Gait Disorders

Question 1

hemiplegic gait - characteristics

Answer 1

*stiff leg
*leg rotated
*foot malpositioned
*arm against body
*arm bent
*thumb in fist

Question 2

hemiplegic gait - mechanics

Answer 2

*upper motor neuron lesion
*spasticity (flexion of UE, extension of LE)
*distal > proximal weakness
*stiff leg = can’t flex hip
*weak ankle = “long leg”

Question 3

hemiplegic gait - etiology

Answer 3

*infarction
*hemorrhage
(i.e. cortex issues)

Question 4

hemiplegic gait - function/safety

Answer 4

*changes in sit/stand
*slowed
*wearing down shoes
*increased trips/falls
*stair safety
*transfer safety

Question 5

hemiplegic gait - treatment

Answer 5

*physical therapy/gait training
*orthotics
*medication
*surgery
*brain-computer interface (BCI)

Question 6

diplegic gait - characteristics

Answer 6

*LE > UE affected
*narrow-based
*flexion hip/knee
*plantarflex/inversion of ankle
*UE “low-guard” position
*UE not synchronized
*“scissoring”

Question 7

diplegic gait - mechanics

Answer 7

*upper motor neuron lesion
*MOTOR CORTEX primarily (leukomalacia)
*corticospinal tract
*basal ganglia
*spasticity/contracture
*flexed at hip, knee, ankle
*adduction at thigh

Question 8

diplegic gait - etiology

Answer 8

*cerebral palsy (periventricular leukomalacia)
*CVA/hemorrhage
*anoxic injury
*midline mass

Question 9

diplegic gait - function/safety

Answer 9

*high energy expenditure
*pain
*muscle/joint breakdown
*pressure sores
*toileting/self care
*dressing
*transfers
*falls

Question 10

diplegic gait - treatment

Answer 10

*physical therapy
*orthotics
*assistive devices (ex. walker, cane)
*medications
*injections/infusions
*surgery

Question 11

neuropathic gait - characteristics

Answer 11

*“foot drop” (unable to dorsiflex the foot)
*high step to “clear the foot”
*“equine” gait (looks like how a horse walks)

Question 12

neuropathic gait - etiology

Answer 12

*peripheral neuropathy (common fibular nerve)
*lumbar radiculopathy /plexopathy (L5)
*fibula fracture
*compartment syndrome
*post-op (TKA/knee arthroscopy)
*tibialis anterior rupture

Question 13

neuropathic gait - function/safety

Answer 13

*increased trips/falls
*shoe wear
*social awareness

Question 14

neuropathic gait - treatment

Answer 14

*orthosis

Question 15

neuropathic gait - mechanics

Answer 15

*dysfunction of muscle
*dysfunction of nerve (root or peripheral)

Question 16

myopathic gait - characteristics

Answer 16

*pelvic drop
*“waddling” or “Trendelenburg”
*widened base
*shifting and swinging of trunk

Question 17

myopathic gait - mechanics

Answer 17

*proximal hip girdle weakness
*gluteus medius is responsible hip abduction (if weak, drop to the contralateral side)
*decreased stability
*torso lean to shift weight

Question 18

myopathic gait - etiology

Answer 18

*muscular dystrophy
*lumbar radiculopathy
*spinal muscular atrophy
*avulsion of gluteus medius
*superior gluteal nerve injury
*hip dysplasia
*pregnancy

Question 19

myopathic gait - function/safety

Answer 19

*falls
*energy expenditure
*social considerations

Question 20

myopathic gait - treatment

Answer 20

*physical therapy (core strengthening)
*assistive devices
*orthotics
*medication/stopping statins (which can cause statin-induced myopathy)

Question 21

choreiform gait - characteristics

Answer 21

*hyperkinetic (additional motion)
*choppy or dance-like
*additional movement/gestures
*BALANCE MAINTAINED

Question 22

choreiform gait - mechanics

Answer 22

*intrusion of abnormal, erratic movements
*inability to inhibit movements
*vestibular function intact
*strength intact
*sensation intact
*balance preserved

Question 23

choreiform gait - etiology

Answer 23

*autosomal dominant mutation (Huntington’s disease)
*repeat CAG = abnormal protein
*high levels of HTT in brain
-synaptic transmission altered
-basal ganglia dysfunction
-erratic

Question 24

choreiform gait - function/safety

Answer 24

*not usually falls unless dystonia
*social implications
*energy expenditure (extremely high)

Question 25

choreiform gait - treatment

Answer 25

*physical therapy (to make their additional movements into more "socially appropriate" gestures) *medication (does not really work) *education

Question 26

ataxic gait - characteristics

Answer 26

*wide base *unsteady trunk *anterior/posterior movement *lateral instability *worse with tandem or running!!!! *INCONSISTENCY in speed, etc

Question 27

ataxic gait - mechanics

Answer 27

*vestibular dysfunction (inability to decipher 3D) *cerebellar -vermis = trunk instability/midline -hemisphere = limb instability -flocculonodular = visual integration/tone *sensory

Question 28

ataxic gait - etiology

Answer 28

*vestibular -alcohol, drugs/toxins -Meniere's disease (unilateral) *cerebellar -infarction/hemorrhage (most common) -infection/inflammation/demyelination -hereditary -drugs, alcohol, toxins

Question 29

ataxic gait - function/safety

Answer 29

*falls *energy expenditure *legal *social implications

Question 30

parkinsonian gait - characteristics

Answer 30

*difficulty initiating movement *small steps, slow speed (hypokinetic) *"festinating" or "shuffling" *stooped, forward-leaning *associated tremor *freezing, stiffness

Question 31

parkinsonian gait - mechanics

Answer 31

*rigidity (lead-pipe, cog-wheel) *decreased hip flexion, knee flexion *anterior pelvic tilt *truncal instability *sequential movement hindered (visual cues can be helpful)

Question 32

parkinsonian gait - etiology

Answer 32

*apoptosis in substantia nigra *dopamine deficiency -decreased ability to stop inhibition for intended movements *less control over "static inhibition" of motor circuit, so more "involuntary" movement

Question 33

parkinsonian gait - function/safety

Answer 33

*falls *fractures *slow walking speed *challenges with ADLs *social implications

Question 34

parkinsonian gait - treatment

Answer 34

*physical therapy *visual/auditory cueing *medication ("dopas")

Question 35

antalgic gait - characteristics

Answer 35

*"limping" *shifting *hopping *"heaviness"

Question 36

antalgic gait - mechanics

Answer 36

*pain leads to weight shift *stance time on affected/painful limb decreased *shortened stride on painful side

Question 37

antalgic gait - etiology

Answer 37

*bone pain (fracture/dislocation) *muscle/tendon pain (strain) *ligament pain (sprain) *skin wounds (lacerations/puncture) *burns

Question 38

antalgic gait - function/safety

Answer 38

*falls *decreased walking speed *pain

Question 39

antalgic gait - treatment

Answer 39

*treat underlying cause