PT Classroom - A Comparison of Gait in the Older Adult vs Gait in the Older Adult Who Suffers From Hemiplegia ׀ by Jennifer Hill, MPT, CSCS & Chai Rasavong, MPT, MBA


Older age is an inevitable dilemma that everyone has to encounter. With older age accompanies many changes. Such changes could affect the ability and way an individual engages in a basic daily activity such as walking. Problems in performing the basic task of walking may lead to gait changes in the older adult population, but consider the further difficulties and changes that could arise in the gait of an older adult who suffers hemiplegia secondary to a cerebral vascular accident/stroke. As physical therapists we should not only be aware of the development of gait in older adults, but we should also be aware of the additional needs and challenges older adult stroke victims will encounter with gait .

With older age various factors can contribute to the developmental changes of the older adult gait. Visual deficits and cognitive impairment are huge factors that can affect such things as balance, motor decision and motor execution (Cwikel et al. 1995). With an increase in age there is a decrease in ability to adjust to minor losses of equilibrium (Cummings et al. 1989 in Cwikel et al. 1995). There is also a decrease in regular physical exercise which is associated with a lower step length and a decrease in the ability to turn the head while walking (Cwikel et al. 1995). Movement for older adults is also more attention-demanding and requires more time for execution (Diggles 1993 in Lajoie et al.)

Many changes occur in the gait of the older adult compared to that of the younger adult. It is important for us to know what these changes are so that we might be able to help these older adults in maximizing efficiency in their gait through the use of inertia and gravity (Lewis 1989). In the study of Nagasaki et al. (1996) they found such changes. They calculated the Walk Ratios of 1,134 subjects age 65 and older. The Walk Ratio, which is a good indicator of an altered walking pattern, is calculated by taking the step length and dividing it by the step rate. From their study, they concluded older adults walked slower and with relatively shorter steps, because they obtained smaller Walk Ratios. They saw such reasons for this outcome in the gait patterns of their older adults characterized by a shorter step length, a longer stance and double stance time relative to the walking cycle, a diminished rotation of the hip, knee, and ankle joints and a decrease in the ability to vertically elevate the heel and toe resulting in an appearance of a shuffling gait. From these findings we can now develop a treatment strategy that can incorporate such things as strength, endurance, and flexibility to help make walking more efficient for these older adults (Lewis 1989).

Lajoie et al. (1996) also drew similar conclusions as Nagasaki et al. (1996) in their study of gait characteristics of eight younger adults compared to eight older adults. Their studies concluded older adults adopted a slower walking speed and a shorter stride length than younger adults. The walking speed for older adults was 1.10 m/s vs. 1.39 m/s for the younger adults. The older adults had a 1.25 m stride length vs. a 1.50 m stride length for the younger adults. The older adults also had a longer cycle duration, a slower cadence time, and a greater percentage of time in double support compared to the younger adults. The older adult’s cycle duration was 1.15 s vs. 1.10 s.; their cadence was 105 steps/min. vs. 109 steps/min., and the percentage time spent in double support for the older adults was 30.9% vs. 26.7%. This time spent in double support was considered one of the most important parameters when studying locomotion by Ferrandez (1988), because the double support phase is dependent on the total duration of the walking cycle and will provide a better comparison when comparing the older adult’s gait with the younger adult’s. Though the above results failed to reach significance statistically, the results further supports the same conclusions other researches such as Rubino (1993) agree with.

Lewis (1989) lists similar gait changing characteristics for older adults which included fewer automatic movements, a decrease in speed and amplitude of automatic movements, an increase in muscle activity in the gait cycle, less accuracy and slower movement especially in the hip, a decrease swing-to-stance ratio, a decrease vertical displacement, a broader stride width, an increase toe-floor clearance, a decrease heel-floor angle, a slower cadence, a decrease rotation of the hips and the shoulders, some mild rigidity and some abnormalities in posture. To these characteristics she attributed such factors as a decrease in the range of motion of the joints, a decrease in strength in the skeletal and muscular systems along with an increase in energy consumption as possible underlying factors.

In many studies of gait in older adults there are controversial issues about how researchers define the term “older adult” (Woollacott 1986). In the studies mentioned earlier, the subjects were older adults that were screened physically and mentally but not as in depth as a study conducted by Gabell and Nayak (1984). A good reason for a need of a reference group free of pathological disorders is to evaluate the progress in such areas as medications or physical therapy (Ferrandez 1988). Gabell and Nayak (1984) set out to obtain such a group and had strict criteria in obtaining their older adults for their gait study. This resulted in different results compared to their peers. Their 32 older adult subjects were age 64 and greater & had no disorders of the musculoskeletal, neurological, or cardiovascular systems. They had no severe bilateral visual impairment, or glaucoma, no history of falls, and no use of a walking aid. From their study they found insignificant differences in measuring the variability of gait in four parameters which included step length, stride time, stride width, and double support time when comparing these older adults with younger adults. From these results they concluded that any increase in variability occurring in the gait cycle of older adults is not normal, but due to pathological causes (Gabell & Nayak 1984). This is somewhat inconsistent with other peer results, but we should realize that the older adults in this study that met the above criterion are really somewhat hard to find and are unrepresentative of the older age group (Woollacott 1986).

The changes in gait already affect the ability for the normal older adult to perform activities as well as they used to, but imagine the decrease in performance that would further arise when an individual suffers hemiplegia secondary to a stroke. A stroke is normally caused by a blockage of blood circulation to the brain or hemorrhaging into the brain from a ruptured blood vessel. These disturbances could result in hemiplegia which is paralysis to one side of the body.

The gait pattern in an older adult that suffers hemiplegia differs greatly from that of a normal older adult. We should really be aware of the great difficulty and frustration a stroke victim endures in trying to produce these movements involved in gate. Rubino (1993) describes the walking of an individual that has a hemiplegic gait by circumducting and dragging the affected leg and holding the paretic arm flexed and immobile across the chest. Granat et al. (1995) characterizes hemiplegic gait by a highly asymmetric gait pattern that is caused by a reduction in the flexor activity on the affected side. He further describes “the imbalance of the subtalar muscles with weakness of the evertors and/or spasticity of the plantar flexors and an imbalance of ankle musculature with weakness of dorsiflexors and/or spasticity of the plantar flexors” resulting in inversion and plantar flexion of the foot.

In a study of gait in older adults with hemiplegia by von Schroeder et al. (1995), the findings will help us to understand the mechanics of gait in hemiplegic older adults better. From this study we acquire more knowledge about other incorrect gait patterns that stroke victims utilized compared to considerably healthier older adults approximately the same age. Von Schroeder et al. found hemiplegic patients walked a lot slower, had a decrease in cadence, an increase in gait cycle and a slightly shorter stride compared to controls of older adults approximately their same age. They found these results due to many factors. They found the affected side spent more time in the swing phase and considerably less time in single leg support and stance. They found the unaffected side spent considerably more time in stance phase and single leg support and just about an comparable amount of time in swing phase compared to controls of older adults approximately their same age. They also detected that a flatfoot pattern with a decreased toe contact was usually seen on the affected side in which the heel and metatarsal regions struck the ground at the same time. Overall the general gait pattern which has been observed in older adults with stroke include a toe first or entire sole down during stance, and toe drag or inversion of the foot during swing (Wall et al. 1986 & Colaso et al. 1971 in von Schroeder et al. 1995 ).

In another study which was conducted by Olney et al. (1991) similar findings of hemiplegic gait differences correlated in comparison with the study of von Schroeder et al.(1995). However, these findings were obtained through experiments focusing on aspects of work and power by Olney et al. (1991) in stroke patients. The amount of work and power is important in gait analysis since this can help provide insight of what is going wrong with gait and provide methods for improvement (Olney et al. 1991). In their study they founded a decrease for knee flexion in the swing phase and a decrease in hip extension with declining walking speed on the affected side. Peak ankle and hip power along with work value also decreased on the affected side. In comparison of the total positive work (shortening of muscles) done, the unaffected leg worked one and a half times harder than the affected leg. It was also concluded that in all cases the stance phase was longer for the unaffected side no matter how much more power or work the older adult had to do. From the findings of this study we could maybe use these results to help design a strength and endurance training and rehabilitation program for individuals suffering from hemiplegia (Olney et al. 1991).

Other things that we could do to help correct the gait in older adults and older adults with hemiplegia would be physical therapy (Rubino 1993). Physical therapy with gait training and the use of assistive devices such as canes, walkers, and footdrop braces could also prove helpful. Rubino also recommends conditioning which would benefit all the older adults as well. Along with the above suggestions, older adults suffering from hemiplegia should participate in weight bearing exercises. The more weight bearing exercises done, the better the outcome for walking (Nugent et al. 1994). Rehabilitation programs such as the Bobath neurodevelopment technique (NDT) and the Brunnstroem, Rood, and proprioceptive neuromuscular facilitation concepts (PNF) can also assist in recovery (Hesse et al. 1994). In fact Hesse et al. (1994) conducted a study where he used the NDT technique on stroke patients for four weeks. His results showed that the ability to accept weight, to push off of both legs, to stand for a longer period of time and at a more symmetrical pose improved significantly independent of changes in gait velocity.

The various studies have shown that gait changes with age and for various reasons. However, from these studies we should realize stroke patients not only have to deal with the effects of aging but the various physical and mental problems associated with a stroke as well. Hopefully from this comparison of older adult gait with the gait of older adults who suffer from hemiplegia, we are able to look at a stroke patient and diagnose there gait inaccuracies and inefficiencies with out confusing it with gait characteristics of normal older adults. We should also now be able to help somewhat correct the gait of individuals suffering from stroke through providing verbal cues and information about their gait.

1. Cwikel, J., Fried, A., et al., (1995). Gait and activity in the elderly: implications for community falls-prevention and treatment programs. Disability and Rehabilitation, 17(6), 277-280.
2. Ferrandez, A., Pailhous, J., Serratrice, G., (1988). Locomotion in the elderly. In B. Amblard, A. Berthoz, & F. Clarac (Eds.), Posture and Gait (pp. 115-124). Amsterdam, Elsevier.
3. Gabell, A. & Nayak U.S.L., (1984). The effect of age on variability in gait. Journal of Gerontology, 39(6), 662-666.
4. Granat, M., Maxwell, D., et al. (!994). A body worn gait analysis system for evaluating hemiplegic gait. Medical Engineering & Physics, 17(5), 390-394.
5. Hesse, S., Jahnke, M., et al., (1994). Gait outcome in ambulatory hemiparetic patients after a 4-week comprehensive rehabilitation program and prognostic factors. Stroke, 25(10), 1999-2003.
6. Lajoie, Y., Teasdale, N., et al. (1996). Upright standing and gait: are there changes in attentional requirements related to normal aging?. Experimental Aging Research, 22(2), 185-198.
7. Lewis, C. (Ed.). (1989). Improving Mobility in Older Adults. Rockville: Aspen.
8. Nagasaki, H., Itoh, H., et al., (1996). Walking patterns and finger rhythm of older adults. Perceptual and Motor Skills, 82(2), 435-447.
9. Nugent, J. Schurr, K., et al., (1994). A dose response relationship between amount of weightbearing exercise and walking outcome following cerebro-vascular accident. Archives of Physical Medicine and Rehabilitation, 75(4),399-402.
10. Olney, S., Griffin, M., et al., (1991). Work and power in gait of stroke patients. Archives of Physical Medicine and Rehabilitation, 72(4), 309-314.
11. Rubino, F., (1993). Gait disorders in the elderly. Postgraduate Medicine, 93(6),185-190.
12. Von Schroeder, H., Coutts, R., et al., (1995). Gait parameters following stroke: A practical assessment. Journal of Rehabilitation Research and Development, 32(1), 25-31.
13. Woollacott, M. (1986). Gait and postural control in the aging adult. In W. Bles & T.H. Brandt (Eds.), Disorders of Posture and Gait (pp. 325-336). Amsterdam, Elsevier.


Last revised: August 8, 2009
by Jennifer Hill, MPT, CSCS & Chai Rasavong, MPT, MBA

Terms & Conditions

Please review our terms and conditions carefully before utilization of the Site. The information on this Site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. It is recommended that you seek professional and medical advise from your physical therapist or physician prior to any form of self treatment.