Hemiparesis and LE weakness

Hemiparesis and LE weakness

John T. Brinkmann

9/4/2007

I'm working with a patient who has right hemiparesis secondary to a TBI. The patient has no hip flexors, knee ext/flex, or PF/DF. She wears a solid AFO, with Tamarack joints in place, so it could be a free dorsi, or a dorsi assist AFO. This was originally provided on the assumption that patient would regain some hip and knee control. This has not happened. Patient is on medication to reduce tone, and currently has passive DF ROM to neutral, but not beyond. (So, articulating the AFO wouldn't accomplish anything.) The patient ambulates by dragging the right LE, with the tip of the shoe rubbing against the floor. She has worn out several shoes this way. She ambulates fairly rapidly with a walker.
   
  The therapist asked about a KAFO, so I applied a post-op KO over the AFO and knee to demonstrate the functional consequences of that option. It was much more difficult for the patient to drag the LE with the KO on.
   
  My question: Is there some orthotic management that would aid in toe clearance? One therapist suggested a leg-lifter - basically, a strap she could use with her hand to raise the foot. Balance is a concern, so this wasn't considered. I recommended a heel/sole lift on the contralateral side. Am I missing something? Is there a simple solution to this situation?
   
  Any suggestions appreciated.
   
  John Brinkmann, CPO

       
---------------------------------
Ready for the edge of your seat? Check out tonight's top picks on Yahoo! TV.