Gait Flashcards

1
Q

gait apraxia

A

Memory or concept of walking “put into action” (praxis: concept is executed or performed “on command”; patients with gait apraxia are immobile when asked to walk, despite having all the other essentials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what 5 things are needed for normal walking

A
  1. Strength (UMNs, LMNs, NMJs, muscle)
  2. Coordination (cerebellar system)
  3. Postural control (extrapyramidal system)
  4. Sensation (particularly proprioception)
  5. Memory or concept of walking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what kind of lesion does a Romberg sign indicate and what function is lacking as a result

A
posterior column (or sensory nerve) lesion
lack of proprioception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

where is the problem if a patient cannot stand with feet together with eyes open

A

cerebellar disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

describe a broad based gate

A
  • feet spread wide apart for stability;

* gait much more unsteady walking a straight line (tandem or heel-to-toe);

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

where is a lesion in a patient with a broad based gait

A

lesion of the posterior columns or sensory (proprioceptive) nerves (worse with eyes closed) or cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe a hemiplegic gait

A
  • affected lower limb is stiffly extended and
    swung or circumducted;
    • affected ipsilateral upper limb is flexed at
      elbow and wrist with decreased armswing;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when is a hemiplegic gait normally seen

A

stroke patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe a tabetic gait

A

“foot slapping” gait, where patient compensates for impaired sensation by forcibly planting the feet down to “feel” the floor;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a tabetic gait associated with

A

neurosyphilis (tabes dorsalis) - would also see Argyle-Robinsin pupils (constrict to near reflex but not light)

or severe neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe a steppage gait

A
  • caused by foot drop (weak dorsiflexion);
    • to prevent tripping over the toes, the hip
      is flexed even higher to elevate the
      drooping foot, which is lowered to the
      floor toe first;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is a steppage gait associated with

A

peroneal nerve or L5 root lesions, or severe peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe a waddling gait

A
  • when walking, weak pelvic or hip muscles cannot support the body “on one leg” while the opposite foot is lifted off the ground;
  • patient compensates by swaying or leaning to the left when the right foot is raised and vice versa, alternately tilting the pelvis from side to side, reminiscent of a waddling duck;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a waddling gait associated with

A

myopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

describe a scissors gait

A
  • although the legs are weak, marked spasms and tightness in the adductor muscles of the thighs force the knees stiffly together when walking;
  • legs tend to cross over each other, like the closing blades of a scissors;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a scissors gait associated with

A

due to corticospinal tract lesions affecting the legs (spastic paraparesis) as in cerebral palsy or MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

describe a Parkinsonian gait

A
  • slow, shuffling gait, with “stooped forward” posture and lack of a normal arm swing;
  • festination—leaning further and further forward to walk, the patient then runs to “catch up” with the center of gravity;
  • turning around is laboriously slow, requiring multiple, small steps, often with a tendency to fall over;
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are some ways to test cerebellar function

A

finger to nose
heel to knee to shin
hand flip flop
rebound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

describe the characteristics of cerebellar dysarthria and what part of the cerebellum is affected

A

slurred, thick, scanning (erratic, jerky, explosive or hyphenated quality) speech

left cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what types of eye movements may be seen with cerebellar problems

A

nystagmus with erratic, jerky, eye movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what kinds of abnormal limb control may be seen in cerebellar disease

A

kinetic tremor
dysmetria
decomposition of movement
loss of check response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is a kinetic tremor

A

rhythmic oscillations during limb movement toward a target

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is dysmetria

A

overshooting or undershooting a target

24
Q

what is decomposition of movement

A

a normally smooth movement becomes jerky, “broken down”

25
what is loss of check response
sudden release of contracted biceps leads to striking the face; triceps does not "check" this action due to imbalance of agonist/antagonists muscle
26
what does a midline cerebellar lesion mostly affect
the trunk
27
what does a cerebellar lesion of the hemispheres mostly affect
the limbs
28
what movement disorders are seen in hemispheral sydrome
* predominantly affects ipsilateral limbs (kinetic tremor, limb dysmetria, dysdiadochokinesia, rebound phenomenon);
29
what causes hemispheral syndrome
ipsilateral infarction, hemorrhage, tumor or multiple sclerosis lesion (bilateral lesions in degenerative diseases)
30
what movement disorders does vermal (vermian) syndrome cause
predominantly affects the trunk - truncal unsteadiness with standing or walking, tremor, postural imapairment, gait ataxia
31
what can cause vermal syndrome
hemorrhage, tumor, MS, degenerative disorders, alcoholic cerebellar degeneration
32
what is alcoholic cerebellar degeneration
atrophy of anteriorsuperior vermis, with gait ataxia and lower limb dysmetria
33
how is spinocerebellar degeneration aquired
hereditary degenerative disorders of unknown cause and no curative treatment
34
what is predominantly affected in spinocerebellar degeneration (ataxias)
the nuclei and tracts of the cerebellum and spinal cord in a progressive fashion (older patients become wheelchair dependent )
35
what is the most common type of Spinocerebellar degeneratiion
Friedreich's ataxia
36
what disease is associated with a predominantly resting tremor
parkinsons
37
what is a familial essential tremor
a postural tremor and a kinetic tremor
38
what is Choreoathetosis
slow, writhing, continual limb movements (athetosis) plus brief, irregular, flowing “dancelike” movements (chorea) affecting limbs, trunk and face
39
what can cause choreoathetosis
lesions in the caudate nucleus (Huntington's disease) or its connecting pathways or high levels of dopaminergic medications may produce choreoathetosis or dystonia
40
what is hemiballismus
rapid, violet ("ballistic"), flinging movements of proximal upper and lower limbs on one side
41
what causes hemiballismus
lesion (usually infarction) of the contralateral subthalamic nucleus
42
what is dystonia
continual or sustained painful contraction of muscles, causing turning and spasms of the limbs or neck, with fixed, unnatural postures no specific lesion or pathology has been correlated with this disorder
43
what type of dystonia is focal
torticollis
44
what type of dystonia is generalized
dystonia musculorum deformans
45
what is a tic
brief, semipurposeful, stereotyped, repetitive contractions of groups of muscles (e.g., eye blink, facial twitch, sniff)
46
what is thought to cause tics
decreased motor inhibition in the basal ganglia possibly
47
What is seen in Tourette's syndrome
- --motor and vocal (e.g., grunts, growls) tics; - --inherited, with variable penetrance; more often in boys; - --attention deficit disorder; - --behavioral problems;
48
what is myoclonus
rapid, shocklike movements of the limbs or body, usually bilateral, but often asynchronous
49
what causes myoclunus
due to diffuse encephalopathies from neurological (e.g., Creutzfeldt-Jakob disease) or medical diseases (e.g., renal or hepatic failure, anoxia);
50
what is asterixis
a flapping tremor of the extended hand or foot due to loss of postural tone
51
when do you see bilateral asterixis
diffuse encephalopathies from medical diseases (renal or hepatic failure)
52
when is unilateral asterixis seen
in structural brain lesions
53
what medications can be given to help alleviate a parkinsonian tremor
anticholinergics, L-dopa, dopamine agonists
54
what medications can alleviate an essential tremor
beta-adrenergic blockers, barbiturates
55
what medications can alleviate choreoathertosis, hemiballismus, and tics
dopamine antagonists
56
what medications can be given to alleviate dystonia
anticholinergics, benzodiazepines, botulinum toxin injections