Post-stroke violent adventitial movement responsive to levo-dopa/carbi-dopa therapy.

Previous reports in the literature concerning cerebrovascular accident have illustrated cases of post-stroke tremor. Treatments of these studies have varied. Trials of levo-dopa have been reported in two such cases. This case study reports on a case of a patient with a left thalamic, left superior cerebellar artery infarction with a lacunar infarction in the basal ganglia. The patient developed a violent tremor/movement disorder which was unresponsive to haloperidol. With this failure, and with the evidence of a basal ganglion lesion, levo-dopa/carbi-dopa was introduced as an intervention. The amplitude of the tremor was dramatically reduced, with protective devices removed, and with complete cessation of the tremor at rest. The medication was withdrawn and reintroduced with a reduction and subsequent resolution of the symptoms. A discussion of the previous studies of movement disorder with cerebrovascular accident is included.

Hip hiking and circumduction: quantitative definitions.

OBJECTIVE: To define and propose clinically useful quantitative measurements of hip hiking and circumduction using standard three-dimensional motion analysis techniques. DESIGN: We studied pelvic, hip, and thigh motions in 23 subjects with hemiparetic, stiff-legged gait as a result of stroke and compared these motions with those obtained from 23 able-bodied controls. RESULTS: We observed significantly increased hip abduction on the unaffected limb during stance, with simultaneous elevation of the affected side of the pelvis during swing. We define these differences as hip hiking and, thus, can quantify the degree to which hip hiking occurs by measuring the unaffected coronal hip angle and/or the coronal pelvic angle when the affected limb is in midswing. We also observed a greater than normal coronal thigh angle during midswing of the affected limb that we can use to quantitatively define circumduction. Of note, hip abduction during swing was not increased on the affected swing limb, compared with the control. CONCLUSIONS: Hip hiking can be defined precisely as unaffected coronal hip and/or pelvic angle when the affected limb is in midswing and circumduction can be defined as greater than normal coronal thigh angle during midswing of the affected limb. These precise definitions should allow us to better communicate and understand the implications of these gait patterns, and can serve as the basis for clinically meaningful quantitative assessment and outcome measurement tools.

Spastic paretic stiff-legged gait: biomechanics of the unaffected limb.

A concern for individuals with hemiparesis affecting their gait, which heretofore has never been studied, is the possibility that various compensations occurring in the unaffected limb may strain or fatigue the muscles or ligaments and/or predispose to joint injury in that limb. We studied the biomechanics of the unaffected limb during walking in 20 subjects with hemiparesis who had stiff-legged gait as a result of stroke. An optoelectronic motion analysis and force platform system was used to estimate torques in all three planes about the hip, knee, and ankle. Sagittal plane joint motion and power about the unaffected hip, knee, and ankle were also studied. Data were compared with control walking data collected from 20 able-bodied controls. On average, peak torques and powers were all either reduced or the same compared with controls, even though in some instances values were >2 standard deviations (SD) above the control means. Our findings suggest that on average the probability of excessive muscular-tendon effort and the risk for biomechanical injury in the unaffected limb are minimal compared with able-bodied, walking controls. However, given individual variability, we recommend routine clinical gait analysis for all people with stiff-legged gait to eliminate excessive values in certain biomechanical parameters, which could, if not addressed, predispose to muscle-tendon strain or joint or ligamentous injury.