In patients with incomplete cord injury we start ambulation training with KAFO but it becomes very difficult how to shift from KAFO to AFO.
What is the solution?
While ambulation training with KAFO we start with knee locked position in KAFO that helps in stabilizing the knee. As patient is showing progress in standing balance, walking efficiently with KAFO and walker. We should start giving trial of unlocking the knee joint of KAFO.
Shall we unlock both the joint at a time? This may lead to knee buckling and patient will collapse down. Then how to solve this problem?
We are not suppose to unlock both knee at a time. Start unlocking the knee on strong side of paraplegics (SCI always show asymmetry in recovery; one limb shows better strength and recovery than the other). By unlocking one side we challenge the control on one side and training him walk with one knee unlocked. The other limb with knee locked will help in providing good stability and prevents collapse. We should give these frequent trials of small distance walking with intermediate periods of walking with knee locked.
Our aim is to give him the abstract idea of how to walk without knee support for walking. This creates the background for us. Then unlock both knee joint KAFO. Let him practice this for 2 -4 weeks. Let patient be efficient and competent before you shift to AFO. As his confidence and strength improves you give the AFO.
Let him walk first with one KAFO and AFO on other side. Then take out bilateral KAFO and shift to AFO.
Please remember one key point of training
Whenever you are challenging the patient always increase the base of support. i. e. you may need to shift from walker to forearm support walker for few days.
So as you are shifting to AFO use forearm support walker for few days.