Hi Jeremy

Sorry that this thread has got a bit mixed up but have put the posts in your initial message - best I could do. Just a couple of further comments:

We did try something similar in the // bars with me asking her to advance the limb with a smaller step than before. It seemed to be all or nothing with step to pattern at best. I just hate to inhibit those hamstrings now that they are trying to fire (arghhh!!) I feel like that is the essence of my dilemma, because I want them to fire briefly for clearance during swing.
It is hard to know if it really is the hamstrings firing inappropriately without sticking an EMG on during swing phase. As you haven't got one it might be difficult to find out. Just one ting about knee flexion in swing phase - my understanding is that the hamstrings aren't normally very active particularly at normal walking speed. The knee flexion required to clear the ground is created by an inertial moment by a short sharp burst of the hip flexors at the very beginning of swing phase. That is: the hip flexors firing causing the thigh to flex but because of inertia the lower leg is left behind causing the leg to flex. I know this sounds counterintuitive but if you look at EMGs or normal gait the hamstrings are relatively quiet during early swing phase. It does make sense though when you think that most of the hamstrings are also hip extensors - why would nature get you to fire hip extensors when hip flexion is needed.

Therefore if you concentrate on getting the hip flexors to fire more briskly and relaxing the hamstrings, the increased power should also increase the overall hip excursion in swing phase. Getting to take smaller steps would be counterproductive because without the momentum she will have to contract her hamstrings. The problem with these patients is they walk so slow that it is hard to use energy saving momentum

You'd asked about quads in sitting...she can do a partial knee extension on the right and minimal on the left. She really gets best quads in closed chain situations. One thing that is great is that she had //bars built at home and has a Total Gym. So she has been doing low incline squats and standing weight shifts with emphasis on quad strength/timing. They are slow to respond, (especially left) but have improved.
Well at least she is getting a contraction there so you have something to work on. If she is better at closed chain but in this case she needs open chain contraction you will really have to work on open chain contractions and yes terminal extension is what needs to be worked on. it may be also that you will need to work on unilateral contractions as she may be better at bilateral but that is no use for gait.

Perhaps someone else may have some comments?