The Journal of Bone and Joint Surgery 78:1506-14 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.
Gait Pattern in the Early Recovery Period after Stroke*
INÈS A. KRAMERS DE QUERVAIN, M.D. ,
SHELDON R. SIMON, M.D. ,
SUE LEURGANS, PH.D. ,
WILLIAM S. PEASE, M.D. and
DAVID McALLISTER, M.D.¶, COLUMBUS, OHIO
Investigation performed at the Gait Analysis Laboratory, Division of Orthopaedics, and the Departments of Physical Medicine and Rehabilitation, Surgery, and Statistics, Ohio State University, Columbus
The gait patterns of eighteen patients who had had a single infarct due to obstruction of the middle cerebral artery were evaluated within one week after the patients had resumed independent walking and before a gait rehabilitation program had been initiated. Gait was analyzed with use of motion analysis, force-plate recordings, and dynamic surface electromyographic studies of the muscles of the lower extremities.
The patterns of motion of the lower extremity on the hemiplegic side had a stronger association with the clinical severity of muscle weakness than with the degree of spasticity, balance control, or phasic muscle activity. There was a delay in the initiation of flexion of the hip during the pre-swing phase, and flexion of the hip and knee as well as dorsiflexion of the ankle progressed only slightly during the swing phase. During the stance phase, there was decreased extension of the hip that was related to decreased muscle effort and a coupling between flexion of the knee and dorsiflexion of the ankle. The abnormal patterns of motion altered the velocity, the length of the stride, the cadence, and all phases of the gait cycle. The duration of the pre-swing phase was prolonged for the patients who had the slowest gait velocities.
There also were abnormal movements of the upper extremity, the trunk, the pelvis, and the lower extremity on the unaffected side in an effort to compensate for the decreased velocity on the hemiplegic side. As velocity improved, these abnormal movements decreased. Therefore, the goal of therapy should be to improve muscle strength and coordination on the hemiplegic side, especially during the pre-swing phase.
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