Gait rehabilitation in a hemiplegic patient with lateropulsion: Clinical case and use of Wheeleo®️

In this article, I will present a clinical case study of gait rehabilitation in a hemiplegic patient with several motor disorders, including lateropulsion, lack of hip flexion, and knee recurvatum. Through this case study, I will explain the use of a specific device, the Wheeleo®️ walker, as well as the use of a Velpeau bandage, which improved this patient’s stability and walking.

Gait rehabilitation in hemiplegic patients

Gait rehabilitation for patients with hemiplegia is a complex process. These patients often present postural and motor disorders that require specific adjustments in order to regain the most functional gait pattern possible. Adapted tools play a key role in compensating for motor and postural deficits, while stimulating walking automatisms.

In this particular case, my patient had a number of motor difficulties that affected the quality of her walking.

Difficulties encountered by the patient

Here are the main problems observed when this hemiplegic patient walks:

• Lateropulsion: an inclination of the body towards the affected side, causing instability.
• Lack of hip flexion in oscillatory and pre-oscillatory phases, limiting foot elevation.
• Adduction of the leg in an oscillatory phase, leading to crossing of the legs and loss of balance.
• Recurvatum of the knee in the stance phase, locking the knee excessively, but offering some stability.

Why choose Wheeleo®️?

To optimize this patient’s rehabilitation, I opted for the Wheeleo®️, a one-handed walker that offers constant support and fluid mobility.

Wheeleo®️ adjustment to counteract lateropulsion

To counteract lateropulsion, I set the Wheeleo®️ to the low position. This causes the patient to spontaneously tilt her body towards the handle of the device, creating a balance. This simple adjustment helps re-establish a more neutral posture by compensating for the initial tilt caused by lateropulsion.

Tip: The key here is to think in terms of balance. By leaning towards the walker with one hand, you can compensate for the inclination of your body (lateropulsion). The support then becomes a corrective tool.

Correction of leg adduction with Velpeau bandage

The Velpeau bandage is an invaluable aid in this context. It enabled me to limit the fall of the body towards the paretic side by correcting the adduction of the leg. By placing the foot further outwards during the stance phase, the leg is aligned correctly, reducing the tendency to cross the legs.

What’s more, this band allows me to directly adjust the progression of the foot as it passes through the step, by adjusting key elements such as amplitude, rhythm, and even the alignment of the foot on contact with the ground.

Management of knee recurvatum

The patient also wears a BlueRocker orthosis, which stabilizes the ankle and foot. However, excessive knee recurvatum persists during the stance phase. The addition of a small wedge under the heel could reduce this phenomenon, but it’s important to note that the recurvatum also provides some stability by locking the knee.

Why avoid tripod or quadripod canes?

In this case, it is essential to encourage two-step walking rather than three-step walking, as is often observed with the use of a tripod or quadripod cane. These devices run the risk of reinforcing a long-term non-functional gait pattern, with irregular rhythm and low symmetry.

Results and benefits observed

Thanks to the use of Wheeleo®️ and Velpeau tape, the patient was able to :

• Significantly reduce lateropulsion.
• Improve walking fluidity.
• Stabilize stepping through better control of leg movements.
• Regain a walking rhythm closer to normal, stimulating automatic walking patterns.

Conclusion: The importance of adapted devices in gait rehabilitation

This case study demonstrates the importance of specialized tools, such as the Wheeleo®️ or the Velpeau bandage, in the gait rehabilitation of hemiplegic patients. By adjusting the devices to compensate for motor and postural deficits, it is possible to significantly improve gait quality and promote patient independence.

The Wheeleo®️ is an excellent example of a simple yet effective tool that helps stabilize gait while reducing compensation patterns. It is one of the key solutions for therapists in optimizing motor rehabilitation.