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DR. GAJANAN BHALERAO (PT) MPTh Neuro, MIACP, MIFNR, MIAP SENIOR LECTURE Masters in physiotherapy, Neurosciences Sancheti Institute College of physiotherapy, Shivajinagar, Pune. Mobile : 9822623701 Email:Gajanan_bhalerao@yahoo.com, gajanan.neurophysio@gmail.com PUBLICATIONS:- Comparison of Motor Relearning program versus Bobath Approach in acute stroke rehabilitation: Journal of Orthopedics And Rehabilitation, India, 2011 RESEARCH PAPER PRESENTATIONS & AWARDS:- INTERNATIONAL 1.Winner Of Young Presenters Scholarship From Epilepsy Foundation India, in the conference of“International congress on neurology and rehabilitation Goa April 2010”, STATE LEVEL: 1. Winner of best paper award in engeering and technology category In Avishkar 201o of Maharashtra university of health sciences (MUHS), Nashik India. 2.WINNER OF BEST PAPER FOR scientific paper presentation in AVISHKAR 2010 of Maharashtra University of Health Sciences (MUHS), AURANGABAD, India. REESOURCE PERSON/COURSE INSTRUCTOR:- I have conducted Conducted workshop on 1. 2D & 3D Gait Analysis and its Management 2. MOTOR RELEARNING PROGRAM- for stroke rehab 3.Spinal Cord Injury Rehabilitation

Wednesday, 16 November 2011

Mamangment of hyper-extension of knee or genu recurvatum inHemiplegic patient

Hemiplegic patient have a common gait deviation during their gait training is hyper-extension of knee or  genu recurvatum.
Cause of  genu recurvatum are,
1. in case of weakness of platar flexors , . flail foot & weakness in whole limb use HIGH AFO. That is the posterior strap of the AFO is hiogh enough up the lower margine of popliteal fossa.this long leverage prevents it from going backward.
2.But this will not work in patients who walk with forward lurch posture or those who take bigger step length of opposite unaffected leg.the solution for this is very simple reduce the step length of opposite leg and allow him to step by the affected leg instead of going ahead. this will pull back the line of gravity which was falling forward to knee and reduce hyper extension.
3. in hte patients having sever hyeperextension and canr be corerected by all these measures then the last solution is use KAFO for walking.
4. knee surgery are not successful for preventing hyperextesnion.
5. In TA tightness -do stretching but the effect doesn't last longer in the functional activity of walking. so we should give functional stretching.  for this  use modified AFO{FRO} : shift the calf bad of AFO anteriorly this produces good three point pressure phenomenon and helps in stretching the TA in functional activity of walking and helps in  reducing  recurvatum.
6. In cases  Poor trunk control and imbalance  or low postural tone ( Down & hypotonic CP. wok on postural tone , trunk control in addition give AFO & walker with forearm support this reduces the forward flexion of trunk

7 comments:

  1. Sir can we also use taping for above and below the popliteal fossa? This would keep the knee slightly flexed and later on we will discard it when patient shows better trunk control

    And if severe Gastro tightness.. 5 degree dorsiflexion night splints can be used?

    thankyou,

    Rohan Sawant

    ReplyDelete
  2. Taping doesnot help in this case. taping doesn't give mechanical block. Aim of taping is to provide proprioceptive feedback of the chaning range when there is stretch due to knee extension.

    taping doesn't stop hyperextension & cant keep in in flexion.

    In case of sever TA tighness. you can use AFO with dorsiflexion. but using AFO as the resting splint will not work. we have to make the the patient walk with AFO. that helps in giving repeated stretch on TA. during stance phase. the new lenght will persist for longer that the repeatative balistic stretching.

    i hope. this clears yours your query!

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  3. Sir are there an particular functional exercises to improve hyperextension of knee without the use of AFO..if the patient is chronic hemiparetic,can walk independently without AFO.

    ReplyDelete
    Replies
    1. chronic patients with spasticity can walk independently, provided they don't get pain and over stretching of knee joint capsule. there are exercises for improving the knee control and decrease hyperextension. i will write it in another blog.

      Delete
  4. hi sir,
    m a patient of ataxia. SSEP reports conformed it as sensory ataxia...have imbalance from trunk and knees. exercising and having alternate therapies. recovering but knee hyper-extention makes situation worse..
    kindly suggest me some ways to get over (already using braces & doing exercises)
    waiting for positive reply
    savneet

    ReplyDelete
  5. Hello sir my sister has genu recurvatum bilateral , she doesn't have other problem mean no neurological problem it was developed from childhood , at the beginning we did not noticed but now she is 27 year old and having pain on walking

    ReplyDelete