2010 The Use of KAFOs and HKAFOs For Ambulation
2010 The Use of KAFOs and HKAFOs For Ambulation
2010 The Use of KAFOs and HKAFOs For Ambulation
Supplement of The O&P EDGE February 2010 ■ The Academy TODAY A-9
as required, use of unilateral HKAFOs is rare and limited to a reasonable amount of literature had been written regarding
short-term application following hip arthroplasty to allow for KAFOs and HKAFOs, the level of evidence regarding their use
protected walking.3 The principal impairments addressed by for ambulation was generally low.29 There was some evidence
KAFOs are paresis or paralysis of the muscles controlling the that use of HKAFOs diminishes with time in both adults and
knee joint, upper motor-neuron lesions resulting in hypertonicity children with paraplegia and that when orthoses are used, they
(spasticity) of the lower limb, or loss of structural integrity of the are used mostly for therapeutic purposes.11, 34–37 There was also
hip or knee joints. A literature review of KAFOs and HKAFOs some evidence that walking speed is slow and energy cost high
for ambulation indicated that KAFO users include children in people with paraplegia regardless of orthotic device used.12,
with Duchenne muscular dystrophy (DMD) and persons with a 28, 38–46
A-10 The Academy TODAY ■ February 2010 Supplement of The O&P EDGE
series trials be used to improve the internal validity and •• Identify and/or develop standardized subjective and objec-
statistical power of future research regarding KAFOs and tive outcome measures.
HKAFOs for ambulation.30 Furthermore, Fatone29 indicated that •• Investigate the short- and long-term effects of KAFO and
the population being evaluated (diagnosis, time since injury, HKAFO use on the neuromusculoskeletal system.
lesion level, whether a lesion is complete or not, residual muscle •• Research application of SCOs.
function, prior experience with orthosis, training provided, •• Define the mechanical loading conditions on KAFO and
type of gait pattern used) and the orthosis being used must be HKAFO devices to guide orthotic design and application.
adequately described in order for study data to be interpreted •• Determine the short- and long-term effects of physical therapy
and the information generalized or compared between studies. intervention, including gait training, on outcome and accep-
tance of KAFOs and HKAFOs.
The following primary research priorities regarding use of •• Measure the impact of pharmacological management on
KAFOs and HKAFOs for ambulation were identified by successful use of KAFOs and HKAFOs in persons with severe
participants of SSC7:33 spasticity.
Acknowledgments
This Evidence Note was compiled by Stefania Fatone, PhD. This Evidence Note was made possible by the Academy through a
grant (Award Number H235K080004) from the U.S. Department of Education. The contents do not necessarily represent the
policy of the Department of Education, and you should not assume endorsement by the federal government. Thanks to Kathy
Dodson, American Orthotic & Prosthetic Association (AOPA), for providing the 2007 Medicare payment data and Scott Magis for
the drawings.
Suggested Citation
Fatone S. Evidence Note: The Use of KAFOs and HKAFOs for Ambulation. Washington DC: American Academy of Orthotists and
Prosthetists. (2009)
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