How to carry out ambulation training with KAFO in patient with a spinal cord injury who had an added complication of an accidental burn on thigh region?

Mr. Shah had a D12 compression fracture, spinal cord compression with ASIA type B with neurological level of injury D12 and fracture of the upper end of humerus. After one and half month of ambulation training he could walk with a walker and a KAFO (In a KAFO we have 3 points of support. 1. Thigh band, 2. Knee cuff & 3. Calf band). Apart from the walker and the  KAFO, he required moderate assistance for balance during the dynamic activity of walking and assistance with stepping forward.  He was using moist heat for the pain around the fractured L shoulder. After heating his L shoulder, he kept the hot water bag by the L thigh and due to the lack sensation below D12 (below groin region), he got a significantly large burn on the anterior aspect of the thigh. 

This where we could have had a major setback in his ambulation training. Because of the burn, he couldn't have worn the KAFO. It would have taken 2-4 weeks for the healing to complete. This meant that Mr. Shah would have to stop walking for that period of time. Instead of losing a whole month of rehabilitation, I came up with a plan. I waited for two days for early inflammation to subside.

Then, I used an AFO, a knee cuff, a thigh pad and a calf band to support his leg while walking. I did not tie the thigh band which was over the burnt area - the anterior aspect of thigh. With the AFO, knee cuff and thigh pad we got 3 point support and could manage without thigh band. He had started walking with a KAFO (like device) within 2 days of the burn.

please click here to see photo.
http://gajananbhalerao.wordpress.com/2011/12/06/how-to-do-ambulation-training-with-kafo-in-patient-of-spinal-cord-who-got-complication-with-accidental-burn-on-thigh-region/ 

HOW TO CHOOSE BETWEEN KAFO WITH STATIC ANKLE UNIT & DYNAMIC ANKLE WHILE PRESCRIBING KAFO IN SPINAL CORD INJURY?

While staring Ambulation Training In Spinal Cord Injury we commonly prescribe KAFO for standing and walking. But there is always a dilemma between KAFO with static ankle unit and dynamic ankle while prescribing KAFO in spinal cord injury.

How to decide between with static dynamic ankle unit and dynamic while prescribing KAFO in spinal cord injury?

When patients with spinal cord injury poor control in trunk then use static ankle.

How to check trunk control in SCI?

Make patient sit bed side with hand support if he is able to stabilize himself and hold the trunk upright with or without hand support. That means he is able to manage his trunk stability.

Is it the best way to check trunk control and standing balance with KAFO?

No the best way is give trail standing with KAFO & walker. You should always have a pair of KAFO spare in department to give a trail of standing. In standing if he manages his trunk stability and doesn’t sways a lot. That means he has poor stability in trunk and he won’t able mange the balance in standing with dynamic AFO. So we should give static ankle KAFO.

ON AN AVERAGE RULE

Always give static ankle KAFO in acute rehabilitation; we can convert static into dynamic when he is having good balance while walking.

If still not clear with the idea and not able to decide and you are in the dilemma then give static ankle KAFO