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Article Knee Hyperextension in Chronic Stroke: Associated Biomechanical and Neuromuscular Factors(Elsevier Sci Ltd, 2025) Korkusuz, Sueleyman; Korkusuz, Busra Seckinogullari; Ozgoren, Nihat; Aritan, Serdar; Ceren, Ali Naim; Topcuoglu, Mehmet Akif; Balkan, Ayla FilBackground: This study aimed to determine the gait phase in which knee hyperextension occurs in stroke patients and to investigate the factors associated with knee hyperextension. Methods: This study included 30 stroke patients aged between 40 and 70 years with maximum knee hyperextension during the stance phase of gait. Muscle strength was evaluated with manual muscle test, and muscle tone was assessed with the Modified Ashworth Scale. Kinematic evaluation of the patients was made using the motion analysis system. Additionally, categorisation was made according to the stance phase of gait, where knee hyperextension was at its highest. Findings: A weak relationship was found between maximum knee hyperextension angle and gastrocnemius spasticity, a moderate relationship between knee flexor muscle strength, and a moderate relationship between ankle dorsiflexor muscle strength. In addition, a weak relationship was found between the maximum knee hyperextension and pelvic retraction angles. According to this clustering, it was observed that 66.67 % of the participants (20 people) showed maximum knee hyperextension in the single support phase. It was observed that the participants who had maximum knee hyperextension, especially after the mid-stance phase, had higher mean gastrocnemius spasticity. It was also observed that participants in Cluster 4, with a greater amount of maximum knee hyperextension, had the worst clinical parameters. Interpretation: Our study observed that the degree of maximum knee hyperextension was related to knee flexor and ankle dorsiflexor muscle strengths, gastrocnemius spasticity and pelvic retraction. As clinical parameters worsened, maximum knee hyperextension was thought to occur late in the stance phase. Clinical Trial code: NCT05679700Article Citation - WoS: 5Citation - Scopus: 4Examining the Effects of Non-Immersive Virtual Reality Game-Based Training on Knee Hyperextension Control and Balance in Chronic Stroke Patients: a Single-Blind Randomized Controlled Study(Springer-verlag Italia Srl, 2024) Korkusuz, Suleyman; Taskin, Gulsen; Korkusuz, Buesra Seckinogullari; Ozen, Melike Sumeyye; Yuruk, Zeliha OzlemBackground Post-stroke hemiparesis can lead to decreased mobility, gait disturbances, impaired balance, postural instability, limitations in activities of daily living (ADL), and long-term disability. Aims The aim of this study was to examine the effect of non-immersive virtual reality game-based training (nIVRGT) in addition to conventional rehabilitation in stroke patients on dynamic balance, knee hyperextension control, and ADL. Methods Twenty-five chronic stroke patients aged between 51 and 70 were included in the study. Stroke patients were randomized to a control group (n = 12) and a study group (n = 13). Individuals in control group participated conventional physiotherapy and rehabilitation program for 60 min, 3 days a week for 6 weeks. individuals in the study group received 40 min of conventional physiotherapy and rehabilitation program plus 20 min nIVRGT. Functional Reach Test, Timed Up and Go Test, Computerized Gait Evaluation System and Barthel Index were used in the evaluation. Result The study group improved significantly in dynamic balance, knee control, and ADL (p < 0.05). In the control group, significant improvements were observed in dynamic balance and knee control (p < 0.05), except ADL (p > 0.05). The study group improved in dynamic balance compared with the control group (p < 0.05). Knee control and ADL improved similarly in both groups (p > 0.05). Conclusion Our results showed that conventional and additional nIVRGT rehabilitation improved dynamic balance and knee hyperextension control in chronic stroke. However, it was observed that the non-immersive virtual reality (nIVR) approach was more effective in improving dynamic balance in stroke patients than conventional rehabilitation alone.
