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ULY CLINIC

10 Septemba 2025, 11:23:43

Gait, Spastic (Hemiplegic Gait)

Spastic gait, also called hemiplegic or paretic gait, is a stiff, foot-dragging walk caused by unilateral hypertonicity of leg muscles, typically resulting from focal corticospinal tract damage. The affected leg exhibits decreased hip and knee flexion, plantar flexion, and often equinovarus foot deformity. To compensate, the pelvis tilts upward, and the leg circumducts during ambulation; ipsilateral arm swing is reduced. This gait usually develops after a period of flaccidity and is often permanent.

History & Physical Examination

Domain	What to Check / Observe	Significance / Interpretation
Onset & Progression	Sudden vs gradual; waxing/waning; exacerbating factors (heat, fatigue, warm baths)	Sudden → stroke or trauma; Gradual → tumor, multiple sclerosis; Exacerbation with heat → MS
Neurologic History	Prior stroke, head trauma, CNS infection, demyelinating disease	Helps identify underlying lesion site
Motor Function	Strength, tone, presence of flaccidity or rigidity	UMN lesion indicated by hypertonia/spasticity; initial flaccidity reflects acute phase
Range of Motion (ROM)	Hip, knee, ankle, foot alignment	Contractures or deformities influence gait mechanics
Sensory Function	Proprioception, vibration, pain, temperature	Sensory loss may indicate lesion extent
Gait Observation	Foot drag, circumduction, pelvic tilt, toe walking, arm swing	Confirms unilateral corticospinal involvement
Associated Signs	Dysarthria, dysphagia, facial weakness, visual deficits, seizures	Suggests lesion location and severity
Pediatric Considerations	History of cerebral palsy, sickle cell crisis, porencephalic cyst, AV malformations	Pediatric-specific causes inform early intervention

Medical Causes

Cause	Distinguishing Signs & Symptoms	Pathophysiology
Stroke	Sudden hemiparesis, facial droop, dysarthria, dysphagia, visual field deficits	Focal ischemic or hemorrhagic lesion disrupts corticospinal tract, producing contralateral spasticity
Brain Tumor	Gradual onset, headaches, seizures, focal neurologic deficits, papilledema	Mass effect or infiltration of corticospinal tracts leads to spasticity and foot drag
Brain Abscess	Fever, headache, vomiting, seizures, hemiparesis	Local infection and edema increase ICP, damaging motor pathways
Head Trauma	Gradual hemiplegia post-injury, personality changes, seizures	Contusion or hemorrhage affecting corticospinal fibers
Multiple Sclerosis	Insidious onset, exacerbations/remissions, heat sensitivity, leg weakness, incoordination, urinary symptoms	Demyelination of CNS pathways, including corticospinal tracts
Cerebral Palsy (children)	Toe-walking, hyperactive DTRs, contractures, abnormal reflexes	Perinatal brain injury → permanent UMN dysfunction
Other Pediatric Causes	Sickle cell crisis, porencephalic cyst, AV malformations	Local ischemia, infarction, or hemorrhage damages motor pathways

Special Considerations

Encourage daily active and passive ROM exercises to prevent contractures.
Monitor for balance deficits and fall risk; provide mobility aids as needed.
Referral to physical therapy for gait retraining and orthotic evaluation (splints, braces).
Maintain awareness of skin integrity and joint health, particularly in children with CP.

Patient Counseling

Educate patients and caregivers on safe ambulation and use of assistive devices.
Emphasize importance of consistent physiotherapy and independent mobility within safety limits.
Explain underlying neurologic cause and prognosis, setting realistic expectations.

References

Ahmari, S. E., Spellman, T., Douglass, N. L., et al. (2013). Repeated cortico-striatal stimulation generates persistent OCD-like behavior. Science, 340, 1234–1239.
Air, E. L., Ostrem, J. L., Sanger, T. D., & Starr, P. A. (2011). Deep brain stimulation in children: Experience and technical pearls. Journal of Neurosurgical Pediatrics, 8, 566–574.
Jang, S. H., & Kwon, Y. H. (2011). Corticospinal tract injury and recovery in hemiplegic patients. NeuroRehabilitation, 29, 109–116.
O’Sullivan, S. B., & Schmitz, T. J. (2019). Physical Rehabilitation, 7th Edition. Philadelphia: F.A. Davis.
Pandyan, A. D., et al. (2015). Spasticity: Clinical measurement, pathophysiology, and management. Journal of Neurology, Neurosurgery & Psychiatry, 86(12), 1201–1207.