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gait Flashcards

1
Q

hemiplegic gait features

A

spastic flexion of the upper limb and extension of the lower limb.
-> circumduction of affected limb

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2
Q

clinical features associated with hemiplegic gait

A

Upper motor neuron

  • Increased tone with clasp-knife spasticity
  • Hyperreflexia with or without clonus
  • Upgoing plantars (i.e. positive Babinski)
  • Reduced power
  • Sensory deficit: the pattern of sensory loss depends on the site of the lesion in the nervous system
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3
Q

causes of hemiplegic gait

A

Unilateral cerebral lesion:

  • Stroke
  • Space-occupying lesion
  • Trauma
  • Multiple sclerosis

Hemisection of the spinal cord:

  • Trauma
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4
Q

features of diplegic gait

A

bilateral

  • spasiticity - worse lower limbs
  • hips and knees - flexed and adducted
  • ankles - extended and internally rotated
  • knees forced together - due to spasticity in adductors = leg overlap (sissor)
  • circumduction

upper limb

  • flexed
  • adduction
  • lack swinging movement
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5
Q

clinical features associated with diplegic gate

A

upper motor

  • Increased tone with clasp-knife spasticity
  • Hyperreflexia with or without clonus
  • Upgoing plantars (i.e. positive Babinski)
  • Reduced power
  • Sensory deficit – if a diplegic gait is caused by spinal cord pathology, the ‘sensory level’
  • Wasting and fasciculations (consider motor neuron disease)
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6
Q

spinal cord lesions of diplegic gate

A

Prolapsed intervertebral disc
Spinal spondylosis
Spinal tumour
Transverse myelitis
Spinal infarct
Syringomyelia
Hereditary spastic paraparesis

(MND)

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7
Q

brain lesion cause of diplegic gate

A

Cerebral palsy
Multiple sclerosis
Bilateral brain infarcts
Midline tumour (e.g. paraspinal meningioma)

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8
Q

features of parkinsonian gait

A
  • slow start
  • reduced stride length
  • reduced arm swing
  • flexed trunk and neck -> stooped
  • resting tremor
  • impaired balance on turning / hesitancy
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9
Q

clinical features associated with parkinsons disease

A

Tremor
Rigidity
Bradykinesia
Hypomimia

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10
Q

causes of parkinsonism

A
  • parkinsons
  • Vascular Parkinson’s disease
  • Dementia with Lewy bodies
  • Parkinson’s plus syndromes (e.g. multisystem atrophy and progressive supranuclear palsy)
  • Drug-induced Parkinsonism (e.g. antipsychotics, antiemetics)
  • Dementia pugilistica
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11
Q

features of ataxic gait

A
  • broad based - due to midline cerebellar pathology (MS / alcohol)
  • stability - staggering, slow and unsteady gait - if unilateral = veer towards side of lesion
  • turning - cerebellar find this difficult
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12
Q

causes of cerebellar ataxic gait

A
  • Cerebellar stroke (ischaemic or haemorrhagic)
  • Space-occupying lesion
  • Multiple sclerosis
  • Alcoholism
  • B12 deficiency
  • Drugs (e.g. phenytoin, carbamazepine, barbiturates, lithium)
  • Genetic disease (e.g. Frederich’s ataxia, spinocerebellar ataxia)
  • Paraneoplastic disease
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13
Q

causes of sensory ataxia

A

Peripheral neuropathy (e.g. diabetes mellitus)

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14
Q

causes of vestibular ataxia

A

Labyrinthitis
Meniere’s disease
Acoustic neuroma

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15
Q

associated features with cerebellar ataxia

A

Nystagmus
Ataxic dysarthria
Dysmetria
Intention tremor
Dysdiadokokinesia

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16
Q

features associated with sensory ataxia

A

Positive Romberg’s sign
Impaired proprioception
Impaired vibration sensation
Absence of other cerebellar signs (e.g. dysmetria, nystagmus, dysarthria)

17
Q

features of vestibular ataxia

A

Vertigo
Nausea
Vomiting

18
Q

features of neuropathic gait

A

foot drop
high stepping gait - knee and hip flex excessively

19
Q

causes of foot drop

A

weakness of the muscles of ankle dorsiflexion (tibialis anterior) supplied by the common peroneal nerve (L4, L5 and S1 nerve root).

  • common peroneal nerve palsy (trauma/compression)
  • L5 radiculopathy
  • polyneuropathy - dm, MND, charcot-marie-tooth
20
Q

features of a myopathic gait (aka waddling / trendelenburg gait)

A

pelvis tilts to unsupported side during swing phase
body compensates by:

  • laterally flex torso away from leg in swing phase = waddling
  • circumducting
21
Q

clinical features associated with myopathic gait

A
  • difficult to stand without arms
  • +ve trendelenburg test
22
Q

muscle type that = positive trendelenburg test

A

hip abductors

23
Q

disease that causes myopathic gait

A

systemic:

  • Hyperthyroidism
  • Hypothyroidism
  • Cushing’s syndrome
  • Acromegaly
  • Polymyalgia rheumatica
  • Polymyositis
  • Dermatomyositis

Duchenne’s muscular dystrophy
Becker’s muscular dystrophy
Myotonic dystrophy

24
Q

features of choriform gait

A

involuntary movements:

  • Oro-facial dyskinesia (grimacing or lip-smacking)
  • Choreic movements of the upper and lower limbs (writhing, dance like semi-purposeful movements)

present at rest, made worse when walking

25
Q

causes of chroiform gait

A

Basal ganglia disease:

  • Huntington’s disease
  • Sydenham’s chorea
  • Cerebral palsy (choreiform type)
  • Wilson’s disease
  • Dopaminergic medications (e.g. Parkinson’s medications)
26
Q

features of antalgic gait

A

reduced time on affected leg -> limping

27
Q

causes of antalgic gait

A

any cause of lower limb pain

Osteoarthritis
Inflammatory joint disease
Lower limb fracture
Nerve entrapment (e.g. sciatica)

paces (4 decks)

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