hemiplegic gait

Tom is a 78 year old man who suffered from a right side stroke 18 months ago. He is walking with a stick but is limited functionally as he is walking very slowing, falls occasionally and complains of pain in his right knee whilst walking. He demonstrates a typical hemiplegic’s gait pattern and has been referred by the consultant of physiotherapy assessment.

5. State at what stage in the gait cycle he is likely to experience knee pain and explain why.

6. list the three movements necessary to allow for foot clearance during swing phase, which movements might this patient is lacking.

You said Tom has typical hemiplegic gait. Means he must have typical pattern of spasticity in lower limb. Which is pelvis retracted, hip in adduction, internal rotation and extension, knee in extension and foot is in planter flexion.
Well, to clear foot in swing phase, hip flexor, knee flexor and dorsi flexor should work. Missing of one of these componant may alter the gait. While in this patient the pattern is totaly opppsite to it.So he would not be able to clear his foot is obvious.
And in Hemiplegia, knee pain start when spasticity is severe and knee is not so mobile. Or patient has knee pain since his premobid stage.You said patient has stroke before 18 months. so may be he is in stage of 2 or 3 of spasticty. So may be you should work on that.

okay.. thank u.. this is my assignment to work on whic is very confusing. thanks =)

I know this is way too late for your assignment, but actually you asked what stage in the gait cycle is he likely to experience knee pain. I believe the answer would be Terminal Stance, or Heel Off, phase. Terminal stance is the point at which the hip comes forward from extension and the knee bends to allow the heel to come up off the floor. If he lacks knee flexion, this is, in my opinion, the first gait phase that he would begin to have considerable pain.

Pain in the hemiplegic knee in chronic stroke could be for a number of reasons. But the classic case is not because of spasticity or inability to flex the knee. It is true that many patients are unable to flex the knee in swing phase but this is usually not particularly painful. The inability to flex the knee is most commonly due to failure of the hip flexors to contract at the very start of swing phase. The hip flexors function in early swing to phase flex the hip and to create a flexor inertial moment at knee. In chronic stroke the quadriceps may have increased stiffness due to spasticity so this could als contribute to the lack of knee flexion. However neither weakness nor spasticity accounts for the pain.

The classic problem is that the knee hyperxtends in mid stance due failure to advance the tibia in early to mid stance phase. The abnormal hyperextension of the knee stresses the posterior structures of the knee joint that over time results in hypermobility and posterior knee pain. The most common reasons for the knee hyperextension and due to lack of tibial advancement is the failure of the tibialis anterior to contract at contact response to mid stance to pull the tibia forward, thereby reducing the extensor moment on the knee. Another reason that often goes hand-in-hand with weakenss of the dorsiflexors is stiffness of the triceps surae. This stiffness in chronic stroke is usually due to contracture, spasticity or a combination of both.