Gait of control dysfunction

Control Dysfunction

stroke, head trauma, high spinal cord injury or cerebral palsy

increased reflexes of spastic paralysis

 

local weakness - impairment of selective control

primitive (mass) patterns

• for swing ; mass action of the flexor muscles (hip flexor, tibialis anterior and perhaps a knee flexor)
• stance ; the extensor pattern is activated (quadriceps, gastrosoleus and gluteus maximus)

Impaired proprioception

• lack positional feedback - prevents some patients from using their available motor control

cerebral palsy patients

• severity of the control deficit > anatomical extent (i.e., hemiplegia, diplegia, quadriplegia)

 

Adult Hemiplegia

several characteristic patterns of dysfunction

1. drop foot (excessive plantar flexion)
2. equinovarus (excessive plantar flexion and inversion)
3. genu recurvatum (excessive extension)
4. stiff-knee gait (inadequate flexion)

Mid swing

• flexor pattern to assure floor clearance ; Flexion of the hip, full ankle dorsiflexion

Terminal swing

• extensor pattern to prepare the limb for stance ; extension of the knee, ankle plantar flexion

The terminal swing and loading response phases of the tibialis anterior are lost

• ankle control of the flexor pattern shifts to the extensor pattern
• soleus begins its action prematurely

 

Drop Foot

A simple drop foot ; visible gait deviation of the mildly hemiplegic stroke patient

- impaired selective control (without primitive flexor synergy emergence)

a. Initial contact ; low heel strike

b. Stance phase ankle dorsiflexion ; normal pattern when dorsiflexor inactivity is the only deficit

• minimal loss of tibial advancement due to the reduced heel rocker
• terminal stance and pre-swing heel rise are appropriate

c. Mid swing

• phase where the disability becomes apparent
• excessively plantar flexed ankle ; toe drag
• failure to avoid the toe drag? – suggests inability to voluntarily increase his hip flexion and the lack of a substitutive flexor synergy