Article

OBJECTIVE: To report our clinical experience and propose a biomechanical
factor-based treatment strategy for improvement of genu recurvatum (GR) to reduce
the need for knee-ankle-foot orthosis (KAFO) or surgical treatment. SETTING: Outpatient clinic of a Department of Physical Medicine and
Rehabilitation in an academic medical center. INTERVENTIONS: Adult
subjects (n = 22) with hemiparesis and GR who received botulinum injections alone
or in combination with multiple types of orthotic interventions that included
solid ankle-foot orthosis (AFO) +/- heel lift, hinged AFO with an adjustable
posterior stop +/- heel lift, AFO with dual-channel ankle joint +/- heel lift, or
KAFO with offset knee joint. Biomechanical factors reviewed included muscle
strength, modified Ashworth score for spasticity, presence of clonus, posterior
capsule laxity, sensory deficits, and proprioception.
OUTCOME MEASUREMENTS:
Outcome factors were improvement or elimination of GR based on subjective
assessment before and after the interventions by the same experienced clinician.
RESULTS: More than one biomechanical factor contributed to GR in all patients.
Botulinum toxin A injection was used in patients who had significant plantar
flexor spasticity and/or clonus. Four types of orthotic interventions were used
based on the biomechanical factor: solid AFO in patients with severe ankle
dorsiflexion and plantar flexion weakness or clonus; hinged ankle joint with
adjustable posterior stop in patients with less severe ankle dorsiflexion
weakness in the absence of clonus; AFO with a dual-channel ankle joint for
quadriceps weakness or severe proprioceptive deficits; and KAFO with offset knee
joints in patients with Achilles tendon contracture or severe proprioceptive
deficits. Adjunctive options included the addition of heel lifts and toeplate
modifications. Combinatorial interventions of botulinum injection, modified AFOs,
and heel lifts improved or eliminated GR and avoided the need for cumbersome
orthotics or surgical interventions. CONCLUSIONS: GR in hemiparesis is
multifactorial and can be successfully controlled by using a conservative
biomechanical factor-based approach and combined medical and orthotic
interventions. An algorithmic approach and a prospective study design is proposed
to determine a combination of effective interventions to correct GR.
CI - Copyright (c) 2015. Published by Elsevier Inc.

Langue : ANGLAIS