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TAM LEVY
NOVEMBER 2011
GAIT AND MUSCLE ACTIVITY
 2 main components – STANCE and SWING
 STANCE – the phase from when the foot strikes the
ground (60%)
 SWING – when the foot starts to leave the ground
(40%)
MUSCLE ACTIVITY
 STANCE – need ‘stability’ by activating extensor
muscles at hip, knee and ankle
 SWING – need a ‘push off’ from calf muscle, then hip
flexor to ‘pull’ leg through
GAIT PROBLEMS
 In HSP there is a combination of spasticity and
weakness
 This causes muscle imbalance and leads to
compensatory movement patterns (‘tug-of-war’
analogy)
ISSUES RELATED TO WEAKNESS
 EXTENSORS : a lack of strength at the knee may cause
buckling or hyperextending (‘flicking’). Buckling
could lead to falling, hyperext may cause knee pain
 HIP FLEXORS : can’t bring leg through straight so
have to compensate and find another way e.g. hitching
the leg or vaulting on the other leg
 DORSIFLEXORS (raise the foot) : toes can’t clear the
ground, so we find another way e.g. hitch or drag toes
ISSUES RELATED TO SPASTICITY
 KNEE EXTENSORS : ‘stiff’ leg that is hard to bend
 HIP ADDUCTORS : ‘scissoring’ gait which may lead to
falls (as trip self)
 CALF : can’t get heel down, which impedes gait and
stability, also makes it harder to clear foot
MANAGEMENT
 AIM IS TO CONTROL SYMPTOMS AND MAINTAIN
MOBILITY
 find what works for you – consult a
neurophysiotherapist to get a personal, safe, specific
program and treatment as needed.
 options would include stretches, exercises for specific
muscle groups, ES (elec stimulation), medication,
fitness
STRETCHES
 SHORT TERM : to loosen up prior to exercise or
mobility
Likely to need to address calf, hip adductors, hip
flexors, hamstrings
 website : physiotherapyexercises.com
 LONG TERM : consider positioning (eg wedge for hip
adductors), splinting (eg AFO), serial casting for calf
shortening
EXERCISES
 ideal is ‘task-specific’, goal-directed and repetitive
 muscles likely to need addressing are hip abductors,
extensors and flexors; knee extensors and flexors;
ankle dorsiflexion (DF) - raise the toes/feet and
plantarflexion (PF) - point the toes/feet
 can supplement with the use of electrical stimulation
(ES), especially for DF (addressing toe-dragging)
Electrical Stimulation: Methods
 Functional Electrical Stimulation (FES)
 Programmed stimulation sequence


Gait
Reach and grasp
OTHER CONSIDERATIONS
 CONSIDER SAFETY at all times in positioning self for
exercises
 DON’T overdo it – rest is important as well
 FITNESS is important- do what you can e.g. hydro,
gym, exercise physiologist, tai chi
 WALKING AIDS – ensure correct aid and at correct
height
 Seek the advice of a neurophysiotherapist. They have
the skills to assess you, treat you and recommend a
program.