Gait (1Q) Flashcards
Cautious gait
Pt walks with an abbreviated stride and lowered center of mass, as if on slipper surface. Very common and non-specific. Often physical therapy can improve gait to level where underlying disorder can be identified.
Stiff-legged gait
aka Spastic gait- characterized by stiffness of the legs, imbalance of muscle tone, and a tendency to circumduct and scuff feet. Pt. may walk on toes and in extreme cases legs may cross.
Consistent with disorder of upper motor neuron.
Common etiologies:
Myelopathy (from cervical spondylosis)
Demyelinating disease (younger pts)
Trauma
Tropical spastic paraparesis (HTLV-I- S. America and Caribbean)
What presents with stiff-legged gait, asymmetry, UE involvement, and dysarthria?
This is cerebral spasticity. Occurs in stroke, MS, and cerebral palsy.
festinate
unintentional acceleration while walking (Parkinson’s)
Gait freezing
Difficulty with initiation of gait (Parkinson’s)
Supranuclear palsy
Parkinson-like neurodegenerative disorder that presents with axial stiffness, postural instability, and shuffling gait without pill-rolling tremor. Fall within first year is suggests this is etiology vs. Parkinson’s.
Frontal gait disorder
aka “gait apraxia”, lower-body Parkinsonism- shuffling, freezing gait, wide base, short stride with imbalance associated with signs of higher cerebral dysfunction. Difficulty with starts and turns, difficulty w/ gait initiation. Strength is preserved.
Common causes:
Vascular disease, esp subcortical small-vessel disease.
Binswanger’s disease (ischemic lesions of deep hemisphere white matter)
Communicating hydrocephalus
Communicating hydrocephalus
Causes frontal gait disorder in adults. Diagnostic triad of mental status change, and incontinence. MRI shows ventricular enlargement, an enlarged flow void about aquaduct, and periventricular white matter changes.
Turn en bloc
Changing direction in gait without turning head. Done in several shuffling steps. Typical in Parkinson’s.
Cerebellar gait ataxia
Wide base of support, lateral instability of the trunk, erratic foot placement, and loss of balance when attempting to tandem walk or turn. Lurching.
Causes:
stroke, trauma, tumor, neurodegenerative disease, fragile X pre-mutation, EtOH cerebellar degeneration.
MRI will show atrophy in cerebellum for all.
Abnormal heel to shin suggests
Cerebellar dysfunction (look for cerebellar ataxia).
Sensory ataxia
Narrow-based, looking at feet, regular stride but irregular path. Will also have Romberg sign and may have loss of proprioception, vibration sense in lower limbs.
Caused by loss of proprioception or vestibular input.
Causes:
Neurosyphilis, B12 deficiency, other large-fiber neuropathy, ototoxic drugs.
Gait in neuromuscular disease (peripheral neuropathy)
Foot drop (with high step height), toe slap, pelvic sway.
Gait disturbance with mental status changes, asterixis, myoclonus, and loss of static balance suggest…
Metabolic disturbance (Renal or hepatic failure), neuroleptic (sedatives) or benzo toxicity.
Psychogenic gait disorder
Bizarre gait (astasia-abasia- wastage of energy), abducted arms (inappropriate overcatiousness)in anxiety or very slow in depression, may occur only when watching.
