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PubMed1987

Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses.

Hemiparetic gait is characterized by slow speed and poorly coordinated movements. Because the values of gait parameters vary with changes in speed, the slow speed that is typical of hemiparetic gait necessitates applying controls for the influence of speed when comparing hemiparetic and able-bodied persons. Gait kinetics and kinematics were measured in seven hemiparetic and seven able-bodied adults to compare their gait patterns at similar speeds and to assess the effectiveness of ankle-foot orthoses which were double-stopped in 5 degrees of dorsiflexion or 5 degrees of plantarflexion. Hemiparetic persons ambulating without the orthoses had a shorter step length, longer duration stance, and shorter duration swing than normal. They displayed greater than normal flexion of the affected hip during midstance, which, by putting the center of mass farther in front of the knee, may explain the increased knee extension moment due to vertical force. Affected hip adduction during single support was less in hemiparetic persons than in able-bodied persons, indicating a decreased lateral shift to the paretic side. During the swing phase, the affected limbs of hemiparetic persons were in less knee flexion and less dorsiflexion than normal, necessitating circumduction to achieve toe clearance. Ankle-foot orthoses increased walking speed to normalize heelstrike duration through use of an optimally adjusted plantarflexion stop. An improperly adjusted orthosis may produce an exaggerated knee flexion moment resulting in knee instability.

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PubMed1987

Shoulder subluxation in hemiplegia: a radiologic correlational study.

A tridimensional (3-D) x-ray method of evaluation of the shoulder was contrasted with six clinical and radiologic techniques used to evaluate shoulder subluxation, in 50 hemiplegic subjects. The 3-D evaluation is obtained through a mathematical computation associating two x-rays of the same shoulder, one taken at 0 degree (anteroposterior) and the other at a 45 degrees oblique view. A vector is thus obtained quantifying the separation from the apex of the humeral head to the inferior border of the glenoid fossa. The Y component (cephalocaudal) of this vector is used to represent the inferior displacement of the humeral head. The six other techniques of evaluation were: a) palpation, or the number of finger breadths inserted between the acromial process and the head of the humerus; b) anthropometry, or the distance between the acromial process and the lateral epicondyle of the humerus; c) templates, or the use of four schemas representing different degrees of separation of the humeral head from the glenoid fossa; d) a measure of the relation of the center of the humeral head to the center of the glenoid fossa; e) the vertical distance between the center of the humeral head and the center of the glenoid fossa; and f) the vertical distance between the apex of the humeral head and the inferior border of the glenoid fossa. Correlation coefficients contrasting the 3-D x-ray technique and the six other measures ranged from .738 to .995. The high level of precision and reliability of the 3-D measure indirectly validated the other measurement techniques.

Female↗
PubMed1986

Biceps tenodesis for painful inferior subluxation of the shoulder in adult acquired hemiplegia.

Painless inferior subluxation of the shoulder is a common finding following stroke and is a manifestation of the adynamic nature of the disorder. The weight of the limb is not counterbalanced by shoulder musculature. This is a preliminary report of a simple tenodesis procedure performed in six patients with uniformly successful reduction of the subluxation. The tenodesis is performed through a short deltopectoral approach. The tendon of the long head of the biceps is looped over the coracoid process of the scapula and secured with a barbed staple, thus reducing the subluxation. The indications were painful inferior subluxation of a flail shoulder and failure of multiple orthotic attempts to relieve discomfort. Follow-up evaluation ranged from ten to 42 months with no instances of pain or recurrent subluxation in five cases. The one failure was in a patient whose pain was thought to be thalamic in origin. The subluxation was reduced, but the pain persisted.

Adult↗
PubMed1986

Facilitation of the maximum voluntary contraction in hemiplegia by concomitant cutaneous stimulation.

The effects of rapid brushing on the maximum voluntary contraction (MVC) and tonic vibratory reflex (TVR) of various muscles requiring facilitation (quadriceps, biceps femoris and tibialis anterior) were studied in two samples of hemiplegics. Brushing was studied under experimental and placebo conditions. In the first experiment, brushing produced significant facilitation of MVC and TVR in the quadriceps, replicating the findings of Spicer and Matyas (1980) and Matyas and Spicer (1980). However, the effect of the TVR failed to predict the gain in MVC that resulted from brushing. In the second sample of hemiplegics, brushing produced significant facilitation of the MVC and TVR in the biceps femoris but not in the tibialis anterior. The results for biceps femoris confirmed the results obtained with quadriceps. The failure to replicate this effect with tibialis anterior may have resulted from problems with the application of the stimulus to the relevant dermatome. Further exploration of the effect of cutaneous stimulation relating to this muscle is required to resolve this issue. The results of this experiment, with its replication of the facilitatory effect of brushing on TVR and MVC in two muscle groups, suggest that investigations of the effect of cutaneous stimulation on the acquisition and retention of voluntary movement should now take place.

Adult↗
PubMed1986

Gait asymmetries in residual hemiplegia.

Temporal gait asymmetries in 25 patients with residual stroke were measured from a walkway which allowed data collection on-line with a microcomputer. An asymmetry ratio has been introduced to reflect the degree of asymmetry in each of the support phases of the gait cycle. Subjects in this study demonstrated residual deficits in walking, and although there was a general pattern of asymmetry, walking patterns varied even though the group had been selected according to criteria which tended to make for relative functional homogeneity. Both the extent and patterns of temporal gait asymmetries with respect to phases of the gait cycle were found to vary. The basic rehabilitative implication of these findings is that it is not possible to design a single gait reeducation program for all residual stroke patients; the exercises prescribed must address the unique deficiencies of each patient.

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