Hyperextension of knee in Hemiplegics

[MGrules]

Hi everybody, I have been working on Hemiplegics adults for a long time. I am not finding good results for hyperextension of knee joint during walking in hemiplegics.
Apart from giving them PSI and strenghtening of Quads and Hams we havent come to a solid treatment. Can somebody help.

[MGrules]

Hey guys why no replies to this thread? pls try to help me or suggest any book.

[claw_pers]

Hi,
what is PSI? we advise hinged knee supports to prevent excessive joint mobility

[MGrules]

Actually if the patient has TA tightness then we provide the patient with Posterior Shoe Insert, which avoids the patient to go into hyperextension. Even hinged knee brace is not the prevention for the hyperextension. Actually i wanted to prevent hyperextension of the knee.

[meagpt22]

Can you tell me about the PSI? How it works? At work we are doing a case study regarding the prevention/treatment of knee hyperextension, and that may be an idea to bring up. Another treatment I've found that works for someone is a brace set in some dorsiflexion, which helps with knee instability and causes a knee flexion moment.

[spandanphysio]

Hi Mgrules for established cases as u mention brace set in dorsiflexion is used.another method for prevetion is positioning from initiation stage.i m using dynamic knee activities like stair climbing and wieght transfer in all direction which helps a lot to control knee joint.

[rose]

hi
MGrules i face knee hyperextension alote with the patients i am using eccentric exercises with the weigt bearing very effective and check up on hip extensor propaply its weak so its another factor try to work on it too.it will helps

[Canuck Physio]

In regards to the problems as listed below:

- Hyper extension of hemiplegic knee?

You are currently utilizing strengthening of Quads + Hams?

You mentioned TA tightness, but this is not present?

How about the Calves? Is there activation in the gastroc? If the gastroc is not activating, and the TA is compensating in some manner or another you may be getting lengthening during stance.

Have you tried strengthening the Gastroc concomitantly? As well what exercises have you completed to strengthen the hamstrings? Isolated curls will not necessarily strengthen the hamstrings sufficiently.

An exercise I would recommend is the following, which is an adaptation of the RDL which has been found to activate the Biceps femoris (via EMG activity) the most:

Position patient with support, slight bend in knee.

Provide 1 Kettle bell to lift:

Perform lift as follows:

Raise weight from the ground while extending the torso in a deadlift fashion while maintaining the slight knee flexion.

* this will train the muscle in an already shortened position, while maximally stimulating the hamstrings over its entire range:
Ref: Medicine and Science in Sports and Exercise 32(5): S55, 2000

The key for this is safety, obviously the non-hemiplegic side must be supported.

Request feedback re: above

[hari priya]

when treating hemiplegic gait i feel that the problem is not solely spasticity. it is the abnormal alignment and abnormal movement pattern that result from abnormal tone
first,do gait analysis.find out where exactly is the problem.in some patients lack of hip and pelvis control may affect knee control by altering the biomechanics and in some patients even an exaggerated tone in upper extremity could change the total alignment of the body.
divide the gait into stance and swing and do analysis. if you suspect that a particular posture or movementpattern or tone as the problem in that particular position then work on that.for example if the knee hyperextension is due to poor pelvis control with posterior pelvictilt and lack of guteus max strength then work from proximal.
remember in most of the cases lack of proximal control result in abnormal distal movement patterrns.
it is better to reducate in suitable position.some patients may exhibit good knee control in lying but when gravity acts along with body wt in walking we can see the difficulty.
so, determine where to start training.in case of subacute stroke which is progressing well by finding the problem and addressing it will give you nice results. of course for long term cases proper braces are recquired.
personally i recommend you to abnormal gait in book named motor control.and apply bobath techinque