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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 # 

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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
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https://online-publication.com/wp/wp-content/uploads/2020/07/VIDEO-2-CPOJ.mov
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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

