Hemiplegic Gait I circumduction gait Physiotherapy Mx

Hemiplegic Gait 

 Gait in which leg is stiff, without flexion at knee and ankle and with each steps is rotated away from the body then towards forming a semi circle.

GAIT PATTERN

The patient stands with unilateral weakness on affected side with  arm flexed, adducted and internally rotated and leg on the same side is in extented with the plantar flexion of the foot and toes on walking

In this gait patient rotates hip side way during swing phases due to hip flexors tightness and he try to place foot in flattened manner or toe strike first before heel strike. 

Clinical features

•        affected side will be weak
•        hyperreflexia
•       arm and hand flexed across the body
•       extension plantar response

Gait analysis

1. In stance phase : toe contact first instead of heel strike, the tip of toe is is maintain throughout with knee in hyperextension and hip in excessive flexion resulting the trunk to lean forward.

2. In swing phase: Toe is dragged due to insufficient dorsiflexion and limited knee flexion.Hip hiking is done to push the leg forward and trunk in extended.

3. Associated condition: Cerebrovascular Accident/ Upper Motor Lesion

Management

Medical treatment

•       vitamin b12
•       folate
•       thyroid replacement
•       calcium supplement- antidepressants 

Physiotherapy treatement

•       Maintain the ROM necessary for normal gait
•       anti synergic position
•       facilitate early weight bearing 
•       stretching for reducing spasticity
•       strengthening exercise of anti gravity muscles to increase strength for providing stability and coordinated ambulation
•       balance training and co-ordination training including frenkel exercise
•       gait training using parallel bar training with visual feedback for providing opportunity to auto correction

•       maintain trunk symmetry
•         progress from low COG(sitting) to high COG(standing)