Abnormal Gait Flashcards
What is balance?
The ability to stand
What is gait?
The rhythmic stepping movements for travel
Do balance and gait problems tend to be found in the same individuals?
Yes
What are walking messages initiated by?
The motor and premotor cortex
What are walking messages modified by?
The subcortical nuclei, brainstem, and cerebellum
How are walking messages interpreted into walking?
The structures modifying the walking messages activate the spine’s central pattern generator, which co-ordinates arm and leg movements into rhythmic gait
What affects the output of the spinal central pattern generator?
Proprioceptive, visual, and vestibular inputs
What is the ability to stand and walk normally dependant on?
Several systems, including;
- Visual
- Vestibular
- Cerebellar
- Motor
- Proprioceptive
- Sensory
What do balance and gait require?
Intact brain, spinal cord, and sensory system
What can cases changes in gait?
- Disease directly affecting this system
- Age
In what % of older people do gait and balance abnormalities occur?
8-19%
What happens as the body moves forward in normal gait?
One limb typically provides support while the other limb is advanced in preparation for its role as the support limb
What is the gait cycle composed of?
Stance and swing phase
What is the stance phase further subdivided into?
- Initial double stance
- Single limb stance
- Terminal double limb stance
What happens to the duration of each aspect of stance as the walking velocity increases?
It decreases
How is the transition from walking to running marked?
By elimination of double support
What normal age-related changes are there to gait?
- Strength
- Walking posture
- Limb motion
- Joint motion
What happens to normal strength with age?
It peaks in mid-20s and declines only a little until the 5th decade, after which it falls off much faster
What happens to normal gait speed with age?
It remains stable until the 7th decade, then slows modestly
What might age-related changes in the balance of older persons result in?
Compensatory responses that meet routine needs but may be ineffective under demanding circumstances
Describe the relationship between normal age related loss of function and caused by disease
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
What happens to limb motion changes with age?
- Cadence (rhythm) does not chance
- Double stance (the time when both feet are on the ground) increases with age
What is the result of the double stance time increasing with age?
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.
What happens to joint motion with age?
- Ankle plantar flexion is reduced during late stage of stance
- Maximal ankle dorsiflexion is not reduced
What are the steps in a gait and stability examination?
- 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
What should be observed when the patient is entering the room in gait examination?
- Speed
- Stride
- Balance
When might it be difficult for a patient to walk heel-to-toe?
In older patients, even in absence of disease
How can cerebellar function be assessed?
- Romberg’s test
- Finger-nose pointing
- Dysdiadochokinesia
- Heel-to-shin testing
What does the assessment and examination of gait and balance need to be supplemented by?
Appropriate history and examination of all systems
What do you need to pay particular attention to when taking history to supplement gait examination?
Speed of onset and rate of any deterioration
What is the importance of acute deterioration in gait?
Feature of many serious conditions requiring urgent assessment and intervention
What kind of serious conditions can cause acute deterioration in gait?
- Vascular
- Infective
- Neoplastic
- Neurological
- Metabolic
- Toxological
- Acute confusional states
What are the patterns of abnormal gait?
- 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
What is antalgic gait?
One in which the patient avoids certain movements to avoid acute pain
What are the typical features of antalgic gait?
- Limited joint range of motion with inability to bear full weight on affected extremity
