A right hemiplegic patient secondary to cerebral infarction for whom right ankle joint dorsiflexion did not result in right forward weight shift due to pelvic right rotation associated with left hip joint external rotation during transfer

Abstract

The patient was an 80-year-old male who had right hemiplegia secondary to cerebral infarction and whose safety and stability of transfer to the left side had decreased. He came in with the chief complaint of, “I feel like I might fall backwards when transferring to a wheelchair”. Thus, the treatment goal was to improve the safety and stability of transfer movements. Specifically, when the patient stood up to transfer to the left side, pelvic left rotation did not occur with left hip joint internal rotation, putting the pelvis in a right rotated position instead. Moreover, when stepping on the left lower limb, the patient’s right thigh and lower leg tilted backwards and the right ankle joint was bottomed out, making it difficult for him to shift his weight to the right front. We considered the main problem to be a decrease in the muscle tone of the anterior fibers of the left mid-density muscle on the non-paralyzed side, and we conducted physical therapy to address this. As a result, the patient became able to shift his weight to the right front, when transferring to the left side, before stepping on the left lower limb, improving the safety and stability of the transfer movement. For this patient, it was necessary to improve not only the functional impairment on the paralyzed side, but also the functional impairment on the non-paralyzed side to improve the safety and stability of the transfer motion.