Disclosures: Eric Altschuler, MD, PhD: Nothing to disclose

Case Description: A 64-year-old male with a past medical history of hypertension and sleep apnea presented with right side weakness. CT showed acute left thalamic hemorrhage. Acute medical stay was complicated by brain edema treated with hypertonic saline. Nineteen days after presentation he was admitted to acute inpatient rehabilitation. Strength then was 5/5 on the right side but sensation on the right—light touch, pain and proprioception—was completely absent in the upper and lower extremities. He needed moderate assistance going from supine to sitting and sit to stand. He could ambulate only 10’ with the parallel bars and moderate assistance, and there was right leg thrusting and knee recurvatum.

Setting: Academic medical center.

Patient: 64-year old male with complete right hemisensory loss following left thalamic hemorrhage.

Assessment/Results: During ambulation the patient found it extremely helpful to watch his reflection in a long frontal plane mirror. At discharge 5 weeks later he was sit-to-stand contact guard. He ambulated 100’ × 2 with a rolling walker and minimum assistance with reciprocal gait, but still some recurvatum.

Discussion: Thirty-five years ago a case of a patient with a left retrorolandic area stroke who experienced proprioceptive loss in the right hand, found that, without visual help, maintaining a constant level of force in the hand was severely impaired. Remarkably, a lower extremity analog of this finding was recapitulated in our patient, who had a deficit in ambulation due to genu recurvatum. This hyperextension may be a mechanism of compensation to achieve stability, due to the inability of the musculature to maintain constant force required to sustain flexion. Furthermore, interestingly, in our case visual feedback using a mirror was able to substitute for absent proprioceptive reafference.

Conclusion: Recurvatum can be a significant functional problem for patients with proprioceptive loss. Mirror visual feedback may be extremely useful in therapy for this problem.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/benefit-of-mirror-visual-feedback-for-ambulation-in-a-patient-with-complete-hemisensory-loss-following-stroke-a-case-report/