GAIT

Question 1

Feet in normal gait

Answer 1

The feet are slightly externally rotated, the
steps are approximately equal, and the medial malleoli
almost touch as each foot passes the other

Question 2

The normal gait cycle, defined as the period between
successive points at which the
_________________

Answer 2

heel of the same foot

strikes the ground,

Question 3

The ________________, during which the foot is in contact

with the ground, occupies 60 to 65 percent of the cycle

Answer 3

stance phase

Question 4

______________begins when the right toes leave the

ground

Answer 4

The swing phase

Question 5

For 20 to 25 percent of the walking cycle, both

feet are in contact with the ground ____________

Answer 5

(double-limb support).

Question 6

the requirements
for locomotion in an upright, bipedal position may be
reduced to the following elements:

Answer 6

(1) antigravity support
of the body, (2) stepping, (3) the maintenance of
equilibrium, and (4) a means of propulsion

Question 7

The muscles of greatest importance in maintaining the

erect posture are the _____ and _______

Answer 7

erector spinae and the extensors of the

hips and knees

Question 8

These____________ depend on the afferent
vestibular, somatosensory (proprioceptive and tactile), and
visual impulses, which are integrated in the spinal cord,
brainstem, and basal ganglia

Answer 8

postural reflexes

Question 9

Transection of the neuraxis
between the red and vestibular nuclei leads to exaggeration
of these antigravity reflexes-__________

Answer 9

decerebrate rigidity

Question 10

_________ the second element, is a basic movement

pattern present at birth and integrated at the spinal midbrain and diencephalic levels.

Answer 10

Stepping

Question 11

The ________ is absolutely integral to initiating

and engaging the gait cycle.

Answer 11

frontal lobe

Question 12

true “gait center” in the cerebrum

Answer 12

supplementary motor areas relating

to the legs

Question 13

the __________________ embody automatic

programs for walking that are intimately tied to adjacent networks in the striatum

Answer 13

medial frontal lobes

Question 14

Patients with a ___________ show unsteadiness in standing and walking, often without widening
their base, and an inability to descend stairs without
holding onto the banister

Answer 14

chronic vestibulopathy

Question 15

Chronic disorders of vestibular function in relation
to gait disorders are most often the result of prolonged
administration of ______ or other toxic medications, which destroy the hair cells of the _______

Answer 15

aminoglycoside antibiotics

vestibular labyrinth.

Question 16

Vestibular suppressants, such as _________
that are available over the counter, can lead to
decreased function of the vestibular system

Answer 16

meclizine and

similar medications, mostly anticholinergic and antihistaminic

Question 17

Where is the lesion?..There is difficulty in taking the first step; once it is taken, and in extreme cases, the body pitches forward and a fall
can be prevented only by catch-up stepping (propulsive
festination) .

Answer 17

BG

Question 18

Pain in the hips or knees can lead to a disorder ___________ that can be challenging to distinguish from neurological
causes of gait problems

Answer 18

(antalgic

gait)

Question 19

the____________-marked swaying or falling with the eyes closed but not with the eyes open-usually indicates a loss of postural sense, not of cerebellar function, although with ___________disease there may be an exaggeration
of swaying.

Answer 19

Romberg sign

vestibular or cerebellar

Question 20

A tendency to veer to one side, as
occurs with unilateral cerebellar or vestibular disease,
can be brought out by having the_________

Answer 20

patient walk around

a chair.

Question 21

More delicate tests of gait are walking a straight

line heel to toe (“tandem walking test”),_______

Answer 21

walking backward, and having the patient arise quickly from a chair, walk briskly, stop and turn suddenly, walk back, and sit down again

Question 22

It is instructive to observe the patient’s postural reaction to a sudden push or tug backward at the shoulders and forward or to the side. With postural instability of
any type there is a delay or___________

Answer 22

inadequacy of corrective

actions.

Question 23

The main features are a wide base (separation of legs),

unsteadiness, irregularity of steps, and lateral veering.

Answer 23

Cerebel l a r G a it

Question 24

This is characteristic of inebriation with alcohol, sedative

drugs, and antiepileptic drugs

Answer 24

Reel i n g G a it of I ntoxication

Question 25

Despite wide excursions
of the body and deviation from the line of march, the
drunken patient may, for short distances, be able to walk
on a narrow base and maintain his balance.

In contrast, the patient with cerebellar gait has great difficulty in _______

Answer 25

correcting his balance if he sways or lurches too far to one side.

Question 26

This disorder is caused by an impairment of joint position or muscular kinesthetic sense resulting from interruption
of afferent nerve fibers in the peripheral nerves, posterior
roots, sensory ganglia, posterior columns of the spinal
cords, or medial lemnisci, and occasionally from a lesion of both parietal lobes.

Answer 26

G a it of Sensory Ataxia

Question 27

The principal features of sensory-ataxic gait are the
______________

To use Ramsay Hunt’s characterization,
the patient with this gait disorder is recognized by
his ________

Answer 27

brusqueness of movement of the legs and stamping of
the feet as the foot is forcibly brought down onto the
floor

“stamp and stick.

Question 28

The most specific feature is that

in sensory ataxia, ataxia is markedly exaggerated___________

Answer 28

when the patient is

deprived of visual cues, as in walking in the dark.

Question 29

This gait pattern is caused by paralysis of the pretibial
and peroneal muscles, with resultant inability to dorsiflex the foot (foot drop).

In its purest form it is the result of ____ and ______

There is a _________ noise as the foot strikes the
floor.

Answer 29

Steppage or Eq u i n e G a it ( Foot-Drop Ga it)

peroneal
nerve or fifth lumbar root damage

slapping

Question 30

The legs are extended or slightly bent at the knees and the thighs may be strongly adducted, causing the legs almost to cross as the patient walks ________

Answer 30

(scissor-like gait)

Question 31

Diminished or absent arm swing, forward bent torso,
short or shuffling steps, turning en bloc, hesitation in
starting to walk, shuffling, or “freezing” when encountering doorways or other obstacles are the features of the_________

Answer 31

parkinsonian gait

Question 32

A normal person readily retains his stability or adjusts to modest displacement of the trunk with a single step, but the parkinsonian patient may ________

Answer 32

lean backward with the upper torso and then stagger or fall unless someone stands by to prevent it.

Question 33

one encounters an elderly patient with
only the instability and freezing components of the
parkinsonian gait disorder, so-called _________

It may be an early manifestation
of :

Answer 33

lower-half parkinsonism.

progressive supranuclear palsy, a basal ganglionic
degeneration, normal pressure hydrocephalus, or widespread
subcortical vascular damage

Question 34

Diseases characterized by involuntary movements and

dystonic postures seriously affect gait

Answer 34

Choreoathetotic a n d Dyston i c G a its

Question 35

As the patient with _______ and _______tands or walks, there is a continuous play of
irregular movements affecting the face, neck, hands, and,
in the advanced stages,

Answer 35

congenital athetosis or Huntington

chorea s

Question 36

__________ an unusual nondystonic disorder
causing severe axial muscle spasm, imparts a characteristic
appearance of stiffness of the legs and buttock
muscles, slow propulsion, and lumbar lordosis; there is
sometimes a mild superimposed ataxic disturbance of
gait (

Answer 36

Stiff-person syndrome,

Question 37

Another unusual disorder affecting
the body position during walking is ___________, a
severe forward bending of the trunk at the waist that is
symptomatic of either a dystonia, Parkinson disease, or
one of several muscle diseases that focally weaken the
extensors of the spine

Answer 37

camptocormia

Question 38

This gait is characteristic of the gluteal muscle weakness that is seen in the progressive muscular dystrophies, but
it occurs as well in chronic forms of spinal muscular atrophy,

in certain inflammatory myopathies, lumbosacral
nerve root compression, and with congenital dislocation
of the hips.

Answer 38

Wad d l i n g ( G l utea l, o r Trendelen b u rg ) Gait

Question 39

With weakness of the ____________, however, there is a failure
to stabilize the weight-bearing hip, causing it to bulge
outward and the opposite side of the pelvis to drop, with inclination of the trunk to that side.

Answer 39

glutei

Question 40

With unilateral gluteal weakness, often the result of damage to the first sacral nerve root, tilting and dropping of the pelvis __________ is apparent on only one side as the patient overlifts the leg when walking.

Answer 40

(“pelvic ptosis”)

Question 41

__________meaning tottering and falling, occurs with
brainstem and cerebellar lesions, especially in the older
person following a stroke

It is a frequent feature of the
___________, in which falling occurs to
the side of the infarction

Answer 41

Toppling,

lateral medullary syndrome

Question 42

dystonia of the neck is combined
with paralysis of vertical gaze and pseudobulbar features,
unexplained falling is often an early and prominent
feature

Answer 42

PSP

Question 43

In a related defect caused by a vestibular disorder,
the patient may describe a sense of________
rather than of imbalance. It is most fully manifest
in the lateral medullary syndrome

Answer 43

being pushed (pulsion)

Question 44

In reaction to a perception
of severe imbalance, which is characteristic of the
disorder, the patient assumes a widened and often stifflegged
stance.

Answer 44

Pri m a ry Orthostatic Trem o r

Question 45

Its main featuresslowed
cadence, widened base and short steps-are the
natural compensations observed in patients with all manner
of gait disorders.

Answer 45

NPH

Question 46

in NPH, Tone in the leg muscles of the NPH patient is often slightly increased, with a tendency to ______

Answer 46

cocontraction of flexor and extensor muscle groups

Question 47

patients with NPH often have ______
and have short steps that are helped by marching to a
cadence or in step with the examiner.

Answer 47

difficulty initiating gait

Question 48

characteristic of NPH gait

Answer 48

They reported a reduction in height of

step, an increase in sway, and a decrease in rotation of the pelvis and counter-rotation of the torso.

Question 49

lesions of frontal lobe causing gait disturbance

Answer 49

particularly their

medial parts and their connections with the basal ganglia.

Question 50

This disorder is sometimes spoken of as a frontal lobe
as an _________ among numerous other labels,
because the difficulty in walking cannot be accounted
for by weakness, loss of sensation, cerebellar incoordination,
or basal ganglionic abnormality

Answer 50

“apraxia of gait”

Question 51

More likely, the frontal gait
disorder represents a loss of integration,___________of the essential elements of stance and locomotion that are acquired in infancy and often lost in old age.

Answer 51

at the cortical

and basal ganglionic levels,