I both love and dread this patient question. I love the question because it means the patient is motivated to improve, but I hate it because discontinuing the AFO too soon jeopardizes the patient’s safety.
The objective clinical evaluations I use to determine if a patient is ready to discontinue an AFO is the Berg Balance Test, Timed Up and Go Test, and the 6 Minute Walk Test. All tests are completed with and without the AFO. If the patient wants to discontinue using the AFO, their scores on the balance tests must not show greater than a 10% difference or categorize them as a fall risk.
The patient and I review the scores and discuss how to work toward elimination of the AFO as well as the ideal time to re-test, if needed. I find it challenging when re-testing because the patient should be ready to make the dramatic shift from a fully assistive orthotic to no assistance. Patients are nervous during this transition as the fall risk is heightened. The ideal solution would be an adjustable AFO allowing decreasing dependence on the AFO support. I have found that using the Push AFO improves the patient’s confidence and is an easy solution.
Because the Push AFO offers adjustable dynamic dorsiflexion assistance via an elastic strapping system, I can gradually decrease the dynamic force. This gradual step down makes the weaning from the AFO much easier. As the patient’s anxiety and fall risk diminish, the patient fully weans from the AFO.
Click here to read more information about different AFO models: A Comparison of leading AFO models
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