A clinical guide to assess the role of lower limb extensor overactivity inhemiplegic gait disorders

Background and Purpose-The aim of this study was to assess the role of knee and ankle extensor overactivity in the hemiplegic gait observed in stroke victims and to propose a clinical guide for selecting patients before treat ment of a supposed disabling spasticity. Methods-A standardized physical examination procedure was performed in 135 consecutive stroke patients. All patients were able to walk without human a ssistance. The period after stroke ranged from 3 to 24 months (mean, 11.5+/ -7.25 months). Spasticity was evaluated with the stroke victim in sitting p osition and during walking. Overactivity of the quadriceps was considered d isabling when inducing inability to flex the knee during the swing phase de spite adequate control of knee flexion in sitting and standing positions; o veractivity of the triceps surae was considered to be disabling when heel s trike was not possible despite good control of the ankle flexion in sitting position; triceps retraction was also considered. Results-Disabling overactivity was observed in 56 (41.5%) patients: 11 time s for the quadriceps femoris, 21 times for the triceps surae. and 21 times for both muscles. It was considered to be the main disorder impairing gait among only 16 (12%) patients: 9 for the quadriceps alone, 3 for the triceps alone, and 4 for both. Sitting spasticity of the lower limb was not predic tive of disabling overactivity during walking. Conclusions-Extensor muscle overactivity is one of the components of gait d isorders in stroke patients. The difficulty in assessing spasticity and its real causal effect in gait disturbances are discussed. A clinical guide is proposed.