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Gait: Clinical Observation and Orthotic Intervention - PART 2

Gait: Clinical Observation and Orthotic Intervention - PART 2

Gait: Clinical Observation and Orthotic Intervention - PART 2

This course includes
10:00:07 of Course Material (View)
Course Forum
Lifetime access after purchase
Certificate of completion


Have you ever wondered how to determine the optimal ankle-foot orthosis (AFO) design for a client? Or, how to evaluate and optimize an AFO's effectiveness once it has been provided?  

Ankle-foot orthosis (AFOs) can improve gait and function, but clinicians are presented with an overwhelming number of design options when considering prescription decisions or when working with individuals who wear AFOs. An evidence-informed, individualized approach is important for optimal benefit.

Part 2 of this course - Individualized AFO prescription, goal setting, and evaluation - builds on Part 1 to guide decisions about the design and alignment of AFOs to optimize the match between the child, orthosis, and footwear. It aims to assist clinicians in eschewing traditional trial-and-error-based approaches for AFO management, in order to create client-specific goals and evaluate their effects based on the best available evidence. 

Part 1 (Gait and clinical observation) and Part 2 (Orthotic intervention) can be purchased together by selecting the bundle option at checkout; if you choose this option, you will have access to the full course - over 14 hours of recorded content, plus learning activities and quizzes to help you integrate the knowledge and skills you gain.

Note: Part 1 is a prerequisite to Part 2.


Learning objectives

Part 1: Normal and Pathological Gait - Mechanics and Observation 

  • Review the gait cycle and identify key aspects for assessment and management
  • Describe the motion of lower extremity joints and segments, and primary muscle actions through the gait cycle
  • Understand the role of the ground reaction force in normal and pathological gait
  • Apply practical tips to improve the reliability and validity of gait observation

You can learn more about Part 1 by visiting this page.

Part 2: Individualized AFO Prescription, Goal Setting, and Evaluation 

  • Describe common types of AFOs and general indications for each type
  • Discuss the biomechanical mechanisms of AFOs and their application or common pediatric gait impairments
  • Identify key components of an AFO prescription and relevant clinical considerations
  • Understand the role of the ground reaction force in tuning and optimizing AFO-footwear combinations
  • Select and use clinical evaluation measures that are relevant to AFO prescription
  • Set biomechanical goals, make AFO prescription recommendations, and evaluate orthotic effectiveness based on best evidence
  • Apply gait observations and physical assessment findings to communicate more effectively about orthotic prescription and tuning to address the biomechanical goals of individual clients



This intermediate course is designed for physiotherapists but is also relevant to orthotists, physicians, and other rehabilitation professionals who assess gait and/or orthoses. While the focus is on pediatrics, the content also applies to adults. 

The instructors
Dr. Kyra Kane (she/her)

Dr. Kyra Kane has been a registered physical therapist since 1997, with clinical experience in pediatrics and orthopaedics. She is a full-time clinician, adjunct professor in the School of Rehabilitation Science at the University of Saskatchewan, and Research Advisor for the Canadian Physiotherapy Association. Kyra has an MSc in Kinesiology and Health Studies, a PhD in Health Sciences, and extensive postgraduate training and clinical experience in biomechanical gait analysis and orthotic intervention.

Kyra is passionate about supporting the clinical application of evidence and best practices. She has presented her research nationally and internationally through journals, conferences, lectures, and webinars. Her research interests include examining evidence-based use of individualized ankle-foot orthoses (AFOs) for children, understanding the experiences of children and clinicians with AFO prescription, and improving pediatric gait measurement and rehabilitation outcomes.

Course Material included in this course
  • 1. Welcome and Review
  • Welcome and Review of Part 1
  • Review: Gait cycle overview handout
  • Gait cycle review quiz
  • One size does not fit all : An Introduction to individualized AFO prescription
  • Welcome survey
  • Course handout
  • 2. Introduction to orthoses
  • Orthoses
  • Types of AFOs
  • Kane, Priebe, & Barden, 2008 Effects of ESR AFOs on gait in individuals with CP
  • Review: General types of AFOs
  • The angle of the ankle in an AFO: Why does it matter?
  • AFO types quiz
  • Lesson 2 feedback (Introduction to Orthoses)
  • 3. Mechanisms of Action of an AFO
  • Review: Biomechanical mechanisms of action of an AFO
  • Mechanisms of action and the GRF
  • Mechanisms of action and the GRF: The GRF in gait
  • Mechanisms of action and the GRF magic wand exercise
  • Mechanisms of action and the GRF part 4: Biomechanical mechanisms
  • Mechanisms of action - Quiz
  • Comparison of GRAFOs and hinged AFOs for a child with meningomyelocele (see paper in the PDF below for optional supplementary detail)
  • Comparison of GRAFOs and articulated AFOs in a child with myelomeningocele (Paper - supplementary information for video above)
  • Lesson 3 feedback (Mechanisms of Action)
  • 4. Individualized AFO prescription decisions: Goals, Type and Design
  • State of current prescription practices and recommendations
  • Collaboration and goal setting practices for orthotic intervention
  • Survey - goal setting in practice
  • Goals and the ICF- Quiz
  • Decisions about AFO type and design: Part 1
  • Comparison of dorsiflexion motion allowed by solid and flexible AFOs for children with CP and equinus
  • Decisions about AFO type and design: Part 2
  • Survey - Reflections on AFO design
  • Lesson 4 feedback (Individualizing AFO type and design)
  • 5. Individualized AFO prescription decisions: Design (Ankle angle in the AFO, assessment)
  • The angle of the ankle in the AFO
  • Individualizing the ankle angle in the AFO: Effects at the knee
  • Decisions about the ankle angle in the AFO (Part 1)
  • Decisions about the angle of the ankle in the AFO (Part 2)
  • Decisions about the ankle angle in the AFO (Part 3)
  • Worksheet: Considerations for determining the ankle angle in the AFO
  • Quiz: individualized AFO design
  • Lesson 5 feedback (individualized design: AA-AFO)
  • 6. Individualized AFO prescription decisions: Optimization considerations and practices
  • ABCs of AFOs: A review of key concepts and introduction to this lesson
  • Individualizing trimlines and other design features (Part 1)
  • Individualizing trimlines and other design features (Part 2)
  • Quiz - Matching AFO-FC design and the individual (Open accompanying PDF below)
  • "Matching the AFO-FC design and the individual" worksheet (Accompanies Quiz)
  • Definitions and overview of the AFO-FC tuning literature
  • Reflections on "tuning" the AFO-FC
  • Considerations for tuning
  • Tuning considerations continued (footwear modifications for AFO-footwear combinations)
  • Quiz -- AFO design features and optimization
  • Lesson 6 feedback (Optimizing and evaluating AFO-FCs)
  • 7. Evaluating and optimizing the AFO-FC
  • Evaluating AFO-FCs
  • Evaluation part 2
  • Quiz - Evaluating and optimizing the AFO-FC
  • Gait observation and orthotic evaluation worksheet for case studies
  • Case study 1 (Excessive knee flexion in stance phase), part 1: Barefoot gait
  • Case study 1 part 2: Physical examination findings and current AFOs
  • Case study 1 part 3: Evaluating and tuning the new AFO-FC
  • Case study 2 (Excessive knee extension in stance phase) part 1: Barefoot gait and physical examination
  • Case study 2, part 2: Current hinged AFOs and clinical decision-making
  • Case study 2, part 3: Evaluation and tuning of the new prescription
  • Summary - Simplified checklist for orthotic care
  • Lesson 7 feedback
  • 8. Summary and conclusion
  • More practice with case examples
  • Summary and next steps
  • References for Sections 1-3: Introduction to orthoses and Mechanisms of action
  • References: Sections 4-6. Individualized prescription decisions (Goals, type, design, optimization)
  • References for section 7: Optimizing AFO-footwear combinations
  • Course (Part 2) feedback
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