Physical therapy for a patient with right hemiplegia after cerebral infarction who had a tendency to fall forward in a Japanese dance

Abstract

We performed physical therapy for a patient who presented with right hemiplegia after cerebral infarction. The patient was a Japanese dancer, and she fell forward toward the right side during a right lower limb backward step movement in a dance. The basic stance of the dance is an upright trunk position with slight flexion of both the hip and knee joints. Furthermore, the right lower limb backward step movement produces right pelvic elevation by slightly lowering lumbar flexion on the right side. The patient had difficulty holding the trunk in the upright position with tilting of the trunk to the right due to the depressed right pelvic position. Moreover, when the patient pulled the right lower limb backward, the trunk tilted to the right due to the persistent depression of the pelvis on the right, with insufficient left lower limb weight shift. Therefore, it was difficult for the patient to maintain an even position during right pelvic elevation due to slight flexion of the lumbar spine to the right side. As a result, the patient tended to fall forward toward the paralyzed right side. Therefore, in physical therapy, we trained the patient to step the right lower limb posteriorly during smooth weight shift to the left side, after gaining an upright trunk position. As a result, the patient showed improved safety and stability during the right lower limb backward step movement. Throughout the course of this case, it was important to understand the performance characteristics of the Japanese dance to understand the right lower limb backward step movement. Evaluation of the problems before and after the onset of cerebral infarction confirmed the need to expand the physical therapy.