People with hemiplegia resulting from cerebrovascular accident commonly demonstrate one or more deviations from the kinematics of normal gait. This paper presents a list of common kinematic deviations for which physiotherapists might look when making clinical observations of hemiplegic gait. A number of likely causes of those kinematic deviations are described, based on a review of the literature, biomechanical considerations and clinical observations. Particularly common and significant stance phase deviations are a decreased peak hip extension in late stance, increased or decreased peak lateral pelvic displacement, increased or decreased knee extension in early or mid stance and decreased plantarflexion at toe-off. The causes of these kinematic deviations lie in the inability to appropriately activate muscles and in the adaptive muscle shortening which commonly occurs following stroke.
Following hemiplegic stroke, many people present with one or more clinically significant kinematic deviations from normal gait. Significant kinematic deviations observed in swing phase include decreased peak hip flexion, decreased peak knee flexion, decreased knee extension for heel strike and decreased ankle dorsiflexion throughout swing. In this paper the causes of these kinematic deviations are discussed in terms of the forces produced by the inappropriate activation and adaptive shortening of particular muscle groups.
The analysis of movement dysfunction often requires that inferences be made about the muscle forces which occur during motor task performance. Physiotherapists probably use a range of different models of analysis to make inferences about such forces. These models differ in the degree to which they invoke simplifying assumptions about the non-muscle forces acting on body segments. In some circumstances even the most simple models of analysis will enable reasonable inferences to be made about muscle forces, but in other situations it may be very difficult to make reasonable inferences about muscle forces from clinical observations alone.
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