EQUIPMENT

Vendors

Know all you can about your equipment and where it came from.

• Who is your vendor?
• Where are they located?
• How can you reach them in case of an emergency
• Do they have an emergency number?
• Who is paying for you equipment?
• Are you responsible for part of this payment?
• Who will pay for repairs?
• How do you get repairs done?
• Can you get an update of this item in the future? If so, how?
• Has your vendor made clear to you what they are required to provide in the way of repairs?

Don't leave this questions unanswered until there is an emergency -- know what to do now.

Temporary Replacements

Nothing is perfect. At some point, equipment breaks down. Do you have a temporary to replace your permanent if it breaks down? This is vital in the case of your wheelchair. It is such a major part of your life that waiting for it to come back from the repair shop could leave you stranded if you don't have a backup. Keep this questions in mind for all the equipment you have.

New Equipment

In the past few years, great strides have been made in updating equipment -- and this process still goes on. You may want to keep yourself informed of what brand new items are coming onto the market. There are magazines that will update you, such as Paraplegia News and Accent on Living.

What is Orthosis?

Orthosis is a fancy word for brace. Braces give some people with spinal cord injuries enough support to stand or walk. Braces support at the ankles, knees, hips, and/or trunk depending on the type of brace. People use braces for the following reasons:

• Standing
  Some people use braces to help stand in order to:
  * Help keep the bones in the legs strong.
  * Relieve pressure on the buttocks and sacrum (tailbone).
  * Stretch muscles at the hips, knees, and ankles.
  * Use this position while performing activities at home or at work.
• Exercise
  Some people use braces to help them walk as a form of exercise in order to:
  * Strengthen muscles.
  * Increase endurance.
• Walking
  Some people uses braces to help them walk:
  * In the house.
  * In the community.

Who might use bracing?

Not all people with spinal cord injuries are able to use braces. The doctor and physical therapist evaluate each person's functional ability and then decide if he or she is appropriate for bracing. The doctor and therapist also determine which type of brace is most appreciate for the person depending upon the following:

• Level of spinal cord injury
• Skin condition
• Strength
• Endurance
• Medical condition/surgery
• Lifestyle
• Reason for using braces

Molded-Ankle-Foot Orthosis (MAFO)

The MAFO is just a simple plastic brace that is molded to exactly fit you lower leg and foot. You would use this if you have weakness in your ankle that cause you to drag your toe when you step forward (toe drop). To help this problem, the mafo supports the ankle joint.

Guidelines to success in wearing your MAFO:

• Inspect your skin often. Looking at your skin after every use of your MAFO will let you know early if a pressure sore is forming. If you see signs of skin breakdown, stop wearing your MAFO right away and call your doctor.
  
  Below is a list of places on your skin that may get sore due to your MAFO:
  * Check where your calf strap goes around your leg.
  * Check the inside, outside and bottom of your foot. These are all the places where a poor fitting brace can harm your skin.
  * Check where the edge of the brace comes in contact with your leg.
  
  
• Pad your skin and brace. Wear a cotton, knee-high sock between your skin and MAFO to help lower the risk of skin irritation.
• Don't leave your brace in the sun or by a heater. Your MAFO is made out of plastic. It will melt if heated up.
• Wash your brace as required by your vendor. Most MAFOs can be washed with mild soap and water and air dried. Make sure this is true for yours by asking your vendor.

Ankle-Foot Orthosis (AFO)

The AFO is a brace made up of a shoe, and ankle joint, two metal uprights, and a calf band. It gives full support to the ankle joint and some support to the knee.

This brace is heavier than the MAFO. A person using an AFO will walk with a reciprocal gait.

Guidelines to success in wearing your AFO:

• Inspect your skin often. Looking at your skin after every use of your AFO will let you know early if a pressure sore is forming. If you see signs of skin breakdown, stop wearing your AFO right away and call your doctor.
  
  Below is a list of places on your skin that may get sore due to your AFO:
  * Check where your calf strap goes around your leg. If it is too tight, it can cause a pressure sore.
  * Check the inside and outside of your ankle. The uprights or ankle joint may be rubbing your skin.
  Check your foot for pressure sore signs that the shoe is too tight or poorly fit.
  

• Pad your skin and brace. Wear a cotton, knee-high sock between your skin and AFO to help lower the risk of skin irritation.
• Clean your brace as required by your vendor. Only use cleaning guidelines and schedule that is recommended by the vendor of your AFO.

Conventional Knee-Ankle-Foot Orthosis (conventional KAFO)

The Conventional KAFO is made up of a shoe, ankle joint, knee joint, medial and lateral metal uprights, calf band, knee pad, and thigh band. It fully supports your knee and ankle when walking.

This brace is fairly heavy. The person using a KAFO like this will use a swing to, swing through a Reciprocal Gait.

Guidelines to success in wearing your KAFO:

• Inspect you skin often. Looking at the skin of your upper and lower leg after every use of your KAFO will let you know early if a pressure sore is forming. If you see signs of skin breakdown, stop wearing your KAFO right away and call your doctor.
  
  Below is a list of places on your skin that may get sore due to your KAFO.
  
  * Check the skin of your thigh for pressure sore signs that the thigh band is too tight
  *Check your knee for signs of the pressure sores showing that the knee pad is too tight or the uprights are rubbing or pressing on your knee.
  *Check the inside and outside of your ankle. The uprights or ankle joint may be rubbing or pressing on your skin.
  *Check your foot for pressure sore signs that the shoe is too tight or poorly fit.
  * Pad between your skin and brace. Wear a cotton, thigh-high sock between your skin and your KAFO if you are wearing the brace under your pants. It will help lower the risk of skin irritation.
  
  
• Clean your brace as required by your vendor. Only use the cleaning guidelines and schedule that is recommended by the vendor of your KAFO.

Plastic Knee-Ankle-Foot Orthosis (KAFO)

The plastic KAFO is made up of a MAFO (molded ankle-foot orthosis), medial and lateral uprights, a knee joint, kneepad, and a plastic thigh cuff with Velcro closures. It gives support to your knee and ankle joints when you are walking. This brace is lighter than the conventional KAFOs and the person wearing it uses reciprocal gait, swing to or swing through gaits.

Guidelines to success in wearing your plastic KAFO braces

• Inspect your skin often looking at the skin of your upper and lower leg after every use of your KAFO will let you know early if a pressure sore is forming. If you see signs of skin breakdown, stop wearing your KAFO right away and call your doctor.
• Below is a list of places on your skin that may get sore due to your KAFO:
  
  * Check the skin of your thigh for pressure sore signs that the molded plastic thigh pieces don't fit right or that the thigh straps are too tight.
  * Check your knee for signs of pressure sores, which happens when the kneepad is too tight or the uprights are rubbing or pressing on your knee. *Check your lower legs for pressure sore signs. The calf piece or shin straps may be too tight or rubbing on your leg.
  *Check the inside and outside of your ankle. The molded foot piece may be rubbing or pressing on your skin.
  *Check your foot for pressure sore signs that the shoe or the foot piece is too tight or poorly fit.
  *Pad between your skin and brace Wear a cotton, thigh-high sock between your skin and KAFO if you are wearing the brace under your pants. It will help lower the risk of skin irritation.
  
  
• Clean your brace as required by your vendor Only use the cleaning guidelines and schedule that is recommended by the vendor of your KAFO.

Using your KAFO knee joint lock

The lock on your KAFO knee joint helps keep your knee straight when you are walking. When the lock is lifted up, the KAFO knee joint will bend, letting you sit down with your foot flat on the floor.

Walking in knee ankle foot orthoses (KAFO)

Walking in KAFOs is done three different ways, either by a swing to, swing through, or reciprocal gait. The user leans on crutches or a rolling walker for help. We have pictures below of the swing to and swing through gait.. A reciprocal gait is when the user sets the crutches or walker a small distance ahead of where they are standing. He/she moves one leg forward and then the other leg forward.

Swing to gait is when the user sets the crutches or walker a small distance ahead of where they are standing. He/she leans onto the crutches or walker and swings his/her legs (not passed) the crutches or walker.

Swing through gait is when the user sets the crutches a small distance ahead of where they are standing. He/she leans onto the crutches and swings his/her legs passed the crutches to a point a small distance ahead of them.

Craig-Scott Orthosis

The Craig-Scott brace is made up of a special shoe, an ankle joint, two metal uprights, a calf band, a knee joint, and a thigh band. The user wears one on each leg, sometimes with a spreader bar between the ankles.

These braces support your feet, ankles and knees. The person wearing the braces uses a special way of standing in order to support their hips and balance their trunk. The specially modified shoes help the user balance with more ease than with other types of braces. The bale releases allow the user to sit from standing without having to unlock the knee joints by hand.

Guidelines to success in using your Craig-Scott Braces

• Inspect your skin often. Looking at the skin of your upper and lower leg after every use of your Craig-Scotts will let you know early if a pressure sore is forming. If you see signs of skin breakdown, stop wearing your Craig-Scotts right away and call your doctor.
  
  Below is a list of places on your skin that may get sore due to your Craig-Scotts:
  
  * Check your feet for signs of pressure sores. The shoe may be too tight or poorly fit.
  *Check the inside and outside of your ankle. The uprights, ankle joints, or stirrups may be rubbing or pressing on your skin.
  *Check for signs of pressure sores on your lower leg. The uprights of the brace may be too close to your leg and need fixing.
  *Check the skin of your shin. Signs of pressure sores there may mean the calf band of your brace fits poorly.
  *Check your knee. Signs of pressure sores there may mean the knee joints of the brace are too close to your knee and need fixing.
  *Check the skin of your thigh for pressure sore signs that the thigh band is too tight.
  
  
• Pad between your skin and brace wear cotton, thigh-high sock or stockings between your skin and the Craig-Scotts if you are wearing the brace under your pants. It will help lower the risk of skin irritation.
• Maintain your brace as required by your vendor. Only use the cleaning guidelines and schedule that is recommended by the vendor of your Craig-Scotts. The mechanical parts of your Craig-Scotts may need to be adjusted every so often. Do not do them yourself - they should be done by your therapist or the vendor.

Reciprocating Gait Orthosis (RGO)

This brace is made to fit both your legs together. For each leg here is a plastic molded foot, ankle, calf and thigh. It has knee and hip joints, with plastic molded pelvic band with cables and thoracic (chest level) uprights.

The RGOs are made to give support to the feet, ankles, knees, hips and trunk. The wearer can use is/her own sneakers or low-heeled hoes. He/she uses crutches or a rolling walker to lean on.

When sitting down, the user must unlock the hip joints by hand. However, bale releases at the knee joints allow the user to sit down without having to unlock the knee joints by hand.

Walking with the RGOs is by fusing reciprocal gait. This means your legs step one at a time.

The cables on the pelvic band help the user swing his/her legs forward one at a time. Therefore, the person wearing them uses less energy walking with RGOs than with other kinds of braces.

Guidelines to success in wearing RGOs

• Inspect your skin often Looking at the skin of your upper and lower leg, feet, and trunk after every use of your RGOs will let you know early if a pressure sore is forming. If you see signs of skin breakdown, stop wearing your RGOs right away and call your doctor.
  
  Below is a list of parts of your skin that may get sore due to your RGOs:
  
  *Check your feet for signs of pressure sores. The shoe could be too tight or the foot piece of the brace could be poorly fit.
  *Check your ankles. The molded plastic parts of your RGOs may be rubbing or pressing on your skin.
  *Check for signs of pressure sores on your lower legs. The calf piece or shin straps of the brace may be too tight or be rubbing on your leg.
  *Check the skin of your knees. Signs of pressure sores there may mean the knee joints are too close to your skin.
  *Check the skin of your thigh for pressure sore signs that the molded plastic thigh pieces don't fit right or the thigh straps are too tight.
  *Check your hips for signs of pressure sores. The hip joint of the brace could be too close to your skin.
  *Check the skin of your low back and buttock. Use a mirror if you have to see it. Signs of pressure sores there mean the pelvic band fits poorly.
  
  
• Check the skin of your trunk. If the uprights are too close to your skin, or the abdominal or chest straps are too tight, there may be signs of pressure sores.
• Pad between your skin and brace wear cotton, thigh-high sock or stockings between your skin and the RGOs if you are wearing the brace under your pants. Also, wear a T-shirt to protect your trunk. It will help lower the risk of skin irritation.
• Maintain your brace as required by your vendor Only use the cleaning guidelines and schedule that is recommended by the vendor of your RGOs. The mechanical parts of your RGOs may need to be adjusted every so often. Do not do this yourself -- it should be done by your therapist or the vendor.

Walkers

Walkers give you the most support and are used by people who have reduced strength and control of their legs and or/ poor balance. The person using this can be wearing long leg braces, or no braces at all.

Although walkers comes in many types, almost all of them are made to fold up. This makes it easier to store them and to get in and out of the car.

Standard Walker

This is the most stable. It is for a person with strong arms and fairly good balance. Sometimes someone will start with this and then got to something else when they get stronger. It is important to have the walker be at the right height.

Rolling Walker (with regular hand grips)

This walker has handles to make it easier to push. The brakes go on when the person presses on the walker to take a step. Sometimes, if the person has trouble with one arm, they will need a forearm support.

Lofstrand Crutches

These crutches are used by people who have fair balance and strong arms. People who walk with Reciprocating Gait Orthoses (RGOs) or long braces can sometimes use these if their balance gets good enough. Lofstrands have cuffs which go around the arm just below the elbow. These cuffs are only a guide to keep them straight and should not be too tight since they could cause sores on the skin with constant rubbing. They should not be too lose either, or they will fall off the arm.

Canes

Canes are used by people with fairly good balance, strong arms, and legs which are not too weak but require braces. Sometimes a person may use 2 canes instead of Lofstrand crutches, but this is harder and takes more energy.

The shape of the bottom of the cane is decided by how much balance and control the person has.

Straight Canes

Straight canes are made of wood or metal and can have all different kinds of handles. A straight cane can be used by someone wearing short leg braces or two canes can be used by someone wearing long leg braces who is strong. These canes have wider bases and are used to give a person more support and balance.

The flat side of the base is next to the person, with the handle facing back. It is very important to hold the cane the right way for safety.

Changing The Height Of Your Equipment

Assistive devices need to be the right height in order to be safe and useful for the person using them.

If a Wooden Cane is too long, it can be cut down by the therapist or another authorized person. Metal Canes are more adjustable, as are walkers and crutches.

To change the height, press the button in and either pull up or press down to put the button in a different hole. Then turn the ring to tighten it.

Taking Care of Your Equipment

Canes and walkers need to be kept clean and in good condition in order to be safe for the person using them. Canes should not be bent.

• Brakes. The brakes on a rolling walker should be working well. If they do not, they need to be checked and fixed.
• Rubber tips. All canes and walkers need to have rubber tips on them. If the tips become too worn down, they are unsafe on floors and slippery surfaces. Check them regularly and have them replaced it they become too worn down.

Back Cushions

The purpose of a back cushion is to help you sit straighter by supporting your lower back region. These cushions are made of a firm foam covered with cloth.

The McKenzie Roll. It is shaped in a circle.

The Lumbar Cushion. It's shape matches the curve of your lower back.

Items for Independence

Environmental Control Units (ECUs)

If you are not able to control any of the items listed above, you may be a candidate for an Environmental Control Unit (ECU). Systems range from the basic to complex, any of which will allow a person to be independent in the control of their household. There are even programs that can adapt your computer to perform as a complex ECU, including your dial phone.

There are also several types of ECUs. Each system has several components and enables you to control: lights, appliances (i.e., radio, stereo, air conditioner, fan), television, telephone, electric bed, intercom system, accessories such as electronic door opener, electric page turners, call buzzer and computer.

Often a basic ECU will be recommended for a person who has limited hand function. This basic system may include:

* Speakerphone (standard telephone that can be used without lifting the receiver)
* Intercom system (to allow communication throughout 2 or more rooms)
* X.1O system (remote control of lights and appliances with the push of a button)
*Touch or sound activated lamps (turn on and off either by touching any part of the lamp by whistling or clapping)

The more complex ECUs allow you to control all electrical appliances and telephone, even if you have very weak or no arm movement at all.

There are many types or switches that will allow you to control your environment, no matter what your level of strength is. For example, if you have no movement in your arms, you may be able to use a Chin Switch or a “Sip & Puff” Switch.

Orthotics

An Orthotic Device (also called Splint) is like a tool, making it possible for you to carry out the activity you choose. Some quadriplegics use their splints only for certain tasks such as school, office, in the kitchen, or for recreation.

For the person who has Wrist Extension and therefore a Weak Teodesis Pinch (see below), two Splints are available to mechanically achieve the same result, as well as give it a useful function by proper finger-thumb positioning.

Wrist Driven - This Splints uses active wrist extension to bring the fingers (index and middle) in contact with the thumb for a strong “3 Jaw Chuck” pinch. Hence the term Wrist Driven.

Key Pinch - This works the same as the above SPLINT, except that the thumb is positioned to the side of the index finger to achieve a “Lateral” pinch, the pinch used when you hold a key.

Ratchet - The ratchet Splint provides a means to independently grasp and release utensils. Elbow and shoulder strength is necessary in both arms to work this splint, which allows the user to lock the thumb and fingers around an object. When finished, the user can release the grip by releasing the ratchet.

Tenodesis

It is important to understand the principle of Tenodesis because it plays a vital part in hand function for the C5-C6 Quadriplegic. It is also an important principle when splinting or when considering hand surgery for persons with other levels of injury.

If you have no motion in your fingers or thumb but can lift your hand back at the wrist, you may be able to pick up and hold things in your hand. How is this possible? You benefit from the natural tightening of the thumb and fingers that occurs when the hand is brought up at the wrist (extended). When the hand is dropped down at the wrist (flexed), the fingers and thumb open. This Tenodesis action gives the C5-C6 Quadriplegic grip.

Other Options

For the person who has shoulder and elbow movement but no wrist or hand function, the following options can be considered...

• Long Opponens With Pocket For Utensils
  This stationary splint is designed to support the wrist and to hold an object such as a pen, fork, or comb, which is inserted into a pocket or a clip on the splint.
• Balanced Forearm Orthosis Supporting The Arm

This site is sponsored by the Amy Alexander Foundation for Spinal Cord Injury.
A nonprofit organization. Supported by public donations.
All content by Amy Alexander except where indicated. © 2007 The Amy Alexander Foundation for Spinal Cord Injury