Background It is known that the knee is divided into 3 compartments: medial, lateral and femuro-patelar. The medial compartment is more exposed to stress due to the knee biomechanics where the weight of load is in biggest proportion. The hemi-paretic patient supports modified forces in the knee-joint due to the muscle spasticity, fact which determines a redistribution of forces, so that through quadriceps failure and gastrocnemian muscle spasticity it would generate genu recurvatum, with modified biomechanics and redistributed areasof taking weight, making a vicious circle.
Objectives We propose to prevent the formation of genu recurvatum at patients who suffered a stroke with hemi-paresis and reduce the changes at those who have already developed these modifications.
Methods There were 26 patients selected for this study (14 women and 12 men, all over 45 years old) with a 2-year-old stroke, with secondary developed knee osteoarthritis at hemi-paretic lower limb. The patients were evaluated both through muscular and joint tests as well as knee front and profile X-rays. These patients were divided in 2 study groups. Both groups followed a rehabilitation program – physiotherapy, peripheral magnetic stimulation on the muscle motor points -18 days, when we followed the toning of the failing muscles to correct the knee muscle balance: quadriceps and tibialis anterioris muscles – to counteract the gastrocnemianus muscle spasticity, correcting position of genu recurvatum and ankle orthotic. The patients of the Study Group A followed this program while being hospitalized – 18 days, repeated and adjusted at 3 months. The patients of Study Group B of followed this program for 6 months with adjustedkineticprogram, the magnetic stimulation being applied 10 days/month. The evaluation was also initially made at 6 months with joint testing scale, and VAS pain scale, the 6MWD (6 Minute Walking Distance test), the WOMAC (Western Ontario and McMaster Universities Arthritis Index), and Ashworth spasticity testing scale (from 0 to 5).
Results Group A did not obtain any improvement at the joint testing. The pain in the knee was reduced from 70.2 to 51.4 mm on VAS scale. The 6 MWD test made by moving with crutch recorded an average improvement of 15.6 m. The WOMAC scale recorded a score drop from 74.2 to 41.4. The Ashworth scale dropped from 3.5 to 3.
Group B presented better results, a reduction of genu recurvatum observed and proved by the improvement with 5 degrees at the joint testing for extension. The VAS scale improved from 71.3 to 34.5. The 6 MWD test proved a growth in the walking capacity with 23.4 m. The WOMAC scale recorded a significant drop from 78.4 to 32.3, and Ashworth scale dropped from 3.6 to 2.7.
Conclusions Sustained physical therapy correctly executed with periodical adjustment of the program as well as the repetitive magnetic stimulation peripherally applied on the failing muscle groups prove that the invalidity induced by genu recurvatum at this special category ofpatients is reduced functional as well as by objective assessment through evaluation tests.
Assessment of genu recurvatum in hemiplegic patients, Figen Gokoğlu MD*, et al. Ankara Fizik Tedavi ve Rehabilitasyon E?itim Araflt?rma Hastanesi, Fiziksel 155;p 2002; 5(2): 73-78
Disclosure of Interest None Declared
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