All articles are permanently available online to the public without restrictions or subscription fees. All articles are free to be used, cited, and distributed, on condition that appropriate acknowledgment is included. Authors are the copyright holders of their original contributions and grant the Canadian Prosthetics & Orthotics Journal (CPOJ) a license to publish the article and identify itself as the original publisher. CPOJ articles are licensed under the Creative Commons Attribution 4.0 International License. CPOJ Website: https://jps.library.utoronto.ca/index.php/cpoj/index Editorial Office: cpoj@online-publication.com ISSN: 2561-987X CPOJ is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE). VOLUME 3, ISSUE 1 2020 Balkaya I, Altschuler E.L. Correcting sherrington’s gait dysfunction with an off the shelf knee orthotic. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.4. https://doi.org/10.33137/cpoj.v3i1.34528 PROFESSIONAL OPINION # # THERE IS NO PEER REVIEW PROCESS FOR PROFESSIONAL OPINION ARTICLES. http://creativecommons.org/licenses/by/4.0/ https://jps.library.utoronto.ca/index.php/cpoj/index mailto:cpoj@online-publication.com https://publicationethics.org/about/our-organisation https://publicationethics.org/about/our-organisation https://doi.org/10.33137/cpoj.v3i1.34528 1 Balkaya I, Altschuler E.L. Correcting sherrington’s gait dysfunction with an off the shelf knee orthotic. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.4. https://doi.org/10.33137/cpoj.v3i1.34528 PROFESSIONAL OPINION CORRECTING SHERRINGTON’S GAIT DYSFUNCTION WITH AN OFF THE SHELF KNEE ORTHOTIC Ihsan Balkaya, Eric L Altschuler* Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA. Orthotics have been used to correct genu recurvatum in patients with hemiparesis following stroke1, 2 but have not typically been used to correct a pure proprioception deficit. In our Physical Medicine and Rehabilitation (PM&R) Prosthetics and Orthotics clinic, we have found that off the shelf orthotics can be beneficial in treating gait dysfunction secondary to sensory deficits. This professional opinion describes, with supporting videos, a case where an off the shelf knee orthotic corrected the gait and function of a patient with hemisensory loss including proprioception following a stroke. Interestingly, this case corrects a human analogue of a functional deficit found experimentally in monkeys in the 19th century by Mott and Sherrington.3 Mott and Sherrington showed that a purely sensory lesion in monkeys—sectioning the dorsal root ganglia—caused profound gait dysfunction.3 Analogously, we saw a patient with a history of left thalamic stroke who presented with the inability to walk more than five minutes before stopping. He had normal strength (5/5) in the right leg, but absent light touch and proprioception (all joints) and his gait demonstrated significant recurvatum (Video 1). A sports knee brace set in fixed 10 degrees of flexion not only prevented recurvatum, but also immediately normalized the gait (Video 2). The patient can now walk more than a mile without stopping, and his quality of life has returned to what it was before the stroke. Video 1 :Severe right knee recurvatum and gait dysfunction without the brace. Video 2: No recurvatum and a normal gait with brace on. It is of interest to note that when the patient in this case tried taking even a single step with the brace on, but his eyes closed, he immediately started to fall. However, when walking with his eyes open and wearing the brace, he did not need to watch his leg, instead simply had to look ahead to where he was going and was able to walk. This indicates that visual feedback on his position and the direction he intended to walk is likely integral to his motor ability to ambulate in the absence of proprioception. We have been pleased to find that we can provide significant clinical benefit to persons with Mott and Sherrington’s gait dysfunction using a simple, inexpensive, off the shelf knee orthotic and believe this approach has the potential to be implemented worldwide. DECLARATION OF CONFLICTING INTERESTS The authors have no financial or other conflicts. The patient gave written informed consent for use of the videos. REFERENCES 1.Portnoy S, Frechtel A, Raveh E, Schwartz I. Prevention of Genu Recurvatum in Poststroke Patients Using a Hinged Soft Knee Orthosis. PM R. 2015;7(10):1042-1051. DOI:10.1016/ j.pmrj.2015.04.007 OPEN ACCESS Volume 3, Issue 1, Article No.4. 2020 Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index ABSTRACT This professional opinion describes the use of an off the shelf knee orthotic to correct the gait and functional mobility of a patient with hemisensory loss including proprioception following a stroke and provides supporting video. Interestingly, this case corrects a human analogue of a functional deficit found experimentally in monkeys in the 19th century by Mott and Sherrington. *CORRESPONDING AUTHOR Eric L Altschuler, MD, PhD Metropolitan Hospital 1901 First Avenue, New York, NY, 10029, USA. E-Mail: altschue@nychhc.org Phone: (212) 423-6448 Fax: (212) 423-6326 ORCID: https://orcid.org/0000-0002-3575-6954 ARTICLE INFO Received: June 25, 2020 Published: July 15, 2020 CITATION Balkaya I, Altschuler E.L. Correcting sherrington’s gait dysfunction with an off the shelf knee orthotic. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.4. https://doi.org/10.33137/cpoj.v3i1.3 4528 KEYWORDS Genu recurvatum, Proprioception, Knee Orthotic, Sherrington. https://doi.org/10.33137/cpoj.v3i1.34528 https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-1-CPOJ.mov https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-2-CPOJ.mov https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-1-CPOJ.mov https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-1-CPOJ.mov https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-2-CPOJ.mov https://jps.library.utoronto.ca/index.php/cpoj/index mailto:altschue@nychhc.org https://doi.org/10.33137/cpoj.v3i1.34528 https://doi.org/10.33137/cpoj.v3i1.34528 2 Balkaya I, Altschuler E.L. Correcting sherrington’s gait dysfunction with an off the shelf knee orthotic. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.4. https://doi.org/10.33137/cpoj.v3i1.34528 ISSN: 2561-987X CORRECTING SHERRINGTON’S GAIT DYSFUNCTION Balkaya & Altschuler, 2020 CPOJ 2.Appasamy M, De Witt ME, Patel N, Yeh N, Bloom O, Oreste A. Treatment strategies for genu recurvatum in adult patients with hemiparesis: a case series. PM R. 2015 Feb;7(2):105-12. DOI: 10.1016/j.pmrj.2014.10.015 3.Mott FW, Sherrington CS. Experiments on the influence of sensory nerves upon movement and nutrition of the limbs. Proceedings of the Royal Society of London 1895; 57: 481–488. AUTHORS BIOGRAPHY Dr. Ihsan Balkaya is currently a PGY-3 PM&R resident at the New York Medical College/Metropolitan Hospital program. After receiving his medical degree from Istanbul University, he completed his internship at Wayne State University in Detroit, MI. A competitive handball player he is interested in sports medicine. Eric Altschuler, MD, PhD is Associate Chief of PM&R at Metropolitan Hospital in New York City and Clinical Associate Professor at New York Medical College. He is board certified in PM&R, Brain Injury Medicine and Neuromuscular Medicine. The main focus of his research is clinically applied cognitive neuroscience. https://doi.org/10.33137/cpoj.v3i1.34528