Hemiplegic Gait

By: Suzanne Howard

What is hemiplegic gait?

Unilateral weakness on affected side
Arm flexed, adducted, and internally

rotated
Leg in extension with plantar flexion of

foot and toes

Patient drags affected leg in

circumduction
https://www.youtube.com/watch?v=jOHhGS-XQPg

Phases of Hemiplegic Gait

Stance Phase
Decreased peak hip extension in late stance

Inability to produce sufficient active tension of hip extensors in

early stance

Adaptive shortening of hip flexors

Production of excessive active tension with hip flexors in stance

Production of excessive active tension with plantarflexors in stance

Adaptive shortening of ankle plantarflexors

Inability to produce sufficient active tension with hip flexors in late

stance

Inability to produce sufficient active tension with knee extensors

throughout stance

Inability to produce sufficient active tension with ankle

plantarflexors in stance

Phases of Hemiplegic Gait

Stance Phase Cont.

Decreased peak lateral pelvic displacement

Inability to produce sufficient active tension with hip adductors in

early stance

Inability to produce sufficient active tension with hip abductors in

early to mid stance

Increase or decreased knee extension in early or mid stance

Increased peak lateral pelvic displacement

Adaptive shortening of hip adductors

Production of excessive active tension with hip adductor muscles

Inability to produce sufficient active tension with hip abductors in

early to mid stance

Phases of Hemiplegic Gait

Stance Phase Cont.
Decrease knee flexion/or knee hyperextension

Inability to produce sufficient active tension with knee flexors in mid

stance

Inability to produce sufficient active tension with knee extensors

Production of excessive active tension with ankle plantarflexors in

early or mid stance

Adaptive shortening of ankle plantarflexors

Increased knee flexion

Inability to produce sufficient active tension with knee extensors in a

shortened range

Adaptive shortening of the knee flexors or decreases the compliance of

other tissues on the flexor aspect

Production of excessive active tension with knee flexors

Decreased plantar flexion at toe-off
Inability to produce sufficient active tension with ankle plantarflexors in late
stance

Phases of Hemiplegic Gait

Swing Phase
Decreased peak hip flexion

Inability to produce sufficient active tension with hip

flexors in pre-swing

Decreased peak hip ext in late stance phase

Decreased peak knee flexion in early swing phase

Inability to produce sufficient active tension with

knee flexors in pre-swing

Production of excessive active tension with the

plantarflexors in pre-swing

Adaptive shortening of plantarflexors

Decreased peak hip extension in late stance phase

Phases of Hemiplegic Gait

Swing Phase Cont.
Decreased knee extension for heel strike

Inability to produce sufficient active tension with knee

extensors in early swing

Production of excessive active tension with knee flexors in

swing

Adaptive shortening of knee flexors, or loss of compliance

of other tissues on the flexor aspect of the knee

Decreased ankle dorsiflexion throughout swing

Inability to produce sufficient active tension with ankle

dorsiflexors in swing

Production of excessive active tension with ankle

plantiflexors in swing

Adaptive shortening of ankle plantiflexors

Causes

Vascular: cerebral hemorrhage, stroke, diabetic neuropathy

Infective: encephalitis, meningitis, brain abscess

Neoplastic: glioma-meningioma

Demyelination: disseminated sclerosis, lesions to the internal

capsule

Traumatic: cerbral lacerations, subdural hematoma

Congenital: cerebral palsy, Neonatal-Onset Multisystem

Inflammatory Disease (NOMID)

Disseminated: multiple sclerosis

Psychological: parasomnia (nocturnal hemiplegia)

Significance
Learned disuse of affected limb can lead to

weight-bearing asymmetries
Problems with generating, timing, and

grading of muscle activity

Hypertonicity and mechanical changes in soft

tissue
Gait speed, stride length, and cadence lower

than normal values

Increased risk for falls

Weak or Imbalanced
Muscles
Kinematic deviations occur as a result of the

inability to appropriately activate muscles, as

well as, from adaptive muscle shortening.
Other than weakness, the person may

experience clonus, spasticity, exaggerated

deep tendon reflexes, and decreased
endurance.
Weakened muscles include hip flexors, knee

flexors, and weak ankle dorsiflexors

Functional Tasks Affected

Difficulty maintaining balance due to limb

weakness

Inability to properly shift their body weight

Staggering and stumbling

Difficulty performing activities of daily living:

walking without an assistive device,

ambulating stairs

getting in/out of cars

dressing

getting in/out of the bathtub

sit-to-stand

toileting

Physical Therapy
Intervention
PT aimed at improving balance

and restoring coordination.

Tx focused on:

Symmetrical weight bearing

Weight shifting

Step training

Heel strike

Single leg stance

Push off/calf rise

References:
Osullivan, S.B., Schmitz, T.J., Fulk, G.D. (2014)

Physical Rehabilitation.
Lippert, L.S. (2011) Clinical Kinesiology and

Anatomy
Mishriki, J., (2013). Hemiplegic Gait [video file].
Retrieved from, https://youtu.be/jOHhGS-XQPg
http://stanfordmedicine25.stanford.edu/the25/gait

.html