although some simply have a history of vascular disease. On the affected side, there are (1) upper extremity adduction and flexion at all levels (elbow, wrist, and fingers); and (2) lower extremity extension at
all levels (hip, knee, and ankle). The foot is internally rotated. Spastic hemiplegic patients have great
difficulty in flexing the involved hip and knee and in dorsiflexing the ankle (which remains flexed
downward and inward—equinovarus deformity). As a result, they do not drag the foot limply behind them,
but swing it on the affected side in a half-circle (circumduction), with the foot scraping the ground on
its lateral edge, in a typical wear-and-tear of the shoes. The upper body tilts to the opposite side (compensating for the semicircular movement of the leg), and the walk is overall difficult and slow. Asymmetric arm-swinging is another typical feature, even though this may also occur in 70% of normal subjects.