15: Gait Abnormalities- Mahoney

Question 1

4 pathways that need to be intact for normal gait

Answer 1

• 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)

Question 2

hyperreflexia =

Answer 2

UMN Lesion

Question 3

normal supraspinal inhibition of antagonistic m. lost =

Answer 3

clonus

sign of UMN lesion

ex: drosiflex ankle, see oscillating motion back

Question 4

________ weakness of arm extensors and leg flexors with UMN lesion

Answer 4

spastic

leg flexor = flexors of hip, knee and ankle dorsiflexors

= decorticate movement

therefore…. SPASTCIITY of arm flexors and leg extensors

Question 5

hyporeflexia =

Answer 5

LMN lesion

Question 6

_______ weakness with LMN lesion

Answer 6

flaccid

observe m. atrophy

Question 7

fine movements of m. seen under skin due to sensitization to Ach

Answer 7

fasciculations

associated with LMN lesion

Question 8

unilateral UMNL –> _______ gait

Answer 8

spastic gait

aka hemiparetic/hemiplegic or STROKE gait

from a CVA, brian injury, brain abscess

Question 9

_____ plegia =

Answer 9

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)

Question 10

describe “stroke gait”

Answer 10

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)

Question 11

CVA patterns
cerebral hemisphere =
brain stem =
spinal cord - cervical =
spinal cord - below cervical =

Answer 11

hemiplegia
quadriplegia
quadriplegia
paraplegia

Question 12

paraparetic/spastic diplegic or CP gait or “scissors gait”

Answer 12

bilateral UMN lesion

due to CP, CVA, MS, spinal cord disease

not CP before the age of 2 b/c brain not fully myelinated

Question 13

type of motor impairment with scissors gait

Answer 13

spastic hemiplegia- lesions of contralateral cerebral cortex

spastic diplegia - bilateral cerebral cortex

spastic quadriplegia

atheotid CP

Question 14

describe scissors gait

Answer 14

• 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

Question 15

cerebellar ataxic aka DRUNK giat

Answer 15

cerebellar leison

broad based, spped and length of stride varies irregularly from step to step

posture is erect, feet are separated

difficulty walking tandem

Question 16

cerebellar ataxic gait is normal in..

Answer 16

children less than 2 yo

NO positive romberg sign

difficult standing with feet together even with eyes open

Question 17

describe sensory ataxic gait

Answer 17

• 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

Question 18

describe vestibular gait

Answer 18

• 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

Question 19

describe steppage gait

Answer 19

• 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

Question 20

describe waddling gait

Answer 20

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

Question 21

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

Answer 21

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

Question 22

describe parkinsonian gait pathology

Answer 22

• form of extrapyramidal disease
• leion of substantia nigra causing decreased dopamine levels
• HYPOkinetic gait

Question 23

what does a parkinsonian gait look like

Answer 23

• 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

Question 24

pathophys of choreoatheotic gait

Answer 24

• 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

Question 25

describe antalgic gait “limping”

Answer 25

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)

Question 26

toe-walkers aka Equinas Gait

Answer 26

• usually secondary to congenitally tight gastroc-soleus or sudden growth spurt
• always consider neurological disorder like CP, myelomeningocele, spastic hemiplegia (especially if from birth)