[28] Abnormal Gait

Question 1

What is balance?

Answer 1

The ability to stand

Question 2

What is gait?

Answer 2

The rhythmic stepping movements for travel

Question 3

Do balance and gait problems tend to be found in the same individuals?

Answer 3

Yes

Question 4

What are walking messages initiated by?

Answer 4

The motor and premotor cortex

Question 5

What are walking messages modified by?

Answer 5

The subcortical nuclei, brainstem, and cerebellum

Question 6

How are walking messages interpreted into walking?

Answer 6

The structures modifying the walking messages activate the spine’s central pattern generator, which co-ordinates arm and leg movements into rhythmic gait

Question 7

What affects the output of the spinal central pattern generator?

Answer 7

Proprioceptive, visual, and vestibular inputs

Question 8

What is the ability to stand and walk normally dependant on?

Answer 8

Several systems, including;

• Visual
• Vestibular
• Cerebellar
• Motor
• Proprioceptive
• Sensory

Question 9

What do balance and gait require?

Answer 9

Intact brain, spinal cord, and sensory system

Question 10

What can cases changes in gait?

Answer 10

• Disease directly affecting this system

- Age

Question 11

In what % of older people do gait and balance abnormalities occur?

Answer 11

8-19%

Question 12

What happens as the body moves forward in normal gait?

Answer 12

One limb typically provides support while the other limb is advanced in preparation for its role as the support limb

Question 13

What is the gait cycle composed of?

Answer 13

Stance and swing phase

Question 14

What is the stance phase further subdivided into?

Answer 14

• Initial double stance
• Single limb stance
• Terminal double limb stance

Question 15

What happens to the duration of each aspect of stance as the walking velocity increases?

Answer 15

It decreases

Question 16

How is the transition from walking to running marked?

Answer 16

By elimination of double support

Question 17

What normal age-related changes are there to gait?

Answer 17

• Strength
• Walking posture
• Limb motion
• Joint motion

Question 18

What happens to normal strength with age?

Answer 18

It peaks in mid-20s and declines only a little until the 5th decade, after which it falls off much faster

Question 19

What happens to normal gait speed with age?

Answer 19

It remains stable until the 7th decade, then slows modestly

Question 20

What might age-related changes in the balance of older persons result in?

Answer 20

Compensatory responses that meet routine needs but may be ineffective under demanding circumstances

Question 21

Describe the relationship between normal age related loss of function and caused by disease

Answer 21

Loss of function caused by disease is of greater impact than age-related change, but it will be superimposed on that caused by age and thus both may contribute to a failure of mobility

Question 22

What happens to limb motion changes with age?

Answer 22

• Cadence (rhythm) does not chance

- Double stance (the time when both feet are on the ground) increases with age

Question 23

What is the result of the double stance time increasing with age?

Answer 23

Increased time in the double stance position reduces momentum and therefore reduces the time for the swing leg to advance, contributing to short step-length.

Question 24

What happens to joint motion with age?

Answer 24

• Ankle plantar flexion is reduced during late stage of stance
• Maximal ankle dorsiflexion is not reduced

Question 25

What are the steps in a gait and stability examination?

Answer 25

• Observe patient entering the room
• Walk across room, turn, and come back
• Walk heel-to-tie in straight line
• Walking on toes in straight line, then heels in straight line
• Hop in place on each foot
• Shallow knee bend
• Rise from chair and walk forwards across room, turn, then come back
• Assess cerebellar functionalists n

Question 26

What should be observed when the patient is entering the room in gait examination?

Answer 26

• Speed
• Stride
• Balance

Question 27

When might it be difficult for a patient to walk heel-to-toe?

Answer 27

In older patients, even in absence of disease

Question 28

How can cerebellar function be assessed?

Answer 28

• Romberg’s test
• Finger-nose pointing
• Dysdiadochokinesia
• Heel-to-shin testing

Question 29

What does the assessment and examination of gait and balance need to be supplemented by?

Answer 29

Appropriate history and examination of all systems

Question 30

What do you need to pay particular attention to when taking history to supplement gait examination?

Answer 30

Speed of onset and rate of any deterioration

Question 31

What is the importance of acute deterioration in gait?

Answer 31

Feature of many serious conditions requiring urgent assessment and intervention

Question 32

What kind of serious conditions can cause acute deterioration in gait?

Answer 32

• Vascular
• Infective
• Neoplastic
• Neurological
• Metabolic
• Toxological
• Acute confusional states

Question 33

What are the patterns of abnormal gait?

Answer 33

• Antalgic gait
• Gait in cerebellar disease
• Gait in Parkinsonism
• Frontal gait disorder
• Cautious gait
• Hemiparietic gait
• Paraparetic gait
• Scissor gait
• Vestibular gait
• Trendelenburg gait
• Waddling gait
• Gait in neuropathic disorders
• Dementia-related gait
• Gait in psychiatric disorders
• Choreic gait
• Medication-related gait disturbance

Question 34

What is antalgic gait?

Answer 34

One in which the patient avoids certain movements to avoid acute pain

Question 35

What are the typical features of antalgic gait?

Answer 35

• Limited joint range of motion with inability to bear full weight on affected extremity