GAIT DISORDERS Flashcards
Normal gait cycle?
Heel-strike
Foot flat and weight transferred
Mid-stance
Heel-off
Toe-off
Swing
What causes a hemiplegic gait?
UMN lesion e.g. stroke, trauma, MS,
What is a hemiplegic gait?
Unilateral weakness
Spastic flexion of the upper limb and extension of the lower limb. The leg is elongated so patients have to circumduct their leg to prevent their foot from dragging on the ground
What is a diplegic gait?
A scissoring gait
Bilateral. Spasticity worse in lower limbs than upper limbs.
Hips and knees flexed and adducted whilst ankles are extended and internally rotated. This forces the knees together so legs overlap when walking. In an attempt to overcome this adduction, the pt circumducts both legs during the swing phase
Upper limb may have flexor posturing of elbows and wrist with shoulders and fingers in adduction. Typically lack arm swinging
Cause of diplegic gait?
UMN lesion e.g. stroke, CP, spinal cord lesion, tumour
What is a parkinsonian gait?
Slow to initiate walking
Reduced step length “shuffling” - each step may get progressively smaller as the patient attempts to retain balance (festinant gait)
Reduced arm swing bilaterally
Flexed trunk and neck
Resting tremor esp when distracted by walking
Impaired balance or hesitancy on turning
Causes of parkinsonian gait?
Idiopathic parkinsons disease
Parkinsonian disorders e.g. dementia with Lewy bodies, parkinsons plus syndromes, drug-induced parkinsonism, dementia pugilistica
What is ataxic gait?
Broad-based
Staggering, slow unsteady gait
May veer towards the side of the lesion
Difficult turning
Cause of ataxic gait?
Cerebellar ataxia - stroke, SOL, MS, alcoholism, drugs, genetics, B12 deficiency
Sensory ataxia caused by peripheral neuropathy
Vestibular ataxia e.g. labyrinthitis, Ménière’s disease or acoustic neuroma
What is a neuropathic gait?
Foot drop and dragging of toes during the swing phase. To prevent this the knee and hip flex excessively creating a “high stepping gait”
Cause of neuropathic gait?
Weakness of muscles of ankle dorsiflexion (tibialis anterior) supplied by the common peroneal nerve
Isolated common peroneal nerve palsy e.g. trauma
L5 radiculopathy e.g. disc prolapse
Generalised polyneuropathy e.g. MND, diabetic neuropathy or Charcot-Marie tooth disease
What is a myopathic gait?
Aka waddling gait or trendelenburg gait
Pelvis tilts down wards towards the unsupported side during the swing phase of the gait. To compensate the body laterally flexes the torso away from the leg in swing phase which draws the pelvis and leg up off the floor. They also circumfuct the gait
Causes of myopathic gait?
It’s due to weakness of the hip abductors so the pelvis can’t be stabilised
Muscular dystrophies
Systemic diseases - polymyalgia rheumatica, polymyositis, dermatomyositis, acromegaly, Cushing, thyrod disease
What is choreiform gait?
Aka hyperkinetic gait
Presents with involuntary movements e.g. Oro-facial dyskinesia (grimacing or lip smacking), choreic movements of limbs (writhing, dance-like semi-purposeful movements)
Walking accentuates these movements
Causes of choreiform gait?
Basal ganglia disease:
Huntingtons disease, cerebral palsy, Wilson’s disease, dopaminergic medications
