Deep flexion activity training in a patient with stroke using task-oriented exercise: a case report

Many individuals with stroke express desires to resume activities involving deep knee flexion, such as daily living, work-related, and sports activities. However, training methods for improving deep flexion activities have not commonly been reported in the stroke rehabilitation literature. The purpose of this case report is to describe the development of a task-oriented training program and demonstrate its use in improving deep flexion activities in an individual with sub-acute hemiplegia.

The patient was a 55-year-old shoe salesman diagnosed with ischemic stroke 6 weeks before physical therapy evaluation. His primary concerns were functional activities that required deep flexion, such as the inability to squat and to maintain a squatting position in the Eastern toilet and difficulty in performing work-related activities (e.g. fitting shoes for customers while sitting on a low stool).

We developed a task-oriented training program that specifically targeted deep flexion activities. The first phase of training consisted primarily of practicing sit-to-stand on a low stool and the second phase consisted of practicing squatting.

After 6 weeks of intervention, the patient achieved more than the expected outcome on the Goal Attainment Scale (score = +2) for both primary goals and reported positive changes in social participation, such as visiting his friends and relatives and praying at the temple.

The task-oriented deep flexion activity intervention was associated with positive changes in functional activity and social participation in a patient recovering from stroke.