State of the art review of knee-ankle-foot orthoses.

Knee-ankle-foot orthoses (KAFOs) are used to assist in ambulation. The purpose of this paper is to review existing KAFO designs which can be grouped into passive KAFOs, stance control (SC) KAFOs, and dynamic KAFOs. The conventional passive KAFOs do not provide any active control for knee motions. SCKAFOs lock the knee joint during the stance phase and allow free rotations during the swing phase. Some SCKAFOs switch between the stance and swing phases using body posture, while others use some kind of a control system to perform this switch. Finally, dynamic KAFOs control the knee joint during both stance and swing phases. Four dynamic systems are identified in the literature that use pneumatics, linear springs, hydraulics, and torsional rods made of superelastic alloys to control the knee joint during the gait cycle. However, only the two systems that use linear springs and torsional rods can reproduce the normal knee stiffness pattern which has two distinct characteristics: a soft stiffness during the swing phase and a hard stiffness during the stance phase. This review indicates that there is a need to conduct research regarding new KAFO designs that duplicate normal knee function during the whole gait cycle.