genu recurvatum orthosis

[ramywhite]

Hi every body,
A case of 4 years old female suffering from head injury about 2 years ago which leads to left side hemiparesis. The case is stable now. On examination I found that:
-normal muscle tone.
-grade 3+ dorsiflxors.
-grade 3+ knee extensors.
-tightness of tendoachilis.
-genu recurvatum at midstance during gait cycle.
I need to know some hints about plan of treatment and also the suitable orthosis
Thanks

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[sdkashif]

Perform passive ROM exercises to maitain the joint mobility and range. Do stretching exercises for the muscles which are tight. Encourge graded active ROM exercises for the muscles with grade 3 so that their power is increased gradually. Correct any deviation in gait and any balance problems. Knee Orthoses for knee control in sagittal plane are used to control genu recurvatum with minimal mediolateral stability. This type of Knee Orthosis includes a swedish Knee Cage and a three way Knee Stabilizer.

Apart from that do the stationary bicycling and walking on treadmill daily for building the endurance in the muscles. This will also improve his gait.

[emad]

Hello Ramyw:
The Problem ,for me , 2 years of certain gait pattern difficult to be changed ! What can I say science did NOT support(enable)us to address such little problem ?

Cheers
Emad

[sdkashif]

But let me add further that upper motor neuron lesions give more positive results than the lower motor neuron lesions to Physical therapy.

[ramywhite]

Hello every body,
I am agree with you that 2 years of false gait pattern is very difficult to fix so I've asked mainly about orthosis. "Swedish Knee Cage" is very nice but I haven't any experience about it. But I am using AFO to prevent planter flexion. I suppose if I decrease planter flexion and increase dorsiflxion a little bit so may be I can decrease genu recurvatum without too much cost. So, if any body has any successful experience in orthosis with these cases, it will be nice sharing his ideas with us.
sdkashif: bicycling is a very good idea indeed I will try this, thanks.

[junior_physiotherapist]

But let me add further that upper motor neuron lesions give more positive results than the lower motor neuron lesions to Physical therapy.

Hi Community Leader
would u plz enlighten us more at this issue ,i think that it's difficult to make more functional advancments for U.E.!!
ANY way i'll still waiting ur responce..

Regards

[sdkashif]

If you see over the deficit and compare them in Upper motor neuron, you may find the difference.

Upper Motor Neurone Lesion

Drift of Upper limb
Weakness with Characteristic Distribution
Increase in the tone of spastic type
Exaggerated tendon reflexes
An extensor plantar response
Loss of abdominal reflexes
No muscle wasting
No electrical excitability of muscle

Lower Motor Neurone Lesion

Weakness
Wasting
Hypotonia
Reflex Loss
Fasciculation
Contractures of muscle
Trophic changes in skin and nail


So generally functional movement are diificult to get in a sense that effector organs not ready to respond well in LMN Lesion. Examples are cases of poliomyelitis, peripheral nerve injuries, etc. However, in UMN lesions after a pleatue phase, a recover patten or motor control start to develop depending upon the extent of lesion. However, there are exceptions and extent of lesions that are debatable.

[ramywhite]

Hi everybody,
Very nice discussion but the case is obviously Upper motor neuron lesion. So how you can deal with that. I mean, if you treat a 4 years old child her knee is hyper extended during mid stance, what will you do? with exercises and also most important the orthosis. The Swedish Knee Cage is very expensive. Is AFO is suitable if we restrict planter flexion to gain a good posture alignment during gait?
many thanks