Hemiplegic gait Flashcards
normal gait
Little energy expenditure Symmetrical Automatic postural adjustments Trunk control LL, UL control Weight transfer Advancement of centre of gravity (COG) over base of support (BOS)
Stance phase essential components
Knee flexion 150 at heel strike –> extension –>flexion at toe off
Hip extension end of stance essential for initiation of swing
Lateral tilt of pelvis / trunk, single leg support
Swing phase essential components
Knee flexion
Limb shortening to advance
Early swing - hip flex, knee flex, ankle DF
Final swing - knee ext / ankle DF pre heel strike
COG forward / Postural adjustments
Lateral pelvic tilt/rotation forward
Trunk counter-rotation with arm swing
Gait dysfunction after stroke
Motor causes Impaired motor control Muscle weakness Soft tissue adaptation Limited ROM Abnormal timing / co-ordination Tone abnormal Sensory loss / Perceptual deficit postural adjustments Loss of trunk / extremity control Oedema (foot)
Stroke stance phase deficits
decrease in hip extension
Limited movement of trunk / pelvis over foot
Excessive lateral horizontal shift of pelvis
increase in downward tilt of pelvis on swing side
Absence of knee flexion at start of stance
Lack of knee extension mid-stance
Absence of knee flex end stance
decrease ankle PF for push-off
stroke swing phase deficits
decreased hip flexion
decreased knee flexion to ‘shorten’ limb for toe clearance as LL swings forward
decreased ankle DF for toe clearance
decreased knee extension + ankle DF for heel contact
Foot
flat / toe first
decreased step length
hemiplegic gait
decreased cadence Uneven step length Short step hemiplegic LL Short stance / long swing hemiplegic LL decrease stride length increased double support time decreased balance control Use of limbs for support Upper limb Loss of reciprocal arm swing / posture decreased trunk / pelvic interplay Adaptive motor behaviours
abnormal gait patterns
Hemiplegic gait Short step with affected leg Asymmetrical posture Asymmetrical weight bearing on lower limbs Hip hitching Circumduction Foot - clawing, equinus, foot drop
hemiplegic foot
Abnormal tone Difficulty accepting BOS Toe curling or clawing Plantar sensitivity Inability to make foot contact Equinus posture Insufficient ankle dorsiflexion and push off
foot abnormalities after stroke
Foot abnormalities are common – 30%.
Equinovarus (supinated/inverted foot) is the most frequent abnormality.
Foot posture is asymmetrical.
more severe impairments –> more severe foot abnormalities.
Foot posture is related to walking ability
severe abnormalities –> more limited walking ability.
hemiplegic gait assessment
Head, Trunk, UL, LL (hip, knee, ankle, foot). Swing and stance phase (observe different components) Turning: Balance / stability Alignment / symmetry Weight transfer BOS Cadence Associated reactions Quality of movement Describe gait pattern (e.g. hemiplegic)
gait re-education
Restore safe functional walking decrease compensatory motor patterns Facilitate normal motor control, strength, tone Prevent adaptive shortening Maintain joint ROM Weight transfer Stability / balance Propulsion Co-ordination Minimise secondary complications e.g. falls
Management principles
Ensure stable sitting Transition to standing Preparation for standing Limb control Sensori-motor rehabilitation Alignment Proximal stability trunk / pelvis Weight-bearing activities Initial standing Stability & WB in standing Hip control Knee control Re-educate foot /ankle Trunk / pelvic control Progression --> Stepping Role of head upper trunk and UL Walking practice (parallel bars, use of aids, assistance) Prevent secondary adaptations
functional electrical stimulation
‘provide the muscles with electric stimulation in cases of a CNS lesion so that at the time of the stimulation the muscle contraction has a functional purpose either in locomotion or in prehension or in other muscle activity’
drop foot correction using FES
Portable unit: Used to house controller, interface and stimulation electronics
Gait sensor Goniometer Foot-switch Accelerometer EMG Electrodes
Gait actuator:
stimulation electrodes
