Lateropulsion and Wheeleo®

Following the use of a gait training ramp (beginning of rehabilitation), I selected the one-handed walker Wheeleo® as the first mobility device for this hemiplegic patient.

This choice was necessary due to a complex motor profile. The patient presents several gait alterations:

• A marked lateropulsion
• A deficit in hip flexion during the (pre)swing phase
• A tendency for leg adduction during the swing phase
• Knee hyperextension during the stance phase

Adapting the Wheeleo® to Counter Lateropulsion

To compensate for lateropulsion, I adjusted the Wheeleo® to a low position. This strategy aims to promote the body’s natural inclination towards the handle, which counterbalances the inclination induced by the pathology. In other words, a controlled inclination towards support can correct a pathological inclination: minus by minus equals plus.

Using a Velpeau® Bandage to Optimize Alignment

To limit falling towards the paretic side, I positioned a Velpeau® bandage to counter leg adduction. By placing the foot more outward, we optimize support and prevent adduction from amplifying lateral imbalance. This phenomenon is common in patients with gluteal muscle weakness.

The Velpeau® bandage also helps me during step-taking:

• It guides foot progression (range, rhythm, alignment),
• It corrects rotation during heel contact with the ground,
• And it allows me to preserve my own back, by intervening from a distance while maintaining a rhythm close to normal walking, an essential factor for reactivating locomotor automatisms.

Orthosis and Strategy for Hyperextension

The patient wears a BlueRocker® orthosis. A small heel wedge could reduce hyperextension, but in this specific case, the hyperextension provides stable knee locking, ensuring some security during the stance phase. As often, this is a compromise between stability and physiology, to be evaluated on a case-by-case basis.

Specific Advantages of Wheeleo® in this Context

The Wheeleo® allows for a two-step gait, which represents a significant progress compared to the three-step gait often observed during ramp exercises or with aids like tripod canes or quadripod canes. The latter sometimes reinforce a degraded gait pattern.

On the other hand:

• The Wheeleo® provides constant support, even in motion.
• It reduces lateropulsion (low height and + security).
• It promotes better gait fluidity, without sacrificing safety.

Conclusion: a Key Tool for Optimizing Hemiplegic Gait

In the context of this complex rehabilitation, the Wheeleo® has proven to be a central tool. It not only allows addressing the patient’s specific deficiencies but also stimulates a more fluid, natural, and secure gait.

Every adjustment counts, and this type of device should be part of the modern rehabilitator’s toolkit.