Reversal of Chronic Post-Stroke Genu Recurvatum with Progressive Robotic Gait Training: A Case Report

Abstract

Objectives: Genu recurvatum is a common gait abnormality in ambulatory stroke survivors, often persisting into the chronic phase and causing problems such as knee pain or interfering with balance ability. While robotic gait training has shown benefits in subacute populations, its application in chronic stroke with longstanding knee hyperextension remains underreported. This study aim to report whether a systematically progressive robotic gait training program can reverse longstanding post-stroke genu recurvatum in a chronic stroke survivor

Case Presentation: We report the case of a middle-aged female, two years post-right middle cerebral artery infarction, who presented with persistent left knee hyperextension during the stance phase and fear of falling. She underwent a year-long outpatient-based robotic gait training program using the SensibleSTEP^® end-effector device, followed by Body Weight Supported Treadmill Training (BWSTT). The training was based on the principle of “as much support as necessary, but as little as possible,” with progressive adjustment of gait speed, step length, and body weight support. A speed challenge protocol was introduced after the patient achieved basic stance-phase control. Despite a mid-course setback due to spasticity, managed with a tibial nerve phenol block, the patient progressed to full prevention of knee hyperextension and achieved independent ambulation at low speed without the use of gait aids.

Conclusions: Carefully structured robotic gait training, incorporating progressive speed challenges, may help reverse chronic genu recurvatum even years after stroke. This case suggests that robotics can extend the therapeutic window for gait recovery in individuals with chronic stroke.