Causes and management of hyperextension of knee in hemiplegic and Paraplegic

English: Right knee. (Photo credit: Wikipedia)

Capsule of right knee-joint (distended). Lateral aspect. (Photo credit: Wikipedia)

Genu recurvatum is a deformity in the knee joint, so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee. This deformity is more common in women and people with familial ligamentous laxity.

Hyperextension of the knee may be mild, moderate, or severe.

Normal range of motion (ROM) of the knee joint is from 0 to 135 degrees in an adult. Full knee extension should be no more than 10 degrees. In genu recurvatum (back knee), normal extension is increased. The development of genu recurvatum, may lead to knee pain and knee osteoarthritis.

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. Weakness of plantar flexors:

2. Flail foot i.e. polio, cerebral palsy etc

3. Tightness of plantar flexors (TA tendon)

Becouse of above factors patient shows a poor loading responce in gait.

In normals loading responce ankle goes from 10 degree of plantar flexon to 10 degree of relative dorsiflexion and knee in 10-20 degree of lexion. There is anterior translation of tibia over the fixed foot.

This anterior translation of tibia over the fied foot is affected due to TA tigthness.

In weakness of  plantar flexors & flail foot  if tibia moves over the fixed foot and goes in to relative dorsiflexion then this may lead to buckling of knee and lead to poor stability during loading responce to mid stance. to avoid this patient does the compansotory movement of, avoiding the anterior translation of tibia and forward lurching gait, with locking of knee. frequent use of this pattern of locking mechanism of knee during walk leads to hyperextension of knee.

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 the patients having sever hyeperextension and can't be corrected 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.

References

1. WHO | Stroke, Cerebrovascular accident [Internet]. [cited 2010 Aug 3]; Available from: http://www.who.int/topics/cerebrovascular accident/en

2. Tapas kumar banerjee et al. Epidemiology of stroke in India. Journal of Neurology Asia.2006;11:1-4.

3. Edward R. Laskowski, M.D. Hyperextended knee: Cause of serious injury http://www.mayoclinic.com/health/hyperextended-knee/AN00283

4.Jennifer Kirkman, Yahoo! Contributor Network. Hyperextended Knee-Causes, Symptoms, Diagnosis, and Treatments

5.  what is genu recurvatum?  http://www.wisegeek.com/what-is-genu-recurvatum.htm.

6. Allison Cooper et al. The Relationship of Lower Limb Muscle Strength and Knee Joint hyperextension during the Stance Phase of Gait in Hemiparetic Stroke Patients. Journal of Physiotherapy research international.2011;(17)1.

7. Lucarli P et al. Alteration of load response mechanism of knee joint during hemiparetic gait following stroke. Journal of clinics.2007;22:813-820.

8. Susan Richardson. Assessing knee hyperextension in patients after stroke: comparing clinical observation and Siliconcoach software. International Journal of Therapy and Rehabilitation, Vol. 19, Iss. 3, 07 Mar 2012, pp 163 - 168. http://www.ijtr.co.uk/cgi-bin/go.pl/library/article.cgi?uid=90240;article=IJTR_19_3_163_168.

9. Bleyenheuft et al. Treatment of genu recurvatum in hemiparetic adult patients: A systematic literature review. Journal annals of physical and rehabilitation medicine.2010;53(3):189-199.

10. Rehabilitation, Treatment and Orthotic Management of the Stroke Patient. http://www.healio.com/orthotics-prosthetics/orthotics/news/online/%7BBDC02BFE-6C76-42E6-8457-462C3F6EC0B7%7D/Rehabilitation-Treatment-and-Orthotic-Management-of-the-Stroke-Patient

Spinal Cord Injury Rehabilitation workshop organized by Indian Association of Physiotherapist Pune Branch and Sancheti Institute college of Physiotherapy, Pune

Indian Association Of Physiotherapy Pune Branch & Sancheti institute College Of Physiotherapy organized a workshop on SPINAL-CORD INJURY REHABILITATION  on 27^th and 28^st October  2012 . Course instructor was Dr. Gajanan Bhalerao (PT) MPTH Neuro, Associate professor, Sancheti College of Physiotherapy & Inchargeof Department of Neuro and Spine Rehabilitation Sancheti Hospital, Pune.

In this course 32 students from all over Maharashtra Physiotherapy colleges & clinical therapist attended the work shop. The workshop was inaugurated By Dr. Meenakshi Pandit, Convener IAP Pune branch, along with Dr. Apurv Shimpi Treasure Executive Committee   Member Dr. Anushree Phansalkar IAP Pune branch.

We had Invited Major Bist, administrator director Paraplegic Rehabilitation Centre Kharaki, Pune to give information the functioning and activities of paraplegic at their centre.  Pararaplegic are living at the centre and all of them are independent in their lifestyle and earning livelihood through vocational rehab.

Dr. Vijay Gupta MPT neuro (USA) was also helped during the practical session for supervising the particiapnt practice of practical demos done in the workshop.

           

The workshop included the neuro anatomy, mat exercises, transfer training, ambulation training etc. Participant were taught how to set the goals according to level, severity and available period of admission, OPD bases taking into account his lifestyle, contextual and environmental factors in his own home/village/town/city.

Practical demos of treatment on patients  was shown. Different techniques of facilitation voluntary control/strengthening was demonstrated on patients with incomplete cord injury TYPE B/C/D/E. Two quadriplegic who were showing type A in first few months were called in the workshop who are now high functioning walking independently, driving two wheelers with added two wheels independently .  Car transfers’ training of patients was shown. Indications and contraindication of different orthotics and prescription of orthosis taught .   

                                                                                                         Modified bike for para

car transfers

Car modifications

Workshop details

Day 1 Saturday -27th /10/12

Registration and breakfast

Introduction Overview of anatomy of spinal cord Incidences of SCI Classification of  SCI Clinical syndromes Physical effect of spinal cord injury Levels of injury & functional abilities

Physical therapy evaluation and goal setting; ASIA scale

Functional goals & Strategies for functional rehabilitation

Case Studies

Evaluation

Day two Sunday - 28th/10/12

Assessment, prescription & Wheel chair ambulation training

PWB Treadmill Training role of Central pattern generators(CPG)

Orthotic prescription

Stair case climbing training

Gait training.

Bladder and Bowel training

Bed sore prevention

Role Of Stem Cell Therapy

Participant's Feedback on course content and training was taken at the end of both day. All the students like the detailed anatomy and its clinical apllication, differential diagnosis & classfication of different spinal cord injury. Every learned a lot from the lab session of ASIA assessment on patients.  On post workshop feedback all the participaants reported that, they leanred lot of new techniques of faciltation, multiple alterantive methods for bed mobility, transfers and ambulation training, wheechair modification, Orthotic fixation, and Role of steam cell in SCI rehabilitation. Everone extreamely satisfied.

STUDENTS PARTICIPATED IN WORKSHOP

S. NO.	NAME	STATUS	PLACE
1	RADHA AJAY MEHTA	PRACTICE	MUMBAI
2	NEHA MANJUNATH	PRACTICE	MUMBAI
3	JUIE MESVANI	PRACTICE	MUMBAI
4	HETAL JITENDRA SHAH	PRACTICE	MUMBAI
5	HIRAL PRASHANY SAMPAT	PRACTICE	MUMBAI
6	DEEPMALA DINESH SHARMA	PRACTICE	MUMBAI
7	DARSHINI VIJAY DESAI	PRACTICE	MUMBAI
8	SNEHA JADHAV	INTERN	PUNE
9	MANALI DEVANE	MPT	PUNE
10	RUCHITA KOTEWAR	MPT	PUNE
11	SURYAKANT GADGERAO	MPT	PUNE
12	TUSHAR DHAWALE	MPT	PUNE
13	MRUNAL HARLE	MPT	PUNE
14	PRATIBHA SALKAR	MPT	PUNE
15	ARCHANA GIDWANI	PRACTICE	PUNE
16	SADHANA	MPT	PUNE
17	PURTI	MPT	PUNE
18	RASHMI	MPT	PUNE
19	NIMISHA MISHRA	MPT	PUNE
20	SANNA SAYED	PRACTICE	MUMBAI
21	SHARDA BHALERAO	INTERN	PUNE
22	CHETANA AHER	INTERN	PUNE
23	JAY PAWAR	PRACTICE	PUNE
24	ABHA BHUTADA	PRACTICE	PUNE
25	RAJASHREE FADNAVIS	MPT	PUNE
26	APOORVA PHADKE	PRACTICE	PUNE
27	ASHWINI KAMBLE	PRACTICE	PUNE
28	NITIN CHOUKE	MPT	PUNE
29	CHANDALI DOSHI	MPT	PUNE
30	HARSHIKA BHANUSHALI	INTERN	PUNE
31	SNEHA MULE	PRACTICE	PUNE
32	DENZIL FERNANDES	PRACTICE	PUNE

Basic Neuro-Developmental Treatment (NDT Paeds) workshop in November -December 2012

Indian Association Of Physiotherapy Pune Branch &  Sancheti College Of Physiotherapy Pune

Organizing a workshop on

Basic Neuro-Developmental Treatment (NDT Paeds)

Course Instructor- DR. ASHA CHITNIS MPT, NDT paeds

This is an exciting and intensive training course for physical therapists, occupational therapists, and speech and language pathologists comprised of both theoretical and practical work. The material presented in the course is based upon the theoretical and practical concepts developed by Dr. Karel and Mrs. Berta Bobath and conforms to the standards established by the NDTA, Inc.

This course will be held at Sancheti Institute College of physiotherapy,Shivajinagar, Pune & Sancheti hospital Shivajinagar, Pune. Please note that this is an intensive weekend format (Saturday  & sunday) on 24th & 25th November and 8th & 9th December 2012. The number of days in class will total 4 days with class running between the hours of 8:30 am and 5:00 pm. This course curriculum is outlined to include a minimum of 24 hours, inclusive of lectures, group work and presentations, discussions, demonstrations, and patient treatment.

The course will cover: fundamentals of NDT philosophy; neurophysiology as it relates to NDT; typical and atypical movement development; fine motor development and sensorimotor aspects of development of functional skills, typical and atypical development of upper and lower extremity  and the progression through space, including gait; and treatment principles and application.

The course is limited to a total of 30 therapists, including physical therapists, occupational therapists,

The course contents 
(1) Motor control & it's clinical Reasoning
(2) Normal & Abnormal Development
(3) Evaluation of child with CP
(4) Guiding Principles of treatment
(5) sensory Processing & NDT
(6) handling treatment Principles & Demo

Who can attend?

1. All the clinical therapist interested in peads (PT &OT)

2. Interns BPT

3. Master of physiotherapy

4. Master of occupational therapy

Why to attend this course?

1. NDT bsci course will help the therapist interested in Neuro & peads in understanding motor control, normal and abnormal development, Evaluation of children with Cerebral Palsy.

2. This course helpfull for all the MPT/MOT students in the masters programe because each master has to study motor control, normal development and neurotherapeutic approches. This course will help them in better understanding.

3. The course in Pune is organised in a educational institute who has very good infrastucture with AC rooms which helps us in keeping the course cunduction cost less compared to the course organized in 3-5 star Hotel in Mumbai (cost of event and food is very high in Mumbai).

Numbar of seats awailable =30

Course fees = Rs 5000/-

Venue = Sancheti College Of Physiotherapy Pune

Contact : Apurv Shimpi (Treasure of IAP Pune branch) 9890183195, apurv008@gmail.com

Or Gajanan Bhalerao -9822623701 gajanan_bhalerao@yahoo.com