BIOMECHANICS OF KAFO

Feryanda Utami, B.PO

March 5th 2019
 OBJECTIVES
At the end of this class, students will be able to:
•Explain the terminologies related to biomechanics
•Apply biomechanical knowledge to KAFO
CONTENTS:

General Knowledge

Terminology

Apply Concepts to KAFO

 WHAT IS BIOMECHANICS?
• BIOlogy is the science and description of life and living nature

• MECHANICS is the branch of physics dealing with motion and the

phenomena of forces acting on bodies as well as the science of
apparatuses and mechinery

• BIOMECHANICS is the science and the branch of physics and biology

dealing with motion and the phenomena of forces acting on living
structures
 BIOMECHANICS IN P&O
The branch of physics and biology dealing with motion and
phenomena of forces acting on the human body under
application of prosthetic and/or orthotic devices
TERMINOLOGY
 Vector & Scalar
• Study of Biomechanics deals with variety of quantities → terms
 Force
▪ Push or pull
▪ The product of mass and acceleration.
▪ Make things move/stops things moving or make things change
shapes.

▪ The unit of force in SI is the Newton (N).

*The International System of Units (French: Système
internationald'unités, SI)

Vector / Scalar?
 Mass and Weight

•Quantity of substance
•Unit of mass is kilograms(KG)
•On the Earth
→ with gravitational force , g = 9.80665 [ m/s2 ]
Therefore weight = m*g [kg. m/s2 or Newton]
 Mass and Weight

❑ Which one is vector???

❑ Which one is scalar???

 COM

▪ COM is the point at which the mass of the object is

considered to be concentrated
▪ To refer to the weight force, its effective point of
application on an object must be defined which is
referred to as the center of gravity.
▪ In physics, a center of gravity of a material body is
a point that may be used for a summary description
of gravitational interactions.
 Adding and Resolving Forces

•Vector operations
•Forces can be added → total resultant force/resultant vector
 Adding and Resolving Forces

•Vector operations
•Forces can be added → total resultant force/resultant vector

Translation
 Big Title
The marketing mix is a business tool used in marketing and by marketers.
 Moment
Turning effect of a force about a point

τ=Fxl
M = Moment
F = Force
l = perpendicular distance from the
fulcrum to the line of action/moment
arm/ lever arm

•Units of moment is Newton metre [Nm]

 Moment

http://www.pt.ntu.edu.tw/hmchai/BM03/BMsports/Run.htm
The whole science of mechanical
engineering is based on the three laws
of force propounded by Sir Isaac
Newton:
 Force: Newton’s Laws of Motion

• The analysis of the forces that cause the motion

 Force: Newton’s Laws of Motion
Newton’s law of motion

Objects Will Keep On

The first law
Doing What They
(Law of inertia) Are Doing

More mass means more force

The second law
needed to accelerate the object
(Law of acceleration) F = ma

The third law For every action there is an equal

(Law of reaction) and opposite re-action.
 Mechanical loads in the
human body

• Compression: pressing or
squeezing force directed axially
through a body

• Tension: pulling or stretching force

directed axially through a body

• Shear : force directed parallel to a

surface
 Pressure

Pressure : the ratio of force to the area over which that force is
distributed.

F
P=
A

http://en.wikipedia.org/wiki/Pressure
 Mechanical loads in the
human body
•Torsion : load producing twisting of a body
around its longitudinal axis

•Bending : asymmetric loading that

produces tension on one side of a body’s
longitudinal axis and compression on the
other side
 Motion
• Linear motion : along line that may be straight or curved with all parts of the body
moving in the same direction at the same speed

• Angular motion : involving rotation around a central line or point

 Anatomical Reference Position

• The anatomical position, with three reference planes and six

fundamental directions.
Anatomical References Axis
The motions of the joints
The motions of the joints
Muscle Force
Muscle Force
 Types of Muscle Contraction

Let‘s guess!
• Concentric contraction a
• Eccentric contraction
• Isometric contraction
b

c
 Concentric Contraction
• Shortening contraction
• One or both attachments move closer to the middle of the
muscle
• Positive work, power generation (accelerators)
 Eccentric Contraction
• Lengthening contraction
• Negative work, power absorption (decelerators/shock
absorbers)
• More energy efficiency than concentric! (hence most
frequent type of contraction in normal gait)
 Isometric Contraction
• Static contraction
• Not enough force to cause movement and does not give
way to another force attempting to cause movement of a
body part, no movement occur between body parts
• Postural & antigravity muscles
• Stabilizers
 Joint Force
➢ The forces that exist
between the articular surfaces
of the joint.

➢ Joint forces are the result of

muscle forces, gravity, and
inertial forces.
Apply Concept To
KAFO
 Function of H/KAFO,KO, HO
• Is it same basic functions of AFO???
 Function of H/KAFO,KO, HO
• Motion control
• Correction
• and Accommodation
***but cover more areas
• Motion control is to assist, support or limit motions in case there are lacked or undesired motions.

• Correct is to realign misalignment back to its reference position if patient’s deformity is flexible.
• For deformities which are no longer responding to the forces, orthoses aim to accommodate
them instead of giving external corrective forces (NYU, 1986).
 Control of Orthotic Devices
• HOW?
 Apply Concept of Force
Orthosis applies forces to a limb or body segment
 Apply Concept of Force
How and where does the orthosis apply force to provide
stability or to control movement at a particular joint?

41
 Apply Concept of Force
In what planes of movement does the
orthosis have an effect?

42
Apply Concept of Force
Apply concepts: Lever Arm & Area
Corrective Force Control System

1.Three Points Pressure 3PP

2.Four Point Pressure 4PP

3.Ground Reaction Force (GRF)

 Three Point Pressure (3PP)

Definition: The use of an orthosis to stop or resist the rotation

of two body segments about their shared point of rotation.
 Three Point Pressure (3PP)
Description: F1

• Two forces (F1, F2); one applied at the F3

free end of each segment

• Opposed by a third force (F3, Corrective

force); applied at the point of rotation.

F2
• F1+F2=F3
 Three Point Pressure (3PP)
F1
• A variation of the 3PP
control system → 4 point F3
pressure system.

• The central force is

divided into two forces F4
(F3, F4)
F2
Why???
 Three Point Pressure (3PP)
F1

• A variation of the 3PP control system

→ 4 point pressure system F3

• The central force is divided into two

Forces (F3, F4)
F4
• Pressure is usually not tolerated directly on
the anatomical joint F2
 Three Point Pressure (3PP)
F1
• A variation of the 3PP
control system → 4 point
F3
pressure system.
• The central force is divided
into two forces (F3, F4)
✓ Pressure is usually not F4
tolerated directly on the
anatomical joint F2
✓ An orthotic trimline too close to the
articulation may restrict motion.
 Three Point Pressure (3PP)
Applications:
• Control foot drop
• Correct calcaneovalgus
• Control forefoot abbduction
• Control knee valgus
• Control knee varus
• Control knee flexion
• Control knee extension
• etc.
 Three Point Pressure (3PP)

How can you apply them into KAFO?

From previous equations:

1. F
P =
A

2.  = F . r
 Three Point Pressure (3PP)

• How can you apply this knowledge to KAFO??

 Three Point Pressure (3PP)
Can the orthosis be adjusted as the patient
grows or as functional status changes?

54
Three Point Pressure (3PP)
 Four Point Pressure (4PP)
• Knee is a modified hinge joint
• Has motions, not only rotation in sagittal and coronal
(flexion-extension and abduction-adduction)
• But also translation
Four Point Pressure(4PP)
 Transverse Plane

Fig 2.12 Internal rotation of the tibia (anticlockwise moment) can be control by using
an opposed direction moment(clockwise).
 Ground Reaction Force (GRF )
Definition :
The use of the GRF to control
the motion of a body
segment and/or joint with or
without the use of an orthosis.
 Ground Reaction Force (GRF)
Description :
During swing phase, the foot not touch the ground and no
GRF is generated. When the foot contact the ground, GRF is
applied by the ground to lower extremity.
 Ground Reaction Force (GRF)
Application :

• GRF produces the movement about the anatomical joint.

• The resulting motion at the anatomical joint is

dependent on:

• position of the line of GRF action

• movement available at anatomical joint.
 Ground Reaction Force (GRF)
Example
 Functional Different Between GRF Control and
3PP Control
GRF control
1. Dependent on contact with
the ground (stance phase only)
2. Dependent on shoe structure and
interface
3. Controls joints proximal to orthosis
4. Less safe – joint stability
dependent on terrain
5. More efficient – may allow more
motion of the affected joint 3PP
control
3PP control
1. Effective in all conditions
(stance and swing phase)
2. Not dependent on shoe structure
and
interface
3. Controls joints within orthosis
4. Safe – joint stable on all terrain
5. Less efficient – may restrict joint
 Functional Different Between GRF Control and
3PP Control
GRF control 3PP control

1. Dependent on contact with the 1. Effective in all conditions ( stance and

ground (stance phase only ) swing phase )

2. Dependent on shoe structure and 2. Not dependent on shoe structure

interface and interface

3. Controls joints proximal to orthosis 3. Controls joints within orthosis

4. Less safe – joint stability dependent on 4. Safe – joint stable on all terrain
terrain

5. More efficient – may allow more 5. Less efficient – may restrict joint
motion of the affected joint 3PP control
 Orthotic Joint Placement

What is the different between

anatomical knee joint and orthotic
knee joint?
 References
• Ron Seymour . “Prosthetics and Orthotics Lower Limb and Spinal”, A wolters kluwer, London, 2002

• Michelle M. Lusardi and Caroline C.Nielsen, Orthotics and Prosthetics in Rehabilitation, Butterworth
Heinemann, New York, 2000

• Calais-Germain, Blandine. "Anatomy of Movement", Eastland Press, 1993

• Michael W. Whittle. “Gait Analysis: An introduction: 4th
Editions”
• http://www.ortho-worldwide.com/afobi.html
• Final draft of SSPO Manual

• P.Bowker, D.N.Condee, D.L. Bader, D.J.Pratt.”Biomechanical Basis of Orthotic Management”, Butterworth

Heinemann, Oxford, 1993