization of stance control technology. Standardization of the outcome measures studied would allow research results to be more easily compared.