Horton's Stance Control Orthotic Knee Joints Update
I recently had a chance to observe the fitting of several patients with the latest version of the SCOKJ being developed by Gary Horton, CO. Frankly, I was amazed how readily the patients adapted to a knee joint that automatically unlocks for swing phase. Most had worn a locked knee KAFO for years, and poliomyelitis was the most common etiology for their unilateral paresis. We all know how hard it is to make a new KAFO that "feels as safe as the old one" to post-polio clients.
This polio survivor has bilateral lower limb paresis and has worn a KAFO on his right leg for many decades.
Much to my surprise, all of the patients in this small group were able to ambulate in parallel bars within a few hours and many were willing to wear the SCOKJ outdoors by the second day. In fact, some were even willing to tackle slopes and uneven surfaces and even try to negotiate very rough terrain! Their enthusiastic acceptance of a knee joint that allows knee flexion in swing phase is very encouraging and makes me feel that this is an approach that can be applied by orthotists in the real world.
Fabrication of the stirrup for release is pretty straightforward but it takes some fiddling around to adjust the joints so they both release at the same time, and at the proper time in the gait cycle. It appears that this method for release works best with a solid ankle design, or at least with an anterior stop to limit excessive dorsiflexion and create a Ground Reaction Force to stabilize the knee in late stance - when the locks are disengaged.
With the SCOKJ, the gait looks much more normal and the patient reports that it takes less effort to walk.
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I worried about premature release when descending slopes or inclines, but the locking cam really holds solidly and actually becomes more stable when a knee flexion force is applied, even if the joint has been unlocked. It only unlocks and flexes after a brief extension moment is applied, so the patients soon learned to trust it.
Commercial release is scheduled for January of 2002, presuming the durability testing continues to go well. I'm sure Horton's will have a booth at the upcoming AOPA meeting with more information about their training courses for next year. You can also visit their web site for more information at www.hortonsoandp.com. Click on "News/Events" to go directly to the SCOKJ information.
