15: Gait Abnormalities- Mahoney Flashcards
4 pathways that need to be intact for normal gait
- intact reflex arc (intact sensory n, functional synapse in spinal cord, intact motor n. fiber, NMJ, and competent muscle)(reflex arc is not dependent on CNS)
- corticospinal/pyramidal tract (fine discrete voluntary movement)
- extrapyramidal tract (manintain m. tone and control gross automatic movements)
- cerebellar system ( by receiving both sensory and motor input, coordinates muscular activity, maintains equilibrium and helps control posture)
hyperreflexia =
UMN Lesion
normal supraspinal inhibition of antagonistic m. lost =
clonus
sign of UMN lesion
ex: drosiflex ankle, see oscillating motion back
________ weakness of arm extensors and leg flexors with UMN lesion
spastic
leg flexor = flexors of hip, knee and ankle dorsiflexors
= decorticate movement
therefore…. SPASTCIITY of arm flexors and leg extensors
hyporeflexia =
LMN lesion
_______ weakness with LMN lesion
flaccid
observe m. atrophy
fine movements of m. seen under skin due to sensitization to Ach
fasciculations
associated with LMN lesion
unilateral UMNL –> _______ gait
spastic gait
aka hemiparetic/hemiplegic or STROKE gait
from a CVA, brian injury, brain abscess
_____ plegia =
spasticity
spasticity = increased muscle tone due to UMNL
due to exaggeration of stretch reflec
rate sensitive or velocity dependent (slow- normal, rapid - increased tone results)
describe “stroke gait”
leg is extended and internally rotated because leg flexors weakened
leg swings laterally and forward to clear ground (circumduction)
contralateral hip may tilt downwards to prevent toes from catching floor as leg advanced forward
ipsilateral arm flexed at elbow, internally rotated and adducted; wrist flexed, fingers flexed(due to weakness of arm extensors)
CVA patterns cerebral hemisphere = brain stem = spinal cord - cervical = spinal cord - below cervical =
hemiplegia
quadriplegia
quadriplegia
paraplegia
paraparetic/spastic diplegic or CP gait or “scissors gait”
bilateral UMN lesion
due to CP, CVA, MS, spinal cord disease
not CP before the age of 2 b/c brain not fully myelinated
type of motor impairment with scissors gait
spastic hemiplegia- lesions of contralateral cerebral cortex
spastic diplegia - bilateral cerebral cortex
spastic quadriplegia
atheotid CP
describe scissors gait
- legs extended and thighs tightly adducted
- legs circumducted
- legs slightly flexed at hips and knees (crouching)
- arms mildly flexed
- mimicked by running in kene deep water
cerebellar ataxic aka DRUNK giat
cerebellar leison
broad based, spped and length of stride varies irregularly from step to step
posture is erect, feet are separated
difficulty walking tandem
cerebellar ataxic gait is normal in..
children less than 2 yo
NO positive romberg sign
difficult standing with feet together even with eyes open
describe sensory ataxic gait
- resembles drunk gait
- problem with propioceptors or peripheral n.
- positive Romberg test
- commonly seen in DIABETICS with loss of positiion sense. need to look at floor to tell them where their foot is
describe vestibular gait
- pathology located in inner ear
- falling to affected side whether standing or walking
- asymmetric nystagmus
- normal proprioception and m. strength exclude sensory ataxia and hemiparesis
describe steppage gait
- DROPFOOT or neuropathic gait
- unilateral = L5 radiculopathy, sciatic neuropathy, common peroneal n. neuropathy
- bilateral = distal plyneuropathy (diabetes*), lumbosacral polyradiculopathy
weakness of ankle dorsiflexion, leg lifted higher than normal during swing phase to prevent toes from catching on floor
describe waddling gait
aka Trendelenberg or gluteus medis limp or duck walk or myopathic gait
- proximal LL weakness due to myopahty, NMJ disease, proximal symmetric spinal m. atrophy
- may see with hip DJD
trendelenger gait: when m. too weak to keep the pelvis levele when the ______ foot is picked up, the pelvis will drop down on the ________ side, producing pelvic rocking
unaffected
unaffected
trunk tilts toward the affected side to lift hip on unaffected side and provide extra distance b/w foot and floor
pelvis rotated forward to assist with forward motion of unaffected side
usually bilateral so looks waddlingly
describe parkinsonian gait pathology
- form of extrapyramidal disease
- leion of substantia nigra causing decreased dopamine levels
- HYPOkinetic gait
what does a parkinsonian gait look like
- forward rigid stoop with head and neck bent forward, with modest flexion at hips and knees
- arms flexed at elbows and adducted at shoulders, with resting pronation-supination tremor
- trouble arising from chair
- center of gravity tends to remain in back of legs, so once standing there is tendency to fall backwards RETROPULSE
- gait initiated with short, shuffling steps whcih is exacerbated when turning PEDESTAL TURNS must stop before turning
- FESTINATION once center of gravity gets in front of legs, body tries to catch up with center of gravity with increasing speed
pathophys of choreoatheotic gait
- WORMlike gait
- extrapyramidal process
- wildly ataxic gait/HYPERkinetic gait-gait interrupted by abrupt lg. amplitude involuntary movements
- similar movements seen in arms, neck, face
- balance not affected
describe antalgic gait “limping”
pt favors (does not put normal weight on painful extremity which usually results in limited knee flexion and less prominent heel strike and toe off, shortened stance phase and smaller steps
seen following surgeries (injury)
toe-walkers aka Equinas Gait
- usually secondary to congenitally tight gastroc-soleus or sudden growth spurt
- always consider neurological disorder like CP, myelomeningocele, spastic hemiplegia (especially if from birth)
