Disorders of Stance & Gait Flashcards
what are the diff structures responsible for gait?
- cerebrum
- visual system
- proprioceptive system (DCLM)
- vestibular system
- spinal cord
- basal ganglia
- cerebellum
what are the functions of structures responsible for gait?
- maintain upright posture
- be stable when standing
- keep appropriate righting reflex to avoid fdall
what is the period between successive points at which heel of the same foot strikes the ground?
normal gait cycle
what are the 2 phases of the cycle?
- stance phase
- swing phase
what are the diff requirements for locomotion?
- antigravity support of the body
- stepping
- maintenance of equilibrium
- means of propulsion
what structures are involved in stepping?
spine
midbrain
diecenphalic levels
as u start asking the px to walk, what should u take note of?
- hesitations in starting
- hesitations in negotiating turns
- width of the base
- foot clearance, cadence
- arm swing
- length of stride
what is indicated if px veers to onse side as they are walking around the chair?
unilateral cerebellar or vestibular disease
What test of gait occurs with marching in place with eyes closed, rotation in the yaw plane?
Unterberger of Fukada Stepping test
during gait, what is also noted?
spasticity of one or both legs = stiffness & dwelay in moving
what does it indicate if a px is unable to walk and retained ability to simulate walking when not erect?
disorder of the integrative mechanisms for gait in the FRONTAL LOBE OR OTHER REGIONS
What are the main features of Cerebelalr gait?
- wide based
- usnteadiness
- irregularity of steps
- lateral veering
- problem in corrdination of the sensory input from proprioceptiion
what are the diff types of abnormal gait?
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
what are key features of hemiplegic gait
cadence: slow
step length: short
base: narrow
other important signs: circumduction & scraping of affected leg
in what cases does hemiplegic gait usually occur in?
- sequelae of stroke/trauma (often)
- any condition that damages the CST on one side
what are key characteristics of Paraplegic gait?
- 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
what is aka as Parinsonian gait? What causes it?
Festinating gait
* dsorders to basal ganglia -> faulty posture of the body
* lesion in the substancia nigra
what are the 2 faulty postures seen in Festinating gait?
- 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
what are eky featuers of Festinating gait?
- 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
what causes steppage or equine or foot drop gait?
paralysis of the pre-tibilar and peroneal muscles from compression of common Peroneal nerve as it rosses the head of the fbula
what conditions can u see steppage/equine gait?
- 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
what are key features of steppage or quine gait?
- 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
what causes Gait of sensory ataxia or Tabetic gait?
- impairment of joint position or muscular kinesthetic sense -> interruption of afferent nerve fibers in the PNS
- lesion in DCLM mpathway
in what conditions do u see Tabetic gait?
- 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
what r principal featuers of Tabetic gait?
- brusqueness of movement of the legs
- stamping of the feet
- (+) romberg test
in what condition can u see waddling gait?
S1 nerve root damage
Muscle dystrophies
what are key featuere of Waddling gait?
normal cadence
normal step length
slightly wide base
Over-lifting o hip (s)
what are key featuere of Waddling gait?
normal cadence
normal step length
slightly wide base
Over-lifting o hip (s)
in what condition do u see CHoreoathetotic or Dystonic gait?
- Huntington’s chorea
- Affectations of the caudate nculei in the basal ganglia
what is seen in CHoreoathetotic or dystonic gait?
- irregular mvement affecting the face, neck, limbs and trunk
- wrist & fingers: alternative flexion & extension, supination & pronation
what is the cause of frontal lobe gait?
- 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
*
what are key features of frontal lobe gait?
- slow cadence
- greatly shortened steps
- slightly wide base (protective)
- difficulty in starting & stopping: tendency for feet to “stick” to the floor
what gait phase makes up 60-65% of gait cycle?
stance phase
what gait phase makes up 60-65% of gait cycle?
stance phase
what gait phase makes up 20-25% of gait cycle?
double limb support
included in the stance phase
what is the initial step in the normal gait cycle?
r
right heel contact
then
left toe off
2nd step: left heel contact -> right toe off
what is the initial step in the normal gait cycle?
r
right heel contact
then
left toe off
2nd step: left heel contact -> right toe off
what is the final step in the normal gait cycle?
right heel contact
What gait abnormality is best correlated with a positive
Romberg Sign?
sensory ataxic
