Gait after Stroke

• Household walkers will walk slower than 0.40 m/s
• Household walkers will take 100 to 2,499 steps per day
• Limited community walkers will walk between 0.40 and 0.80 m/s
• Limited community walkers will take 2,500 to 7,499 steps per day
• Community walkers will walk faster than 0.80 m/s
• Community walkers will take more than 7,500 steps per day
• Hemiparetic gait requires 50-70% more energy when compared to healthy norms.
• In hemiplegic gait, the stance phase will be exaggerated on the unaffected side and decreased on the involved side
• The swing phase is shortened on the affected side and increased on the unaffected side during hemiplegia.
• The most common gait problem after stroke is decreased or absent dorsiflexion.
• Many stroke patients may have mediolateral instability after due to decreased proprioception leading to rolling of the ankle
• Issues at the ankle after stroke leads to problems with limb swing, like foot drop, push off weakness, and catching of the toes.
• Common knee issues after stroke include hyperextension, decreased knee flexion, and instability.
• Hip gait deviations after stroke are mostly strength-related. We will see hiking, circumduction, and inadequate limb swing.
• Propulsion is the ability to move the body in an intended direction.
• Stance control is the ability to prevent limb or trunk collapse.
• Limb swing is the ability to advance the swing limb forward.
• Lateral stability is the ability to maintain balance and stay upright.
• Propulsion accounts for 50-75% of the metabolic cost of gait.
• Stance control accounts for 25% of the metabolic cost of gait
• Limb swing accounts for 5-10% of the metabolic cost of gait
• Lateral stability accounts for 5-10% of the metabolic cost of gait.
• If the involved upper extremity is flaccid or subluxated, it must be supported.