
A stroke occurs when an area of the brain is deprived of oxygen and nutrients due to a blocked or ruptured blood vessel. This can lead to paralysis, weakness, and spasticity on one side of the body, resulting in a condition called hemiplegia. Hemiplegia affects a person's ability to walk properly, leading to an abnormal gait. The most common type of abnormal gait observed in stroke survivors is the hemiplegic gait, which is characterised by a stiff leg that either drags or swings in a semicircular motion when lifted. This gait pattern is often associated with conditions such as cerebral palsy, multiple sclerosis, or hemiplegia.
Characteristics | Values |
---|---|
Gait abnormality | Shuffling feet, difficulty supporting body weight, trouble with coordination |
Antalgic gait | Limping, avoiding stepping with or putting pressure on the affected leg or foot |
Propulsive gait (Parkinsonian gait) | Stooping, rigid posture, head and neck bending forward, short and fast steps |
Scissors gait | Knees and thighs hit or cross in a scissor-like pattern, slow and small steps |
Spastic gait (hemiplegic gait) | Walking with one stiff leg, leg drags or swings around in a semicircular motion |
Steppage gait (neuropathic gait) | High steps, foot may appear floppy, toes point down and scrape the ground |
Waddling gait | Exaggerated movement of the upper body, waddling or duck-like walk |
Crouching gait | Ankles, knees and hips flex while walking, toes may drag |
Ataxic gait | Irregular steps, difficulty walking in a straight line |
Shuffling gait | Walking without lifting feet off the ground, feet drag |
Lurching gait | Slow and long stride, upper body jerks forward or backward |
What You'll Learn
The hemiplegic gait is a common abnormal gait pattern
The hemiplegic gait is often seen in people with cerebral palsy, multiple sclerosis, or hemiplegia. It can also be caused by a lesion in the central nervous system, such as a stroke, which results in unilateral weakness and spasticity. The gait may also be observed in patients with Parkinson's disease or any other condition causing parkinsonism.
The hemiplegic gait can vary in severity depending on the level of muscle weakness, the severity of spasticity, and the degree of involvement. For example, in the Slow-Extended walker group, the quadriceps muscles are weakened to the extent that they cannot support the knee during the stance phase. The gluteus maximus muscle is still active and retracts the femur into knee hyperextension to provide support for the body. There is also some plantar flexor contracture and spasticity, which provide additional ankle stability. During the swing phase, there is persistent gluteus maximus and ankle plantar flexor spasticity, and the person may hike their hip and circumduct their leg to achieve foot clearance. This group typically requires assistive devices to walk and their speed is significantly reduced.
Gait abnormalities can have a significant impact on a person's daily life, affecting their ability to perform basic tasks and increasing the risk of falls and injuries. Gait recovery is a major goal in stroke rehabilitation, aiming to improve walking safety and speed to prevent falls and enhance quality of life. A range of interventions are available, including muscle strength training, task-specific gait training, treadmill training, electromechanical and robot-assisted gait training, functional electrical stimulations, ankle foot orthoses, and botulinum toxin injection for spasticity management.
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Gait recovery is a major goal for stroke patients
The functional limitations and impairments after a stroke are unique to each individual and often include impairments in mobility. Gait recovery is a major objective in the rehabilitation program for persons with stroke, and often a person's top goal. Gait recovery requires skilled personalized therapeutic interventions for successful stroke rehabilitation. Gait recovery is a complex process involving spontaneous recovery and the effects of therapeutic interventions. Gait recovery is a major goal for stroke patients as it is a symbol of their independence and a return to normal.
Therapeutic interventions to improve gait in persons with stroke range from physical hands-on cuing techniques, electrical stimulation, treadmill training, biofeedback, and robotics. New treatments are constantly being developed, adding to the treatment arsenal. It is often a combination of multiple treatment modalities and clinical experience and skill which lead to the best patient outcomes.
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Gait abnormalities can cause falls and injuries
Abnormal gaits can be caused by injuries or underlying medical conditions. Anything that affects the brain, spinal cord, legs or feet can change a person's gait. Some examples of an abnormal gait include shuffling, difficulty supporting the weight of the body, and trouble with coordination.
A stroke can cause a spastic gait, also known as a hemiplegic gait. This type of gait causes a person to walk with one stiff leg. When the leg is lifted to walk, it either drags or swings around in a semicircular motion, known as circumduction. This type of gait is common among people with cerebral palsy, multiple sclerosis or hemiplegia.
A stroke can also cause a crouch gait, which is when there is excessive knee flexion in the initial phase of gait due to weak hip extensors, knee extensors, or ankle plantar flexors. This can lead to an inefficient gait pattern.
Another type of gait that can be caused by a stroke is a stiff-knee gait, which is characterised by significantly diminished and delayed knee flexion during the swing phase. This is mainly caused by the spasticity of the rectus femoris muscle, weakness of the hip flexor, and over-activity of the ankle plantar flexor.
Gait abnormalities can lead to a higher risk of falls and injuries. Falls are a common concern for people who have had a stroke and can have dramatic consequences. Gait abnormalities can also cause a reduction in a person's ability to maintain their independence.
To prevent falls and injuries, healthcare providers will give instructions on how to walk safely. This may include the use of assisted mobility devices such as a cane or walker, adjusting footwear, or using splints or braces. Physical therapy and strengthening exercises can also help to improve gait abnormalities.
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Gait training is an important part of stroke rehabilitation
Gait training aims to address these issues and improve walking ability through a range of interventions. These include preventing adaptive changes in lower limb soft tissues, eliciting voluntary activation in key muscle groups, increasing muscle strength and coordination, and improving static and dynamic balance. Gait training is highly individualised, taking into account the patient's specific needs and limitations.
Conventional gait training involves breaking down the gait cycle into its component parts, addressing abnormalities, and then reintegrating them to achieve a more normal gait. This can include symmetrical weight-bearing, weight shifting, stepping training, heel strike, and push-off, among other components.
In addition to conventional gait training, other interventions may be used, such as strength training, neuromuscular re-education, body weight-supported treadmill training, functional electrical stimulation, and robotic-assisted training.
The complexity of ambulation and the individuality of each patient's needs require intensive, personalised rehabilitation programs to optimise recovery. Gait training plays a crucial role in helping stroke patients regain their independence and improve their quality of life.
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Gait abnormalities can be temporary or require lifelong management
Stroke is a leading cause of long-term disability, and walking dysfunction is common among stroke survivors. A stroke occurs when an area of the brain is deprived of oxygen and nutrients due to a blockage or rupture of a blood vessel. This results in neuronal damage, which can lead to impaired postural control and voluntary movements, affecting a person's ability to walk.
Post-stroke gait abnormalities are often a result of damage to the motor cortices and their descending corticospinal tracts, leading to muscle weakness, changes in muscle tone, and abnormal synergistic movement patterns. These abnormalities can vary in severity and may include foot drop, knee hyperextension, circumduction (swinging the leg in a semicircular motion), and difficulties with foot clearance and stability during stance.
The management of post-stroke gait abnormalities aims to improve gait quality and independence in daily activities. Treatment options include physical therapy, gait training, bracing and assistive devices, functional electrical stimulation, and in some cases, botulinum toxin injections into spastic muscles. While some individuals may regain their pre-stroke gait quality, others may require lifelong management to maintain or improve their gait and mobility.
The recovery process is complex and varies for each individual. While most people with stroke regain the ability to walk, many do not fully recover their ambulatory endurance, speed, or security to perform daily activities independently. Gait rehabilitation is highly individualized and may involve a combination of interventions to optimize recovery.
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Frequently asked questions
An abnormal gait is a change to your walking pattern. While everyone has a unique walking style, injuries and medical conditions can affect this. Anything that affects your brain, spinal cord, legs or feet can change your gait.
There are several types of abnormal gaits, including:
- Antalgic gait: Limping due to pain.
- Propulsive gait: A stooping, rigid posture with short, fast steps.
- Scissors gait: Knees and thighs hit or cross in a scissor-like pattern.
- Spastic gait: Walking with one stiff leg which either drags or swings in a semicircle.
- Steppage gait: Walking with a high step, lifting the hip to lift the leg higher than normal.
- Waddling gait: Exaggerated movement of the upper body, creating a waddling or duck-like walk.
- Crouching gait: Ankles, knees and hips flex while walking, appearing as if you're about to bend down.
There are many causes of abnormal gaits, including injuries, sores on the feet, ill-fitting shoes, and underlying health conditions.
Treatment depends on the type of gait and its cause. Treatment options include medication, rest, physical therapy, surgery, use of assisted mobility devices, adjusting footwear, and wearing splints or braces.