At the 2011 American Orthotic & Prosthetic Association’s
National Assembly, Jonathan Moore, DPM, MS, presented research on how an
AFO could reduce the risk of falling for seniors by improving
balance and ankle stability.
According to Moore, one in three adults aged 65 years and older falls
each year, accounting for the highest rate of death due to injury in this age
group. In order to mitigate this potentially fatal risk, Moore encourages
assessing a patient’s balance and postural control in order to determine
whether a patient is at risk for falling.
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| The lightweight Moore Balance Brace is easy for seniors to don and doff. |
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| Image: Moore, J. |
“Ankle strategy is a vital part of the way we stabilize our bodies
in order to remain balanced. Ankle strategy governs postural sway when we are
standing. Patients who are diabetic, have weakness, joint instability or loss
of proprioception are going to have increased, abnormal amounts of postural
sway, which means that they are going to have poor postural control,”
Moore said.
Moore said that the most common factors that cause abnormal amounts of
postural sway are lower extremity muscle weakness, ankle or foot arthritis,
reduced peripheral sensation, visual acuity problems, sensory input problems
and diabetes.
According to Moore, an AFO can be used to control ankle motion, improve
proprioceptive information and prevent fatigue, which reduces the risk for
falling.
“An AFO should increase sensory motor function by adding sensory
information to the brain by having something around the skin of the ankle,
improve postural control and stabilize one in the presence of fatigue,
osteoarthritis, and pain. All of this means that these strategies all can be
dramatically enhanced through usage of an AFO device,” Moore said.
However, Moore said that the standard AFO can pose problems for senior
patients, because of its typical size, weight and bulkiness. Most importantly,
the average AFO can be very difficult to put on and often requires the patient
to wear a different shoe in order for the AFO to fit.
“Seniors simply won’t be compliant wearing a device if
it’s too heavy or too cumbersome to put on,” Moore said.
In response, Moore designed the Moore
Balance Brace (MBB), a light-weight, custom AFO that can be
worn with most shoes and is easy to put on and wear.
“I tried a variety of different AFO designs for those at risk for
falls, but I couldn’t find a product that worked. Moreover, I
couldn’t find a product that my senior patients could put on themselves.
Many products were simply too cumbersome for the elderly to put on, and many
restricted motion excessively around the ankle, making it even harder to
walk,” Moore stated in his paper, “Stepping Up to Prevent
Falls.”
The MBB stabilizes the ankle medially and laterally and maximizes
contact with skin mechanoreceptors. The lightweight design allows it fit into
most shoes, and the custom orthosis provides arch support and midfoot
stability.
Moore illustrated how easy the AFO was for seniors to put on in a video
demonstration. He suggested first removing any insole or orthosis in the shoe.
A flat Spenco insole should be inserted into the shoe followed by the AFO. This
allows the patient to easily slide his or her foot into the shoe and secure the
AFO with two Velcro straps at the top.
Moore also emphasized the importance of assessing balance and postural
sway from an educational and team approach. AFOs should be prescribed only
after a fall risk assessment has been conducted, and the patient should also
work with a physical or occupational therapist to improve strength and balance.
“Before recommending the MBB, or any AFO, the podiatric physician
should always conduct a fall risk assessment and at least offer to refer the
patient for strengthening and exercise with physical or occupational therapy.
My practice brings patients back into the office after about a month of MBB use
for a follow-up appointment with me and our therapy team. The therapists put
the patient through several assessments with and without their AFOs to assess
benefit,” Moore said. — by Megan Gilbride
Disclosure: Moore is the developer of the Moore Balance Brace.
