Abnormal Posture & Gait

Question 1

What are common NM conditions affecting posture and gait?

Answer 1

• Stroke
• Parkinson’s
• Cerebral palsy
• Cerebellar palsy
• NM changes with ageing
• Spinal & lower leg pain
• Muscle weakness
• Lower leg biomechanics

Question 2

What is stroke (cerebrovascular accident)?

Answer 2

Neurological deficit due to acute focal injury of CNS by a vascular cause

Question 3

What are the signs & symptoms of stroke?

Answer 3

• Sudden weakness/numbness to face, arm, leg (usually on one side)
• Dizziness
• Confusion
• Severe headache
• Fainting/unconsciousness
• Difficulty speaking/understanding speech
• Difficulty seeing with one/both eyes

Question 4

What are some of the vascular causes of stroke?

Answer 4

• Cerebral infarction
• Intracerebral haemorrhage (ICH)
• Subarachnoid haemorrhage (SAE)

Question 5

What does the FACE acronym stand for?

Answer 5

• Face: Mouth drooping
• Arms: Can they raise both arms?
• Speech: Slurred, strange, not understanding
• Time: Call 000 immediately

Question 6

What are the common posture signs associated with a hemiplegic (one-sided) stroke patient?

Answer 6

• Arm bent, hand spastic/floppy, often of little use
• Walking on tiptoe/outside of foot on affected side
• Unaffected side almost/completely normal

Question 7

What is Parkinson’s?

Answer 7

• Progressive neurological condition due to decline in production of dopamine in basal ganglia
• Average age of diagnosis 65 years

Question 8

What are the signs & symptoms of Parkinson’s?

Answer 8

• Tremor - shaking at rest, rigid muscles, stooped posture
• Slowed movement (bradykinesia)
• Loss of automated movement (e.g. blinking, smiling, swinging arms)
• Speech - softly, quickly, slurred, hesitate, monotone (vocal cords affected)
• Writing - small, hard to read

Question 9

What are the common posture signs associated with a Parkinson’s patient?

Answer 9

• Repetitive “pill rolling” movement with hands
• Persistent tremors
• Shuffling gait, taking small steps

Question 10

What is cerebral palsy?

Answer 10

• Persistent but not unchanging disorder of movement & posture due to defect or lesion of developing brain

Question 11

What is the clinical presentation of cerebral palsy?

Answer 11

• Delayed motor milestones (e.g. sitting, standing, walking)
• Asymmetric movement patterns
• Abnormal muscle tone (hypertonia or spasticity)
• Visual problems
• Hearing problems
• Speech/language problems
• Epilepsy
• Cognitive impairments

Question 12

What are the 4 types of cerebral palsy?

Answer 12

• Monoplegia (one limb, usually an arm)
• Hemiplega (one side of the body)
• Diplegia (symmetrical parts of the body, legs or arms)
• Quadriplegia (affects all 4 limbs)

Question 13

What are the common posture signs associated with a cerebral palsy patient?

Answer 13

• Spastic gait (legs apart, feet turned in)

- Scissor gait (legs falling together)

Question 14

What is cerebellar ataxia?

Answer 14

Inflammation or damage to cerebellum due to viruses, head trauma, degeneration or toxins
E.g. MS

Question 15

What are the sign & symptoms of cerebellar dysfunction?

Answer 15

• Decomposition of movement (uncoordinated)
• Intentional tremor
• Dysdiadochokinesia (difficulty performing rapidly alternating movements)
• Deficits in motor learning

Question 16

What are the signs of ataxia?

Answer 16

• Unsteady gait, staggering, tripping, falling, unsteadiness
• Difficulty with fine motor coordination e.g. writing, buttoning
• Speech & swallowing difficulties
• Visual abnormalities
• Fatigue
• Cognitive & mood disorders

Question 17

What is the role of the cerebellum?

Answer 17

• Maintenance of balance & posture
• Control of voluntary movements (coordination)
• Motor learning - adapting & fine control of motor patterns, cognition & mood

Question 18

What is the impact of ageing & posture on gait?

Answer 18

• Reduction in muscle strength/mass
• Decreased ROM & flexibility (stooped standing posture, OA, increased kyphosis)
• Change in psychomotor speed (slowed reaction & movement times)
• Reduction in sensation
• Reduction in vestibular function (dizziness, poor balance)

Question 19

What is the potential impact of ageing on posture?

Answer 19

• Increased postural sway & greater muscle activity at rest
• Delayed onset muscle activity & smaller responses to pertubation
• Delayed activation of postural anticipatory/reactive responses

Question 20

What is the potential impact of ageing on gait?

Answer 20

• Reduced velocity due to shorter step length & variability in step timing
• Flexed posture & excessive lateral trunk movement
• Difficulty performing dual tasks

Question 21

What is the definition of low back pain?

Answer 21

Pain between buttock folds & 12th ribs in posterior trunk, +/- leg pain

Question 22

What are the impairments associated with low back pain?

Answer 22

• Painful loss of movement due to muscle spasm, tightness, joint stiffness
• Pain with loading in different postures with different activities
• Weakness & delayed onset of deep stabilising lumbopelvic muscles, overactivity of superficial muscles

Question 23

What is OA?

Answer 23

Degenerative joint disease ass. with radiographic chanes (joint space narrowing, osteophytes, bony slcerosis)

Question 24

What are the risk factors for OA?

Answer 24

• > 45 years in knee & hip
• Modifiable: Excess body mass, join injury, knee pain, occupation, structural malalignment, muscle weakness
• Non-modifiable: Gender, age, race, genetics

Question 25

What are the signs and symptoms of OA?

Answer 25

• Pain
• Swelling
• Stiffness of joint
• Decreased ROM
• Loss of flexibility & muscle strength

Question 26

What is Trendelenberg Gait?

Answer 26

• Excessive adduction of WB hip in mid stance
• Due to inefficient strength of glud med
• Common in several hip & knee pathologies (glut med tendinopathy, PFS)

Question 27

When is excessive pronation common?

Answer 27

• Plantar fascitis
• Tib post strain/tendinopathy
• Med tibial tress syndrome
• PFS
• Achilles tendinopathy