Recording Gait Patterns of
Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018
Adult Hemiplegic Patients
SI0NE BRUNNSTROM * M.A.
NY PECULIARITIES of the motor
behavior of adult hemiplegic patients may be bet­
ter understood if they are examined against the
background of the gross limb synergies charac­
teristic of such patients. These synergies—their
probable origin, manifestations, manner of elicita-
tion, and so forth—have been dealt with compre­
hensively in medical literature.1-12 The extent to
which these limb synergies dominate the motor
behavior of hemiplegic patients gives significant
information concerning the neuromuscular status
of the patient toward which rehabilitation proce­
dures must be oriented.
That the dominance of primitive movement
synergies of the affected lower extremity of a
hemiplegic patient has a decisive influence on his
gait pattern will be stressed in this paper. The
strong association of those muscles which belong
to the flexion synergy on one hand and to the ex­
tension synergy on the other hand oppose and re­
sist the use of muscle combinations needed for
normal human gait.
For a basic understanding of the gait problems
of patients with hemiplegia, therefore, a compari­
son must be made between the phasic action of
muscles in normal walking and the muscle com­
binations characteristic of the primitive move­
ment synergies of flexion and extension. After
this comparison has been made, the challenging
task of finding ways and means of conditioning the
gross movement synergies to bring about muscle
combinations resembling, if not identical with,
* Instructor of Physical Therapy, Columbia University,
New York, New York.
January 1964 • Volume 44 • Number 1
those employed in normal walking presents itself.
Walking patterns of normal individuals are now
reasonably well known with respect to both joint
movement and muscular activity. Under standard­
ized conditions, these patterns vary but little
among individuals.13 Gait patterns of hemiplegic
patients, on the other hand, are quite variable, de­
pending upon the severity of the involvement and
the manner of compensation which the patient
employs.
A decade ago, the gait patterns of eleven patients
who had sustained cerebral vascular accidents were
investigated by electromyography.14 The study re­
vealed that considerable changes in the phasic
action of muscles, as compared to muscle action in
normal walking, had occurred. The changes also
involved the normal limb. This was to be ex­
pected, since the normal limb must make major
adjustments when the affected limb fails to perform
properly. That the patients selected for this study
had relatively mild involvement may be con­
cluded from the records which show heel-toe gait
and marked activity of the anterior tibialis in swing
phase.
The study confirmed a number of common
clinical observations: that the stance phase on the
affected side of these patients is considerably
shorter, and the swing phase correspondingly
longer, than on the normal side; that the quadri­
ceps and the gastrocnemius on the paretic side are
active throughout stance phase; and that all muscle
groups of the nonparetic limb intensify their ac­
tivity, as compared to normal gait.
The electromyograms from this study also in-
11
 G A I T RECORD FOR ADULT PATIENTS W I T H HEMIPLEGIA

Name Aee Side affected

Date of onset Diagnosis
Date of test

WALKING: without brace with brace (short ___ long ) in parallel bars without cane with nane
supported by attendant escorted alone. Elbow held flexed arm swings flaccidly near normal
arm in sling _

Ankle: stance phase Ankle: swing phase

Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018

Entire sole down Toes drag
Toes first Inversion
Inversion, early stance Exaggerated dorsiflexinn
throughout Whip
Affected foot leads Eversion
Heel-toes, near normal

Knee: swing phase

Knee: stance phase Stiff
Knee buckles Moderately stiff
Hyperextension, mild . Free, near normal
moderate Exaggerated flexion
severe
Stable in slight flexion
Near normal Hip: swing phase
Circumduction
Pelvic hike
Hip: stance phase Stiff (pelvic tilt)
Trendelenburg Moderately stiff
Trunk forward Free, near normal
Stable, near normal Exaggerated flexion
External rotation

Remarks

FIG. 1. Form for recording gait deviations of adult hemiplegic patients.

dicated that the gluteus maximus and the semiten-
dinosus on the affected side contracted throughout
stance phase, characteristics which would be diffi­
cult to observe clinically. It is also interesting
that the phasic action of muscles of the nonparetic
limb showed considerable resemblance with that
of the paretic limb.
To the author's knowledge, extensive objec­
tive records of hemiplegic patients with varying
degrees of involvement and utilizing different
types of compensation are not available.
C L I N I C A L RECORDING O F G A I T
FOR PATIENTS W I T H H E M I P L E G I A
The method of recording gait presented here is
essentially a subjective one, inasmuch as it does not
use instrumentation. Its lack of true objectivity is
by far outweighed by its practical aspects: no
time-consuming preparations are needed, very little
space is required, and it is easy to administer. The
experienced observer can evaluate and record the
gait without the patient's knowing that he is being
"tested," which has definite advantages. By sys­
tematically observing the behavior of the three
main weight-bearing joints—ankle, knee, and hip
—specific data are collected which, when put to­
gether, furnish a rather complete picture of the
patient's gait.
The test form illustrated in Figure 1 has been
employed by the author for the last ten years
and has been found quite satisfactory—only minor
changes have been made from time to time. It
is designed to record indoor level walking only.
The items which apply to the patient's evaluation
are checked. Write-in lines are provided for the
recording of deviations not included in the form.
Since the gait elevation proper does not require a
full page, available space may be utilized for re­
cording items such as ability to stand erect with or
without support; to balance on the unaffected limb,

12 JOURNAL OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION

 160
140
120
100
80
120
100
80
60
40
180
160
140
FIG. 2. Knee, ankle, and toe-foot angles in level walking by normal male subject at 90 steps per minute.
Eberhart and Inman, 1947.
on the affected limb; to walk on uneven ground, up
and down slopes; to ascend and descend stairs.
A complete gait evaluation can be given only if
the patient is capable of walking alone without a
brace and without using a cane. At an early re­
covery stage and in the case of severely involved
patients, only part of the test form can be com­
pleted. Regardless of the amount of recovery
present, the patient's ambulatory status can be re­
corded on the form.
Figures 2 and 3, illustrating certain aspects of
the kinematics and the kinetics of normal gait,
should be consulted freely during the discussion
which follows, particularly by those readers who
are not familiar with the locomotion study men­
tioned above. 13 The vertical lines in Figure 2
indicate heel-contact, ball-contact, heel-rise, ball-
rise, and toe-off, respectively, of one limb. In
Figure 3 only those vertical lines that represent
heel-contact and toe-off are shown. The contra­
lateral limb is not included in these two illustra­
tions, i .e., the period of double stance is not indi­
cated.
The movement combinations characteristic of
the basic limb synergies of the lower extremity are:
FLEXION SYNERGY
Hip: flexion, abduction, external rotation
Knee: flexion
Ankle: dorsiflexion and inversion
January 1964 • Volume 44 • Number 1
Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018
Redrawn from
EXTENSION SYNERGY
Hip: extension adduction, internal rotation
Knee: extension
Ankle: plantar flexion and inversion
The electromyographic curves in Figure 3
show that at no time during the walking cycle do
the muscles act in combinations identical with
those incorporated in the basic limb synergies.
When these limb synergies dominate the motor
behavior, the activation of muscle groups in com­
binations and sequences required for normal walk­
ing is prevented.
The electromyograms of normal walking also
indicate that a rapid rise and fall in tension of the
muscle groups is required. By contrast, when the
basic limb synergies are activated, muscular ten­
sion is slow in building up and slow in fading out.
In general, it may be stated that the walking
difficulties encountered by patients with hemi­
plegia are related to two main factors: firm link­
age of muscle groups in accordance with the dic­
tum of primitive movement synergies and slow­
ness of reaction of muscle groups.
The main portion of the test chart (Fig. 1)
provides space for recording of the behavior of
ankle, knee, and hip on the hemiplegic side during
stance phase and swing phase. The deviations
listed all have been observed clinically, though
with varying frequency.
13
 WALKING CY
SWING PHASE STANCE P H A S E
= 100
_i 80 =
<
o 60
u 20
liJ Q \
3
/
A\ , , .
A\, , , /
10 20 30 40 50
FIG. 3. Idealized summary curves representing phasic action of major muscle groups in level walking at 90 steps per minute.
Redrawn from Eberhart and Inman, 1947.
KEY: 1—Pretibial Group; 2—Calf Group; 3—Quadriceps Group; 4—Hamstring Group; 5—Abductor Group; 6—Adductor Group;
7—Gluteus Maximus; 8—Erector Spinae.
The individual test items will now be discussed
step by step.
Ankle Joint: Stance Phase
For the present discussion, it is convenient to
speak about early stance, midstance, and late
stance because the forces acting on the support­
ing limb change significantly in the course of the
weight-bearing phase. No attempt has been made
to define these subdivisions in terms of percentage
of the walking cycle.
Early stance, normal gait. As the heel strikes
the ground at the beginning of stance phase, the
angle between the foot and the leg (see angle B,
Fig. 2) is approximately 90 degrees. As weight
is being transferred to the forward foot, the sole
of the foot is gradually and smoothly lowered to
the ground. During this phase, only minor
changes in the foot-leg angle occur, owing to the
stabilizing action of the muscles which prevent a
sudden plantar flexion of the ankle. For this
stabilization, the dorsiflexors of the ankle (see
pretibial group, Fig. 3) are responsible as they
resist the stretching force caused by the impact
of the body weight on the heel.
Early stance, hemiplegic gait. When the basic
limb synergies are dominant, weight bearing on
the affected limb activates all the components of
the extension synergy, including the plantar flexors
of the ankle. The tension which is thus set up in
14
WALKING CY
SWING P H A S E " * « SWING PHASE STANCE PHASE SWING P H A S E
Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018
7A / J
60 70 80 90 100%
v Vk 10 20 30 40 50
V
60 70 80
/
90 100%
the calf muscles maintains the ankle in plantar
flexion, and, as a result, the heel and the ball of the
foot make contact with the ground simultane­
ously. The dorsiflexors of the ankle, being com­
ponent parts of the flexion synergy, refuse to asso­
ciate themselves with the knee extensors. On the
test chart this condition is described as entire sole
down. If spasticity is marked, the patient may
even touch the ground with the toes first. When
inversion of the ankle is pronounced, the weight
will be borne on the outside of the foot and in that
case walking without an ankle brace or other
control is not advisable. Many patients, however,
display only a moderate amount of inversion in
early stance, an inversion which corrects itself as
the weight is shifted over the foot.
In severely involved patients the extension syn­
ergy may set in strongly before the affected foot
touches the ground. The adduction component
may be so marked that the affected limb draws
close to the normal one, or goes into extreme ad­
duction, crossing in front of the unaffected limb.
In that case, weight bearing on the affected limb
becomes impossible.
Midstance, normal gait. When the ball of the
foot has made contact with the ground, the task
of the dorsiflexors of the ankle has been com­
pleted. With the sole firmly on the ground, the
leg starts pivoting forward about the ankle joint,
causing the foot-leg angle (see angle B, Fig. 2) to
JOURNAL OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION
decrease somewhat. As the body weight advances
in front of the axis of the ankle joint, action of the
plantar flexors begins (compare electromyogram,
Fig. 3). Excessive forward pivoting of the leg at
the ankle is prevented by a lengthening contraction
of the calf muscles as these muscles resist the
stretching force of the body weight. During this
phase, a gradual and controlled elongation of small
range of the calf muscles takes place.
Midstance, hemiplegic gait. Spastic muscles are
hypersensitive to stretch. When stretched, they
respond by increasing their tension. The calf
muscles are no exception to this rule. When acted
upon by the body weight, their tension is rein­
forced, often to such a degree that no elongation
can take place. This prevents forward pivoting
of the leg at the ankle and interferes with proper
forward motion of the body. The patient finds it
difficult to advance the normal foot the right dis­
tance in front of the affected one and the strides
become unequal. The swing phase of the normal
limb is executed too rapidly, which further con­
tributes to the disturbances of the natural walking
rhythm. When tension in the calf muscles is
marked and unyielding, the affected foot may lead
all along, so that the patient advances the affected
foot, then draws the normal foot up to, but not
beyond, the affected one.
Late stance, normal gait. Toward the end of
stance phase, as the limb prepares for the for­
ward swing, the heel rises from the ground and
simultaneously the knee begins to flex (Fig. 2).
The electromyogram shows a rapid increase in ten­
sion and peak activity of the calf muscles. Since
in this phase the ankle plantar flexes, it is obvious
that the calf muscles have reversed their action
from a lengthening to a shortening contraction.
Because the knee extensors at this time are in­
active and because the main portion of the body
weight is now on the contralateral limb, the push-
off of the calf muscles causes the foot to detach
itself from the ground as hip and knee flex. To­
gether with other muscular and gravitational
forces, the calf muscles thus are instrumental in
initiating the forward swing of the limb.
Late stance phase, hemiplegic gait. The failure
of the affected limb to perform properly is particu­
larly noticeable in late stance phase. First, tension
in the quadriceps often persists into this phase and
prevents the knee from flexing, or causes it to
flex too slowly. Second, flexion of the hip and
knee together with active push-off by the calf
muscles, as required in normal walking, does not
materialize, for neither the flexion synergy nor
the extension synergy provides this combination.
Detachment of the foot becomes difficult and the
forces needed for initiation of swing phase are in­
adequate. The limb therefore has to be brought
forward by some compensatory method.
January 1964 • Volume 44 • Number 1
Knee Joint: Stance Phase
Early stance and midstance, normal gait. At
the moment when the heel makes contact with
the ground, the knee is extended or nearly ex­
tended. After heel-contact, under the impact of
the body weight, a knee flexion of short duration
and small range sets in, followed by knee exten­
sion (angle A, Fig. 2). This flexion-extension
movement is instrumental in keeping the path of
the center of gravity of the body from rising and
falling abruptly, thus aiding a smooth forward
translatory movement of the body. The electro-
Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018
myograms show peak activity of the quadriceps
during the flexion portion of the knee curve in
early stance (Fig. 3). Muscular activity thus pre­
vents a buckling of the knee at a time when the
body weight acts posterior to the knee axis. A
sharp drop and complete cessation of activity of
the quadriceps follows, indicating that in mid-
stance knee extensor activity is no longer needed.
Early stance and midstance, hemiplegic gait. If
the limb is essentially flaccid, as in the early stages
following a cerebral vascular accident, the knee
may be incapable of supporting the body weight,
that is, the knee buckles, and a fall may result. A
temporary splint is then required to make weight
bearing safe. Gait analysis at this early stage is
hardly feasible.
A common deviation in this phase of walking
is hyperextension of the knee at a time when a
flexion-extension movement should take place.
The hyperextension may be mild, moderate, or
severe. The quadriceps usually responds, but it
fails to regulate its activity to the requirements of
normal gait. There no doubt are a number of fac­
tors which contribute to hyperextension, but these
cannot be authoritatively discussed here. The fol­
lowing points, however, are pertinent to this dis­
cussion: a hyperextended knee offers increased
stability and is therefore a purposeful compensa­
tion for a patient who does not have full knee con­
trol; a rapid decrease in tension of the quadriceps
following its peak activity at the transition from
swing to stance, as required in normal gait, does
not take place; 14 tight calf muscles prevent a for­
ward pivoting of the leg at the ankle and hyperex­
tension of the knee may occur because the ankle
fails to yield.
Some patients show an increased flexion of the
knee in early stance, and the knee momentarily
appears to give, but the knee becomes stable in
slight flexion and forward weight shift is facilitated.
It would seem as if the quadriceps were called into
action on heel-contact but perhaps with insuffi­
cient speed or strength. As the body weight starts
flexing the knee, the quadriceps becomes
stretched, and this stretch reinforces its contrac­
tion so that weight bearing on a slightly flexed
knee becomes possible.
Late stance, normal gait. In this phase, the
15
knee flexes and the ankle plantar flexes (angles
A and B, Fig. 2). This requires an inhibition of
the contraction of the quadriceps and a strong
activation of the calf muscles (peak contraction,
Fig. 3). This combination, together with flexion
of the hip, initiates the forward swing of the limb.
Late stance, hemiplegic gait. The strong link­
age which exists between the calf muscles and the
quadriceps in hemiplegic patients does not allow
the muscle combination which is required in late
stance phase for normal progression. Preparation
for swing phase, as described above, therefore
fails, and the patient seeks other ways of moving
the affected limb forward.
Hip Joint: Stance Phase
Early stance and midstance, normal gait. One
important requirement at the hip during normal
weight bearing is the activation of the abductors of
the hip. These muscles provide lateral stabiliza­
tion of the pelvis, preventing the opposite side of
the pelvis from sagging. The hip abductors show
peak activity just after heel-contact and they con­
tinue being active (with lesser intensity) through­
out midstance. The extensors of the hip show a
burst of activity after heel-contact, an activity
which then rapidly decreases and ceases before
midstance (Fig. 3).
Early stance and midstance, hemiplegic gait.
When the extension synergy is activated on weight
bearing (often prior to weight bearing), the adduc­
tors of the hip together with other components of
the extension synergy contract. The abductors, on
the other hand, which belong to the flexion syn­
ergy, fail to respond, and lateral stabilization at the
hip is lacking. The result is a Trendelenburg limp,
characterized by a lowering of the pelvis on the
normal side when the affected limb carries the
body weight. This type of limp, common among
patients with hemiplegia, may be recognized at a
glance by observing the summit of the head when
the patient walks. Each time the affected limb is
in stance phase, the summit of the head is lowered,
which is not the case in the corresponding phase
on the normal side. It must be pointed out, how­
ever, that hyperextension of the affected knee in
stance phase also results in a lowering of the sum­
mit of the head, so that closer investigation is re­
quired. Often a Trendelenburg limp and hyperex­
tension at the knee occur simultaneously.
The Trendelenburg limp can only be observed if
the patient is capable of walking alone and without
a cane, for when a cane is used the limp becomes
disguised. If walking without a cane is not safe,
the behavior of the hip abductors on weight bear­
ing may be observed in the standing position, as
the patient shifts his weight over the affected limb.
The trunk forward item on the test form indi­
cates that the patient flexes the hip by inclining the
trunk forward in early stance. Such trunk move­
16
ment often occurs in conjunction with hyperexten­
sion of the knee and with insufficient yield of the
calf muscles in midstance.
Late stance, normal gait. This phase, utilized
in preparation for the swing-through of the limb, is
characterized by flexion of the hip (Fig. 2). It
may be assumed that the iliacus and the psoas ma­
jor muscles are instrumental in flexing the hip at
this time. However, to the author's knowledge,
electromyograms showing these muscles in walk­
ing are not available. (The electrical activity of
the iliopsoas in standing has been investigated by
Joseph 15 and by Basmajian 16 > 17 .) In the Berke­
Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018
ley locomotion study, no attempt was made to re­
cord the electrical activity of these deep-seated
muscles.13 When the subjects walked at medium
or fast speeds, the electromyograms of the quadri­
ceps showed a secondary peak in late stance, no
doubt to be interpreted as originating mainly in the
rectus femoris, acting as a hip flexor.
Late stance, hemiplegic gait. Since the domi­
nance of the basic limb synergies prevents a combi­
nation of calf muscle activity with hip and knee
flexion, the proper preparation for the swing-
through is lacking. In many hemiplegic patients
the required cessation of activity of hip and knee
extensors is absent or too slow to allow flexion of
these joints. The calf muscles may persist in their
activity throughout stance, but the rapid rise in
tension needed for the push-off is missing.14
When the behavior of the three joints in stance
phase has been observed and recorded, attention
is focused on the manner in which the hemiplegic
limb is brought forward.
Swing Phase, Normal Gait
As previously pointed out, swing phase is initi­
ated during the last portion of stance, when muscu­
lar and gravitational forces act to bring about a
forward acceleration of the limb. Hip and knee
flexion, and plantar flexion of the ankle occur at
this time. The electromyograms indicate that mus­
cular activity is minimal during most of swing
phase, the limb then moving forward by inertia.
The dorsiflexors of the ankle (see pretibial group,
Fig. 3) show slight activity throughout swing
phase—this to prevent a drop foot. Toward the
end of swing phase, muscular activity again picks
up for the purpose of decelerating the limb in prep­
aration for weight bearing.
Swing Phase, Hemiplegic Gait
In general, when the extension synergy does not
let go its grip in late stance, or does so too slowly,
the limb is moved forward in a stiff manner, hip
and knee joints fail to flex, or flex insufficiently,
and the ankle remains in plantar flexion. Patients
who are capable of activating the flexion synergy
do so in an exaggerated manner, particularly as
far as the hip is concerned. The exaggerated hip
JOURNAL OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION
flexion is accompanied by a belated flexion of the
knee and by dorsiflexion of the ankle.
The swing phase items listed on the test chart
will now be discussed briefly.
Ankle. Failure of the dorsiflexors of the ankle
to contract during swing phase results in a drop
foot and in insufficient ground clearance which is
recorded as toes drag. More often than not, the
ankle simultaneously inverts, and, if markedly so,
it may not be safe for the patient to walk without
an ankle brace or other device which restricts in­
version. Exaggerated dorsiflexion occurs in pa­
tients who are capable of activating the flexion
synergy and who then also use exaggerated hip
flexion. Whip is a term difficult to describe accu­
rately. A rapid back-and-forth movement takes
place, probably mainly at the lower ankle joint
(subtalar joints). The ankle appears unstable,
but the position of the foot corrects itself prior to
weight bearing. Eversion is occasionally observed
in patients who drag the affected limb (see also
hip, page 12).
Knee. Failure of the knee to flex normally
during swing phase is recorded as stiff, or moder­
ately stiff, as varying degrees of tension in the
quadriceps persists in swing phase. Exaggerated
flexion indicates that the patient uses the flexion
synergy. Actually, the amount of knee flexion
which occurs may not exceed that of normal walk­
ing, but the onset of knee flexion is delayed, prob­
ably because the calf muscles do not provide the
proper push-off in late stance. The knee is lifted
forward-upward, and the leg hangs more or less
vertically, the foot well off the ground, as if the
patient were stepping over an obstacle.
Hip. With the persistence of the extension syn­
ergy, or a delayed release of extensor tension, a
normal shortening of the limb required for the
swing-through does not materialize and the pa­
tient must find other ways of bringing the affected
limb forward. In order to get toe-clearance, a
circumduction movement of the limb or a pelvic
hike on the affected side or both may be commonly
utilized, sometimes aided by a rising on the toes
of the normal foot. If the hip is held stiff (no hip
flexion), the patient may nevertheless succeed in
advancing the affected limb by tilting the pelvis
backward, the gait then resembling that of a pa­
tient with an ankylosed hip. A moderately stiff
hip is a common appearance, necessitating some
anteroposterior or lateral pelvic movements. Ex­
aggerated flexion of the hip occurs when the pa­
tient utilizes the flexion synergy, as previously
described.
Occasionally, a patient may drag the affected
limb, never advancing it beyond the normal foot.
The pelvis stays behind on the affected side and
the hip is externally rotated so that the toes point
in a lateral direction. Eversion of the ankle may
accompany this gait. The limb does not play an
January 1964 v Volume 44 • Number 1 17
active part in walking, and the body weight is kept
mainly on the leading normal foot.
SUMMARY
A clinical method of recording gait patterns in
patients with hemiplegia has been presented, and
the procedure explained step by step. As a basis
for comparison between normal walking and hemi-
plegic gait patterns, specific aspects of the kinema­
tics and kinetics of normal level walking have been
discussed.
Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018
The inability of hemiplegic patients to walk in a
normal fashion appears to be related to two main
factors: (1) the dominance of basic, primitive limb
synergies which prevent and resist the activation of
muscle combinations and sequences characteristic
of normal walking and (2) the failure of the mus­
cles on the affected side to produce a rapid rise
and fall in tension as required in normal walking.
Variations in gait patterns of hemiplegic patients
seem to be determined mainly by (a) the degree of
dominance of the basic limb synergies and (b) the
manner of compensation which the patient has
adopted.
From the completed gait record certain aspects
of the neurophysiological status of the patient's
lower extremity may be deduced, particularly with
respect to the relative strength of the linkage of
muscle groups in primitive synergy combinations.
The gait record which pinpoints the patient's
failures and difficulties may serve as a rationale
for the establishment of training procedures.
REFERENCES
1. Marie, P., et Foix, C.: Les syncinesies des hemiplegi-
ques, Rev. Neurol. 1916, 1st Semest., pp. 3—27, and
2nd Semest., pp. 145-162.
2. Riddoch, G., and Buzzard, E. F.: Reflex movements
and postural reactions in quadriplegia and hemiplegia,
with special reference to those of the upper limb, Brain,
44:397-489, 1921.
3.Walsche, F. M. R.: On certain tonic or postural re­
flexes in hemiplegia with special reference to the so-
called "associated movements," Brain, 46:1-37, 1923.
4. Simons, A.: Kopfhaltung und Muskeltonus. Zeitschr.
f.d. ges. Neurol, u. Psychiat. 80:499-549, 1923. (Ab­
stracted by Brunnstrom, Phys. Ther. Rev., 33:409-419,
1 9 5 3 -) • r, ,•
5. Magnus, R.: Korperstellung, Julius Springer, Berlin,
1924. (Chapter III, "Haltung", abstracted by Brunn­
strom, Phys. Ther. Rev., 33:281T290, 1953.)
6. Brunnstrom, S.: Associated reactions of the upper ex­
tremity in adult patients with hemiplegia, an approach
to training, Phys. Ther. Rev., 36:225-236, 1956.
7. Brunnstrom, S.: Methods used to elicit, reinforce, and
co-ordinate muscular response in upper motor neuron
lesions. In APTA-OVR Institute Papers. New York:
American Physical Therapy Association, 1956, pp. 100-
110.
8. Brunnstrom, S.: The use of associated reaction patterns
in the training of adult patients with hemiplegia. In
Proceedings, Second Congress, World Confederation
for Physical Therapy. New York: American Physical
Therapy Association, 1956, pp. 56-61.
9. Brunnstrom, S.: Motor behavior of adult hemiplegic
patients, hints for training, Amer. J. Occup. Ther.
15:6-12, 1961.
10. Reynolds, G. G., and Brunnstrom, S.: Excerpts from
the report on the study of neurophysiology reactions
facilitating recovery following hemiplegia. New York:
Institute of Physical Medical and Rehabilitation, New
York University-Bellevue Medical Center, 1957.
11. Reynolds, G. G., Archibald, K. C., Brunnstrom, S., and
Thompson, N.: Preliminary report on neuromuscular
function testing of the upper extremity in adult hemi-
plegic patients, Arch. Phys. Med., 39:303-310, 1958.
12. Reynolds, G. G., and Brunnstrom, S.: Problems of sen­
sorimotor learning in the evaluation and treatment of
the adult hemiplegic patient, Rehab. Lit., 20:163-171,
1959.
13. Eberhart, H. D., and Inman, V. T.: Fundamental
studies of human locomotion and other information
Emanuel Swedenborg, A Versatile Man of Science
One of the lesser known and heralded men of
medical science is Emanuel Swedenborg, who was
born January 29, 1688, in Stockholm, Sweden.
Son of the Royal Chaplain who later became
Bishop of Skara, Swedenborg was reared in an
intellectual atmosphere.
His life was largely devoted to scientific studies
which covered the whole field on science. He
was a psychologist, philosopher, mathematician,
geologist, inventor, metallurgist, mineralogist,
botanist, chemist, aurist, physicist, zoologist,
aeronautical engineer, assayer, musician, author,
crystallographer, instrument maker, machinist, leg­
islator, mining engineer, economist, editor, cos-
mologist, theologian, lens-grinder, clockmaker,
poet, linguist, biographer, reformer, astronomer,
bookbinder, physiologist, hydrographer. He was
an inveterate traveller; his researches took him to
many foreign countries. He published volumes on
mathematics, geology, chemistry, physics, mineral­
ogy, astronomy, anatomy, and theology, which
contain the germs of brilliant discoveries.
Swedenborg sketched out the plans for a ma­
chine gun, submarine, pianola, airplane greatly
in advance of his time. A model of his airplane
hangs in the Smithsonian Institute, Washington. It
has been said to contain the first embodiment of
aerodynamic features essential to successful flight.
Swedenborg is the father of a decimal system of
coinage and of crystallography. He originated the
nebular hypothesis of the solar system and ex­
plained the nature of the Milky Way. He produced
an ear trumpet and made important discoveries on
the composition and circulation of the blood.
Called the Swedish Aristotle, Swedenborg at an
early age collected a large library of scientific
volumes and mastered the contents. After thirteen
years of reading and study, and while serving in
the College of Mines and the upper house of the
Swedish Diet, he published his first large work on
the philosophy of creation and on the smelting of
iron and copper. His Principia for the first time
postulated the Nebular Theory, usually credited to
LaPlace who expanded and published it fifty years
18
relating to design of artificial limbs. Report to Na­
tional Research Council. Berkeley: University of Cali­
fornia College of Engineering, 1947. (For brief re­
view of locomotion material, see Brunnstrom: Clinical
Kinesiology. Philadelphia: F. A. Davis Company,
1962.)
14. Hirschberg, G. G., and Nathanson, M.: Electromyo­
graphic recording of muscular activity in normal and
spastic gaits, Arch. Phys. Med., 33:217-224, 1952.
15. Joseph, J.: Man's Posture. Electromyographic Studies.
Springfield, Illinois: Charles C Thomas, 1960.
16. Basmajian, J. V.: Electromyography of the iliopsoas,
Anat. Rec., 132:127-132, 1958.
17. Basmajian, J. V.: Muscles Alive. Baltimore: Williams
& Wilkins Co., 1962.
Downloaded from https://academic.oup.com/ptj/article-abstract/44/1/11/4628899 by guest on 02 December 2018
later. In his first large work Swedenborg developed
a number of philosophical principles which he
called "universals" or "doctrines." These he fol­
lowed throughout later researches in the realm of
anatomy-physiology.
The next area of his study was the human body.
Following ten years of study and experiment, in­
cluding much time in dissection rooms in Paris, he
published a series of anatomico-physiological
works on the philosophy of the human body in
action. He analyzed the works of earlier men—
Malpigius, Eustachius, Harvey, Swammerdam,
Leeuwenhoek, and others—and applied to them
the principles he had worked out and found sound
in his earlier studies. His most important findings
include location of motor centers in the cerebral
cortex, functions of many of the ductless glands, of
the crossed pyramidal tract, the pituitary gland,
the optic thalami, and others. These were not
always the result of observable fact, but were the
result of what a modern review of his book, The
Cerebrum, terms "happy intuitions." In his work
he applied the technique of induction as well as
deduction.
Swedenborg travelled widely and profitably.
From visits to the universities, dissecting rooms,
mines, glass works, and quarries of Europe, he sent
lists of "novelties" to be used in his homeland.
New optical instruments, telescopes, and micro­
scopes went to his Alma Mater, Upsala University.
When he was home, he sat in the upper chamber
of the Parliament and was confindant and adviser
of the Swedish sovereigns of his time.
He was a deeply religious and philosophic man,
and his theological writings fill thirty volumes. In
London in 1787 a philosophic society was founded,
based on Swedenborg's teachings. It became the
New Jerusalem Church, which has continued and
is now spread throughout the world.
Swedenborg died March 29, 1772, in London.
Not only a product of his culture, but also a man
whose vision was far beyond his times, his legacy,
though little heralded, is recognized increasingly
today.
10URNAL OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION