key words : Stroke, Hemiplegic Gait, Circumductory gait, Post stroke gait rehab, post stroke recovery, benefits of gait training, rehabilitation, Gait Rehabilitation, Parallel bars, balance board, core strength, balance, functional training, treadmill training, body weight support treadmill training, strength training, Hi tech gait rehabilitation, functional electrical stimulation, virtual reality gait training, orthosis, AFO, Assistive devices, exercises, heel raises, toe raises, Physiotherapy, physical therapy, recent advances in gait training, learning, education, functional independence, functional training, task specific training, physiotherapist, physical therapist, neuromuscular gait deviation, pathological gait, gait deviation, central nervous system, exercise, ambulation. Hemiplegic Gait Rehabilitation is a vast area of therapeutic intervention in post stroke patients. various components of hemiplegic gait rehabilitation is discussed in this slide.

1. HEMIPLEGIC GAIT
REHABILITATION
-By Dr. Rima Jani PT (B.P.T., M.P.T.)

2. HEMIPLEGIC GAIT
• Hemiplegic gait is also known as Circumductory
Gait.
• It includes impaired natural swing at the hip and
knee with leg circumduction.
• The pelvis is often tilted upward on the involved
side to permit adequate circumduction.
• With ambulation, the leg moves forward and then
swings back toward the midline in a circular
movement.

3. COMPONENTS OF
HEMIPLEGIC/CIRCUMDUCTORY GAIT
• Hip Hike
• Circumduction of the leg
• Reduced hip & knee flexion
• Decreased weight shift towards affected side
• Foot drop, poor dorsiflexion, toe first or flat foot placement

4. HEMIPLEGIC GAIT REHABILITATION
Traditional Gait Rehabilitation
High Tech Gait Rehabilitation
Additional Strength Training
Improving UE movement Pattern

5. TRADITIONAL GAIT REHABILITATION :
• Gait Training in parallel bar
• Gait Training exercises
• Balance and core training
• Use of Assistive devices &/or Orthotics
• Task-specific training.
• Treadmill Training

6. GAIT TRAINING IN PARALLEL BAR
• Parallel bars are used to assist individuals to re-learn to walk and
for gait training, as well as to regain balance, strength, range of
motion, and mobility.

7. GAIT TRAINING EXERCISES
• Seated Marching
• Knee Extension
Exercises
• Toe Taps
• Braiding Exercises
• Side Stepping
• Ankle Dorsiflexion
Exercises
• Assisted Toe Raise
• Heel Raises

8. SEATED MARCHING
• This basic gait training exercise can be
done from any seated position.
• Start by lifting affected leg up towards
the chest, and then place it back down
onto the floor. Then repeat on the other
leg, alternating back and forth.
• Be mindful of keeping the back straight
and maintaining controlled movement.

9. KNEE EXTENSION EXERCISES
• Knee extensions are a classic gait training
exercise because knees are constantly bending
during walking.
• To perform this exercise, start from a seated
position. Then extend one leg out in front
parallel to the floor. Do it on both side in
alternate pattern.
• Try to avoid locking the knee completely and
keep a soft bend.

10. TOE TAPS
• While lying on back, lift legs up and bend the knees
at a 90 degree angle. Shins should be parallel to
the floor and core should be fully engaged.
• From there, bring the left leg down and gently tap
the floor with left foot. Then, bring leg back up.
• Focus on using core muscles instead of just legs.
Maintain a 90 degree bend in the knee the entire
time.
• Repeat on the other leg and alternate between each
leg.

11. BRAIDING EXERCISE
• Braiding exercise
is performed by
crossing one leg in
front of or behind
the other in a
continuous
manner.

12. SIDE STEPPING EXERCISES
• Pick up your feet instead of sliding
them.
• Stand tall.
• Walk 3 times to Left and Right side.

13. ANKLE DORSIFLEXION EXERCISES
• This gait training exercise will help target feet and improve
conditions like foot drop after stroke.
• To begin, start from a seated position and cross the affected leg
over the other leg.
• Then, move foot into dorsiflexion by using patient’s own
unaffected hand to move foot up towards their knee.
• Next, move into plantar flexion by extending foot back down.
• For added challenge, complete these exercise without the use of
hand.

14. ASSISTED TOE RAISE
• This gait training exercise can be difficult if patient has a foot
drop.
• However, it can help improve foot drop by retraining the
brain to send the correct signals to their foot.
• Patient position: Sitting. Then ask to place their unaffected
foot underneath their affected foot. Then, ask them to use
their foot to assist affected foot up. Then release back down.
• Once patient regains the ability to perform these without
assistance, make them perform active exercise for added
challenge.

15. HEEL RAISES
• This is an advanced gait training
exercise.
• Ask patient to start with feet flat
on the ground.
• Then, point toes and lift their
heels off the ground. Then
place feet back down flat on the
floor and repeat.

16. BALANCE AND CORE TRAINING
• Balance and core training both also help
improve gait.
• Walking is a full-body task that requires
coordinated movement from the feet, legs
&core.
• Reach outs in Standing
• Walking on different surfaces
• Balance Board Exercises
• Weight Shifts on Affected side

17. USE OF ASSISTIVE DEVICES &/or ORTHOTICS
Ankle Foot Orthosis:
• Solid AFO
• Posterior leaf spring
AFO (PLS)

18. TREADMILL TRAINING
• Once patient gains postural stability
than treadmill training without BWS
can be started.
• Initially treadmill speeds are slow
(0.23 m/sec)
• Over a period of few weeks it is
gradually increased up to (0.98
m/sec)

19. TASK-SPECIFIC TRAINING.
• This simply refers to walking.
• Walking in different environments.
• Hurdle walking.
• Climbing small slope.
• Taking turns while walking.

20. HIGH TECH GAIT REHABILITATION :
• Partial Body Weight Supported Treadmill Training
• Functional Electrical Stimulation
• Virtual Gait Training

21. BODY WEIGHT SUPPORTED TREADMILL TRAINING
(BWSTT)

22. • An overhead harness is used to support a portion of the patient’s
body weight.
• The harness controls the upright position of the patient in the
absence of good postural stability & reduces fear of falling.
• The use of harness also eliminates the need for adaptive UE
support to compensate for LE weakness.
BODY WEIGHT SUPPORTED TREADMILL
TRAINING (BWSTT)

23. FUNCTIONAL ELECTRICAL STIMULATION.
• Adding electrical stimulation to the affected
muscles during gait training exercises can
help boost results, according to studies.
• NMES improves dorsiflexion and prevents
foot drop
• Significant improvement in gait is proven
with use of FES.

24. VIRTUAL REALITY GAIT TRAINING
• Studies suggest that VR
training is more
effective than balance
or gait training without
VR for improving
balance or gait ability in
patients with stroke.

25. UPPER EXTREMITY MOVEMENT PATTERN
• Finally, persistent posturing of the UE in
flexion & adduction during gait should be
addressed.
• Post stroke there is reduced arm swing on
affected side during walking.
• Therapist need to provide assistance in
positioning the hemiplegic UE in extension &
abduction with the hand open.

26. ADDITIONAL STRENGTH TRAINING
• Some muscle atrophy is common after a stroke.
• Therefore, adding some strength training can help improve
overall health and gait.
• Keep in mind that this addresses the secondary complication of
muscle atrophy, while rehab exercise addresses the primary
concern

27. BENEFITS OF GAIT TRAINING AFTER STROKE
• Gait training exercises can help prevent falling after stroke,
because strong legs can help with stabilization if patient loses
balance.
• Ultimately, a consistent rehab exercise program can help patient
get back onto their feet and back to the activities that they
enjoy.
• Focus on high repetition of exercises to help rewire the brain.
• Be sure to target core and feet along with legs to improve
overall coordination and balance.