gait Flashcards
hemiplegic gait features
spastic flexion of the upper limb and extension of the lower limb.
-> circumduction of affected limb
clinical features associated with hemiplegic gait
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
causes of hemiplegic gait
Unilateral cerebral lesion:
- Stroke
- Space-occupying lesion
- Trauma
- Multiple sclerosis
Hemisection of the spinal cord:
- Trauma
features of diplegic gait
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
clinical features associated with diplegic gate
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)
spinal cord lesions of diplegic gate
Prolapsed intervertebral disc
Spinal spondylosis
Spinal tumour
Transverse myelitis
Spinal infarct
Syringomyelia
Hereditary spastic paraparesis
(MND)
brain lesion cause of diplegic gate
Cerebral palsy
Multiple sclerosis
Bilateral brain infarcts
Midline tumour (e.g. paraspinal meningioma)
features of parkinsonian gait
- slow start
- reduced stride length
- reduced arm swing
- flexed trunk and neck -> stooped
- resting tremor
- impaired balance on turning / hesitancy
clinical features associated with parkinsons disease
Tremor
Rigidity
Bradykinesia
Hypomimia
causes of parkinsonism
- 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
features of ataxic gait
- 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
causes of cerebellar ataxic gait
- 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
causes of sensory ataxia
Peripheral neuropathy (e.g. diabetes mellitus)
causes of vestibular ataxia
Labyrinthitis
Meniere’s disease
Acoustic neuroma
associated features with cerebellar ataxia
Nystagmus
Ataxic dysarthria
Dysmetria
Intention tremor
Dysdiadokokinesia
features associated with sensory ataxia
Positive Romberg’s sign
Impaired proprioception
Impaired vibration sensation
Absence of other cerebellar signs (e.g. dysmetria, nystagmus, dysarthria)
features of vestibular ataxia
Vertigo
Nausea
Vomiting
features of neuropathic gait
foot drop
high stepping gait - knee and hip flex excessively
causes of foot drop
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
features of a myopathic gait (aka waddling / trendelenburg gait)
pelvis tilts to unsupported side during swing phase
body compensates by:
- laterally flex torso away from leg in swing phase = waddling
- circumducting
clinical features associated with myopathic gait
- difficult to stand without arms
- +ve trendelenburg test
muscle type that = positive trendelenburg test
hip abductors
disease that causes myopathic gait
systemic:
- Hyperthyroidism
- Hypothyroidism
- Cushing’s syndrome
- Acromegaly
- Polymyalgia rheumatica
- Polymyositis
- Dermatomyositis
Duchenne’s muscular dystrophy
Becker’s muscular dystrophy
Myotonic dystrophy
features of choriform gait
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
causes of chroiform gait
Basal ganglia disease:
- Huntington’s disease
- Sydenham’s chorea
- Cerebral palsy (choreiform type)
- Wilson’s disease
- Dopaminergic medications (e.g. Parkinson’s medications)
features of antalgic gait
reduced time on affected leg -> limping
causes of antalgic gait
any cause of lower limb pain
Osteoarthritis
Inflammatory joint disease
Lower limb fracture
Nerve entrapment (e.g. sciatica)
