CVA impairments part 4 (gait, modalities and assisted tech, orthotics)

Question 1

What are some spatial asymmetries seen in hemiplegic gait?

Answer 1

↓ Step length​

↓ Stride length​

Variable step width ​

↓ Step height in swing

Question 2

what are some temporal asymmetries seen with hemiplegic gait?

Answer 2

↓ Single-limb stance time​

↑ Double limb stance time ​

↑ Swing time​

↓ Cadence

Question 3

Study GAIT speed slide (slide 6)

Answer 3

:)

Question 4

What hemiplegic gait abnormalities do we see with the UE?

Answer 4

Decreased or absent arm swing

Question 5

What hemiplegic gait abnormalities do we see with the trunk?

Answer 5

-Decreased rotation
-Ipsilateral lateral trunk lean
-glute med weakness
Forward trunk lean

Question 6

Common hemiplegic gait impairments in heel strike to mid stance at the pelvis?

Answer 6

↓ pelvic rotation ​

↓ hip flexion​

↑ hip IR ​

↑ hip adduction​

Trendelenburg

Question 7

Common hemiplegic gait impairments in heel strike to mid stance at the knee?

Answer 7

3 common knee patterns:​

​

1. ↑ knee flexion (particularly at initial contact)​
2. ↓ knee flexion during the early-stance phase, followed by knee hyperextension in mid to late-stance ​
3. Excessive knee hyperextension throughout most of the stance phase

Question 8

Common hemiplegic gait impairments in heel strike to mid stance at the foot/ankle?

Answer 8

↓ tibial progression** ​

​↓ ankle DF​

​Lack of heel strike ​

​Foot flat initial contact​

​Foot slap after initial contact ​

​Instability at foot/ankle complex  inversion, supination​

​Pes planus

Question 9

Common hemiplegic gait impairments in mid stance to terminal stance at the pelvis?

Answer 9

Decreased pelvic rotation ​

​

Decreased hip extension/terminal stance** ​

​

Hip flexion during forward progression​

Question 10

Common hemiplegic gait impairments in mid stance to terminal stance at the knee?

Answer 10

Decreased knee extension​

​Knee buckling​

​Delayed movement into knee flexion in preparation for the swing phase

Question 11

Common hemiplegic gait impairments in mid stance to terminal stance at the foot/ankle?

Answer 11

May still see ↓ tibial progression (step-to pattern)​

​
↓ heel off at terminal stance

Question 12

Common hemiplegic gait impairments from initial swing to mid swing at the pelvis?

Answer 12

↓ hip flexion​
Hip hiking​
Circumduction ​
↑ compensatory ER

Question 13

Common hemiplegic gait impairments from initial swing to mid swing at the knee?

Answer 13

↓ knee flexion

Question 14

Common hemiplegic gait impairments from initial swing to mid swing at the foot/ankle?

Answer 14

Poor foot clearance**​
Toe drag​

​↓ ankle DF​
↑ inversion

Question 15

Common hemiplegic gait impairments from mid swing to terminal swing at the pelvis?

Answer 15

↓ hip flexion​
Hip hiking​
Circumduction​
↑ compensatory ER

Question 16

Common hemiplegic gait impairments from mid swing to terminal swing at the knee?

Answer 16

↓ knee extension

Question 17

Common hemiplegic gait impairments from mid swing to terminal swing at the foot/ankle?

Answer 17

Poor foot clearance​
Toe drag​
↓ ankle DF​
↑ inversion

Question 18

What other impairments from CVA can contribute to gait abnormalities?

Answer 18

Spasticity- jerky movements during gait
Hypotonia- buckling LE, floppy UE

Somatosensory deficits
variable foot placement at IC
variable joint placement through GAIT
Risk for ankle rolling
often visually reliant