Non-affected Side Preceding Forward Approach on Descending Stairs in Hemiplegic Patients: Report of 3 Cases

Abstract

This report describes the clinical experiences of “non-affected side preceding forward approach” namely, the method to descend stairs by turning forward to stairs, unloading affected lower extremity (L/E) after non-affected L/E and placing both feet on the same step in hemiplegic patients. Three hemiplegic inpatients (two cases with intracerebral hemorrhage in chronic phase and one with brain tumor) who could not descend stairs by traditional approach due to the marked adduction of affected L/E. At the onset of the exercise, all the patients had moderate motor paresis (Brunnstrom stage III) and mild or moderate hypesthesia including both superficial sense and deep sense of affected L/E. They were independent in all activities of daily living (ADL) except for descending stairs and bathing. Although all the patients needed a handrail on descending stairs by non-affected side preceding forward approach, they became independent in descending stairs within a week after the onset of the exercise. In addition, no adverse effects such as joint pain, increase in spasticity of affected L/E and falling on descending stairs due to non-affected side preceding forward approach were observed from the onset of the exercise to follow-up period after discharge (approximately two years) in all the patients. These results suggest that non-affected side preceding forward approach would be one of the means to improve in ADL of hemiplegic patients who cannot descend stairs by traditional approach.