Hemiplegic Gait: New Treatment Strategies

L. Finch and H. Barbeau

Summary by Patty Davis, MS, Mobility Research, 20 March 1997

Existing research on hemiplegic gait patterns lacks uniformity in the definition and classification of walking ability. Current gait classification defines a "functional walkers" to be any individual who can walk 20 meters without the assistance of a second person. Further, it was found that a high percentage of "functional walkers" have perceptible gait problems and/or require an assistive device to walk. Because the classification of "functional walker" is very broad in its definition, a more qualitative approach needs to be taken with the classification of gait function. The purpose of this article was to outline hemiplegic gait, discuss the pathology and current therapy and outline a new treatment strategy.

It has been postulated that temporal distance variables such as cadence, cycle time, stance time, swing time, walking speed, stride length and step length have a direct correlation with level of function. Analyzing temporal distance factors provides valuable information as to the functional level of the individual, but tells very little as to the causal mechanism of the gait disturbance. A kinematic analysis of internal and external forces produced during the gait cycle provides data for a possible causal link. Research has shown the phasic activity of muscle during locomotion to be directly related to limb stability, acceleration and deceleration. Therefore, the analysis of EMG data provides valuable information about the muscle activation patterns and the ability to control motor patterns.

Standard treatment strategies include the following objectives: 1) improve stance control of knee flexion-extension; 2) increase the ability to support total body weight; and 3) create a smoother weight-acceptance phase in the gait cycle. These strategies have had limited success, especially in patients who are unable to handle the increased stretch of full weight bearing. Techniques which involve a progression from supported partial body weight to full weight bearing is thought to be a more effective approach. The ability to control the amount of load placed on the muscles of the lower extremities could enable a retraining of the load-compensation mechanism, based on each patient's capabilities. The patient could then progress from supported partial weight bearing to full weight bearing, working to improve posture and balance, in a fall free environment. The fall free environment created by a partial weight bearing protocol enables the introduction of a motorized treadmill into the gait therapy protocol. This fall free environment also enables treatment to begin much earlier in the recovery process, which has been shown to be very important to overall recovery.

There seems to be no one common hemiplegic gait pattern. Treatment programs must, therefore, be adaptable to the individual needs and capabilities of each patient. Supported partial body weight protocols which progress a patient to supported full body weight activity seems to show the most promise for hemiplegic gait disorders.