strokes are tricky things to fix... to be good at it it takes years and a lot of continuing education and mentoring...
but to help you along, try this basic plan:
1) ask for a motion (for example, "lift your leg" or "walk over here")
2) if they can't do the motion, facilitate it with the lightest/least-intrusive facilitation: a) verbal commands, b) hand over the part you want moving without any real pressure, c) hand over the part you want with very light pressure increasing to moderate pressure
3) if they can't do the physiologic motion that is necessary with your facilitation, try passively taking them through this range
4) if they don't have the range, you need to stretch the muscles that are spastic/limiting the range
as far as what you're describing, there are lots of things that could be causing these deviations... you essentially need to put your hands on the patient when they ambulate and fix whatever is going wrong...
lower extremity circumduction and hip hike are often due to lack of active dorsiflexion... they may benefit from an AFO and dorsiflexor strength training (AFOs should almost always be articulating-- never solid)... they also may be keeping their knee stiff from terminal stance through heel strike--- try pushing directly inferiorly through the iliac crest when the extremity is in terminal stance so that the knee achieves some flexion and the extremity can be swung through without circumduction... mirrors also may help at this point... also consider that most of the swing phase of gait comes about as a function of the trailing limb during terminal stance being in hip EXTENSION and the extensors release, allowing gravity and momentum to swing the leg through to midstance, where the quads pull the knee into extension for terminal swing and into heel strike... strength of your hip flexors is not really a factor in normal gait, though spasticity and decreased passive range into hip extension is HUGELY important...
i suggest you start your education with Pat Davies' "Steps to Follow"... it's one of the quintessential books on stroke rehab... as my karate instructor used to say "when you achieve black belt, you education has only just BEGUN"... graduating and getting your license is just the beginning!!!
keep us posted!!
patrick, MPT





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