Gait Flashcards
gait apraxia
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
what 5 things are needed for normal walking
- Strength (UMNs, LMNs, NMJs, muscle)
- Coordination (cerebellar system)
- Postural control (extrapyramidal system)
- Sensation (particularly proprioception)
- Memory or concept of walking
what kind of lesion does a Romberg sign indicate and what function is lacking as a result
posterior column (or sensory nerve) lesion lack of proprioception
where is the problem if a patient cannot stand with feet together with eyes open
cerebellar disease
describe a broad based gate
- feet spread wide apart for stability;
* gait much more unsteady walking a straight line (tandem or heel-to-toe);
where is a lesion in a patient with a broad based gait
lesion of the posterior columns or sensory (proprioceptive) nerves (worse with eyes closed) or cerebellum
describe a hemiplegic gait
- affected lower limb is stiffly extended and
swung or circumducted;- affected ipsilateral upper limb is flexed at
elbow and wrist with decreased armswing;
- affected ipsilateral upper limb is flexed at
when is a hemiplegic gait normally seen
stroke patients
describe a tabetic gait
“foot slapping” gait, where patient compensates for impaired sensation by forcibly planting the feet down to “feel” the floor;
what is a tabetic gait associated with
neurosyphilis (tabes dorsalis) - would also see Argyle-Robinsin pupils (constrict to near reflex but not light)
or severe neuropathy
describe a steppage gait
- 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;
- to prevent tripping over the toes, the hip
what is a steppage gait associated with
peroneal nerve or L5 root lesions, or severe peripheral neuropathy
describe a waddling gait
- 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;
what is a waddling gait associated with
myopathy
describe a scissors gait
- 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;
what is a scissors gait associated with
due to corticospinal tract lesions affecting the legs (spastic paraparesis) as in cerebral palsy or MS
describe a Parkinsonian gait
- 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;
what are some ways to test cerebellar function
finger to nose
heel to knee to shin
hand flip flop
rebound
describe the characteristics of cerebellar dysarthria and what part of the cerebellum is affected
slurred, thick, scanning (erratic, jerky, explosive or hyphenated quality) speech
left cerebellum
what types of eye movements may be seen with cerebellar problems
nystagmus with erratic, jerky, eye movements
what kinds of abnormal limb control may be seen in cerebellar disease
kinetic tremor
dysmetria
decomposition of movement
loss of check response
what is a kinetic tremor
rhythmic oscillations during limb movement toward a target
what is dysmetria
overshooting or undershooting a target
what is decomposition of movement
a normally smooth movement becomes jerky, “broken down”
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
what does a midline cerebellar lesion mostly affect
the trunk
what does a cerebellar lesion of the hemispheres mostly affect
the limbs
what movement disorders are seen in hemispheral sydrome
- predominantly affects ipsilateral limbs (kinetic tremor, limb dysmetria, dysdiadochokinesia, rebound phenomenon);
what causes hemispheral syndrome
ipsilateral infarction, hemorrhage, tumor or multiple sclerosis lesion (bilateral lesions in degenerative diseases)
what movement disorders does vermal (vermian) syndrome cause
predominantly affects the trunk - truncal unsteadiness with standing or walking, tremor, postural imapairment, gait ataxia
what can cause vermal syndrome
hemorrhage, tumor, MS, degenerative disorders, alcoholic cerebellar degeneration
what is alcoholic cerebellar degeneration
atrophy of anteriorsuperior vermis, with gait ataxia and lower limb dysmetria
how is spinocerebellar degeneration aquired
hereditary degenerative disorders of unknown cause and no curative treatment
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 )
what is the most common type of Spinocerebellar degeneratiion
Friedreich’s ataxia
what disease is associated with a predominantly resting tremor
parkinsons
what is a familial essential tremor
a postural tremor and a kinetic tremor
what is Choreoathetosis
slow, writhing, continual limb movements (athetosis) plus brief, irregular, flowing “dancelike” movements (chorea) affecting limbs, trunk and face
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
what is hemiballismus
rapid, violet (“ballistic”), flinging movements of proximal upper and lower limbs on one side
what causes hemiballismus
lesion (usually infarction) of the contralateral subthalamic nucleus
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
what type of dystonia is focal
torticollis
what type of dystonia is generalized
dystonia musculorum deformans
what is a tic
brief, semipurposeful, stereotyped, repetitive contractions of groups of muscles (e.g., eye blink, facial twitch, sniff)
what is thought to cause tics
decreased motor inhibition in the basal ganglia possibly
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;
what is myoclonus
rapid, shocklike movements of the limbs or body, usually bilateral, but often asynchronous
what causes myoclunus
due to diffuse encephalopathies from neurological (e.g., Creutzfeldt-Jakob disease) or medical diseases (e.g., renal or hepatic failure, anoxia);
what is asterixis
a flapping tremor of the extended hand or foot due to loss of postural tone
when do you see bilateral asterixis
diffuse encephalopathies from medical diseases (renal or hepatic failure)
when is unilateral asterixis seen
in structural brain lesions
what medications can be given to help alleviate a parkinsonian tremor
anticholinergics, L-dopa, dopamine agonists
what medications can alleviate an essential tremor
beta-adrenergic blockers, barbiturates
what medications can alleviate choreoathertosis, hemiballismus, and tics
dopamine antagonists
what medications can be given to alleviate dystonia
anticholinergics, benzodiazepines, botulinum toxin injections
