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Neurology > Disorders of Stance & Gait > Flashcards

Disorders of Stance & Gait Flashcards

1
Q

what are the diff structures responsible for gait?

A
  1. cerebrum
    1. visual system
  3. proprioceptive system (DCLM)
  4. vestibular system
  5. spinal cord
  6. basal ganglia
  7. cerebellum
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2
Q

what are the functions of structures responsible for gait?

A
  • maintain upright posture
  • be stable when standing
  • keep appropriate righting reflex to avoid fdall
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3
Q

what is the period between successive points at which heel of the same foot strikes the ground?

A

normal gait cycle

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4
Q

what are the 2 phases of the cycle?

A
  • stance phase
  • swing phase
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5
Q

what are the diff requirements for locomotion?

A
  • antigravity support of the body
  • stepping
  • maintenance of equilibrium
  • means of propulsion
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6
Q

what structures are involved in stepping?

A

spine
midbrain
diecenphalic levels

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7
Q

as u start asking the px to walk, what should u take note of?

A
  • hesitations in starting
  • hesitations in negotiating turns
  • width of the base
  • foot clearance, cadence
  • arm swing
  • length of stride
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8
Q

what is indicated if px veers to onse side as they are walking around the chair?

A

unilateral cerebellar or vestibular disease

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9
Q

What test of gait occurs with marching in place with eyes closed, rotation in the yaw plane?

A

Unterberger of Fukada Stepping test

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10
Q

during gait, what is also noted?

A

spasticity of one or both legs = stiffness & dwelay in moving

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11
Q

what does it indicate if a px is unable to walk and retained ability to simulate walking when not erect?

A

disorder of the integrative mechanisms for gait in the FRONTAL LOBE OR OTHER REGIONS

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12
Q

What are the main features of Cerebelalr gait?

A
  • wide based
  • usnteadiness
  • irregularity of steps
  • lateral veering
  • problem in corrdination of the sensory input from proprioceptiion
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13
Q

what are the diff types of abnormal gait?

A

cerebellar gait
festinating gait
hemiplegic gait
paraplegic gait
steppage or equine gait
tabetic gait (gait of sensory ataxia)
waddling gait
staggering or drunken gait
choreoathetotic or dystonic gait
frontal lobe gait

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14
Q

what are key features of hemiplegic gait

A

cadence: slow
step length: short
base: narrow
other important signs: circumduction & scraping of affected leg

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15
Q

in what cases does hemiplegic gait usually occur in?

A
  • sequelae of stroke/trauma (often)
  • any condition that damages the CST on one side
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16
Q

what are key characteristics of Paraplegic gait?

A
  • both lower ex are afffected
  • slow & stiff each leg and restricted motion at hips & knees
  • stiffness of the stepping mechanism & in propulsion, not in support equilibrium
17
Q

what is aka as Parinsonian gait? What causes it?

A

Festinating gait
* dsorders to basal ganglia -> faulty posture of the body
* lesion in the substancia nigra

18
Q

what are the 2 faulty postures seen in Festinating gait?

A
  • Propulsive festination => body pitches forward & fall can be prevented on by catch-up stepping
  • Retropulsive festination -> a step backward may induce a series of quixkening steps in that direction
19
Q

what are eky featuers of Festinating gait?

A
  • involuntary acceleration or hastening of steps
  • rigidity of both upper and lower ex and shuffling whent hey walk
  • trunk is bent forward
  • arms are slightly flexes and do nto swing
  • steps are short, and turning takes a lot of pivots
20
Q

what causes steppage or equine or foot drop gait?

A

paralysis of the pre-tibilar and peroneal muscles from compression of common Peroneal nerve as it rosses the head of the fbula

21
Q

what conditions can u see steppage/equine gait?

A
  • affects the peripheral nerevs of legs or motor neurons in the spinal cord
  • Charcot-Marie-tooth diseases (Peroneal msucular atrophy)
  • Progressive spinal msucular atrophy
  • poliomyelitis
  • muscular dystrophy
22
Q

what are key features of steppage or quine gait?

A
  • regular and evens steps with foot drop
  • excessive hip flexion with the leg lifted abnormally high in the order for the foot to clear the ground
23
Q

what causes Gait of sensory ataxia or Tabetic gait?

A
  • impairment of joint position or muscular kinesthetic sense -> interruption of afferent nerve fibers in the PNS
  • lesion in DCLM mpathway
24
Q

in what conditions do u see Tabetic gait?

A
  • friedrich ataxia (spinocerebellar degeernation
  • subacute combined degeneration of s spinal cord (VIT B12 def)
  • Large # of sensory polyneuropathies
  • Sensory gangliuonopathy of various cases
  • Casees with multiple sclereois or compression of SC
25
Q

what r principal featuers of Tabetic gait?

A
  • brusqueness of movement of the legs
  • stamping of the feet
  • (+) romberg test
26
Q

in what condition can u see waddling gait?

A

S1 nerve root damage
Muscle dystrophies

27
Q

what are key featuere of Waddling gait?

A

normal cadence
normal step length
slightly wide base
Over-lifting o hip (s)

28
Q

what are key featuere of Waddling gait?

A

normal cadence
normal step length
slightly wide base
Over-lifting o hip (s)

29
Q

in what condition do u see CHoreoathetotic or Dystonic gait?

A
  • Huntington’s chorea
  • Affectations of the caudate nculei in the basal ganglia
30
Q

what is seen in CHoreoathetotic or dystonic gait?

A
  • irregular mvement affecting the face, neck, limbs and trunk
  • wrist & fingers: alternative flexion & extension, supination & pronation
31
Q

what is the cause of frontal lobe gait?

A
  • loss of coordination betw the cortex and basal ganglia
  • normal pressure hydrocephalus
  • alzheimers disease
  • alrge neoplasms
  • subcortical areriosclerotic encephalopathy
  • frontotemporal lobar degenration
  • frontal lobe damge from trauma, stroke or the residual of a ruptured anterior communicating aneurysm
    *
32
Q

what are key features of frontal lobe gait?

A
  • slow cadence
  • greatly shortened steps
  • slightly wide base (protective)
  • difficulty in starting & stopping: tendency for feet to “stick” to the floor
33
Q

what gait phase makes up 60-65% of gait cycle?

A

stance phase

34
Q

what gait phase makes up 60-65% of gait cycle?

A

stance phase

35
Q

what gait phase makes up 20-25% of gait cycle?

A

double limb support

included in the stance phase

36
Q

what is the initial step in the normal gait cycle?

r

A

right heel contact

then

left toe off

2nd step: left heel contact -> right toe off

37
Q

what is the initial step in the normal gait cycle?

r

A

right heel contact

then

left toe off

2nd step: left heel contact -> right toe off

38
Q

what is the final step in the normal gait cycle?

A

right heel contact

39
Q

What gait abnormality is best correlated with a positive
Romberg Sign?

A

sensory ataxic

Neurology (8 decks)

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