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Question: My patient is having external rotator deformity in the left leg. She had a stroke three years ago with upper limb spastic deformity. Please guide me on how to correct all deformities. Now she is having good balance for 20 min standing, and grade 2 and 3 hip movements
: Many patients learn to walk and still maintain balance even with external rotation at the hip so I would not over focus or get too sidetracked with treating the deformity/spasticity. I would continue to work on gait and balance. You could also emphasize exercises that strengthen all the muscles around the hip and work on active internal rotation as well. You also want to work on standing on the affected leg with hip in neutral position while moving/doing exercises with the non affected leg so the patient can feel what it is like to have the hip in neutral while doing weight bearing on that leg. This will also help strengthen hip stabilizers on that side. I wouldn't worry though if the hip continues to externally rotate especially since it has been this way for some time. Many patients learn to work around this posturing and still be very functional.
As far as the arm, I would again emphasize trying to use the arm if the patient has any active movement. Strengthening and range of motion can be done with spastic muscles. Years ago, it was believed that strengthening may have a negative effect on spasticity, but it has been shown that strengthening does not have a negative effect on spasticity and is recommended if the patient is able to move the arm. If you want to know specifically about spasticity treatments, you can review what research says about spasticity treatment and stroke at: http://www.ebrsr.com/sites/default/files/Appendix-spasticity.pdf
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