Abstract
We encountered a patient with post-stroke right hemiplegia in whom equinovarus foot developed with dragging of the toe in the swing phase on the hemiplegic side interfering with walking. The problems in this case were abdominal muscle hypotonia on the hemiplegic side, hypertonia of the bilateral back muscles and ankle joint muscles on the hemiplegic side, and superficial hypesthesia of the sole on the hemiplegic side. Based on these findings, we performed treatment to improve functions of the hemiplegic leg and trunk, focusing on the problem in the swing phase, which the patient most strongly showed. Functions of the hemiplegic leg and trunk were inproved, and the gait improved immediately after treatment, but returned to the previous condition at the following outpatient session, showing no persistent therapeutic effect. We re-investigated the gait, and found that the patient walked while being conscious of dorsal flexion of the ankle joint to avoid the hemiplegic leg being caught. Assuming that walking while being unconscious of ankle joint dorsal flexion is necessary, we performed treatment to promote walking without consciousness of the dorsal flexion. The patient's gait improved, and a persistent therapeutic effect and ability to walk a long distance were achieved. The acquisition of this unconscious gait may have involved central pattern generators (CPGs) and motor learning.
