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June 2018

Management of Gait Impairments in Chronic Unilateral Upper Motor Neuron Lesions: A Review

Author Affiliations
  • 1Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
  • 2Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
  • 3Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
  • 4Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, the Netherlands
  • 5Rijndam Rehabilitation Center, Rotterdam, the Netherlands
  • 6Roessingh Research and Development, Enschede, the Netherlands
  • 7Biomedical Signals and Systems, MIRA–Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
JAMA Neurol. 2018;75(6):751-758. doi:10.1001/jamaneurol.2017.5041

Importance  Gait impairments are common in patients with chronic supratentorial upper motor neuron lesions and are a source of disability. Clinical management aimed at improving the gait pattern in these patients is generally perceived as a challenging task because many possible abnormalities may interact. Moreover, a multitude of treatment options exist, ranging from assistive devices and muscle stretching to pharmacologic and surgical interventions, but evidence is inconclusive for most approaches and clear treatment guidelines are lacking.

Observations  Gait deviations in adults with a chronic supratentorial upper motor neuron lesion can approximately be reduced to the following 3 groups of primary deficits: (1) imbalance of muscle strength, length, and activity around the ankle and tarsal joints leading to pes equinovarus or pes equinus; (2) calf muscle weakness; and (3) overactivity of proximal leg muscles.

Conclusions and Relevance  A stepwise treatment algorithm emphasizes medical-technical interventions, which are based on evidence when available and otherwise reflect practice-based experience.