Hemiplegic gait

Any lesion interrupting the corticospinal pathways to one-half of the body may cause a hemiplegic gait.(1,2) The patient stands with the elbow, wrist and fingers flexed, the shoulder adducted and internally rotated, and the leg extended. There is plantar flexion of the foot and toes, either due to foot dorsiflexion weakness or to heel cord shortening, referred to as an equinus deformity. The lower extremity on the involved side is functionally slightly longer than on the normal side. When walking, the patient drags or shuffles the foot and scrapes the toes because of the equinus deformity. With each step, she may tilt the pelvis upward on the involved side to aid in lifting the toe off the floor (hip hike) and may swing the entire extremity around in a semicircle from the hip (circumduction). Loss of normal arm swing and slight circumduction of the leg may be the only gait abnormalities in very mild hemiparesis.

The video shows a girl with a right hemiparesis.(3) Note how she holds her right upper extremity flexed at the elbow and the hand with the thumb tucked under the closed fingers ("cortical fisting"). There is circumduction of the right lower extremity.

References

1. Campbell WW. DeJong's the neurologic examination, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.

2. Campbell WW. Clinical signs in neurology: a compendium. Philadelphia: Wolters Kluwer Health, 2016.

3. Video used by permission of Paul D. Larsen, M.D., University of Nebraska Medical Center and Suzanne S. Stensaas, Ph.D., University of Utah School of Medicine. Additional materials were drawn from resources provided by Alejandro Stern, Stern Foundation, Buenos Aires, Argentina; Kathleen Digre, M.D., University of Utah; and Daniel Jacobson, M.D., Marshfield Clinic, Wisconsin. The movies are licensed under a Creative Commons Attribution-NonCommerical-ShareAlike 2.5 License. Available at http://library.med.utah.edu/neurologicexam/html/gait_abnormal.html#13.