GAIT Flashcards
Feet in normal gait
The feet are slightly externally rotated, the
steps are approximately equal, and the medial malleoli
almost touch as each foot passes the other
The normal gait cycle, defined as the period between
successive points at which the
_________________
heel of the same foot
strikes the ground,
The ________________, during which the foot is in contact
with the ground, occupies 60 to 65 percent of the cycle
stance phase
______________begins when the right toes leave the
ground
The swing phase
For 20 to 25 percent of the walking cycle, both
feet are in contact with the ground ____________
(double-limb support).
the requirements
for locomotion in an upright, bipedal position may be
reduced to the following elements:
(1) antigravity support
of the body, (2) stepping, (3) the maintenance of
equilibrium, and (4) a means of propulsion
The muscles of greatest importance in maintaining the
erect posture are the _____ and _______
erector spinae and the extensors of the
hips and knees
These____________ depend on the afferent
vestibular, somatosensory (proprioceptive and tactile), and
visual impulses, which are integrated in the spinal cord,
brainstem, and basal ganglia
postural reflexes
Transection of the neuraxis
between the red and vestibular nuclei leads to exaggeration
of these antigravity reflexes-__________
decerebrate rigidity
_________ the second element, is a basic movement
pattern present at birth and integrated at the spinal midbrain and diencephalic levels.
Stepping
The ________ is absolutely integral to initiating
and engaging the gait cycle.
frontal lobe
true “gait center” in the cerebrum
supplementary motor areas relating
to the legs
the __________________ embody automatic
programs for walking that are intimately tied to adjacent networks in the striatum
medial frontal lobes
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
chronic vestibulopathy
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 _______
aminoglycoside antibiotics
vestibular labyrinth.
Vestibular suppressants, such as _________
that are available over the counter, can lead to
decreased function of the vestibular system
meclizine and
similar medications, mostly anticholinergic and antihistaminic
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) .
BG
Pain in the hips or knees can lead to a disorder ___________ that can be challenging to distinguish from neurological
causes of gait problems
(antalgic
gait)
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.
Romberg sign
vestibular or cerebellar
A tendency to veer to one side, as
occurs with unilateral cerebellar or vestibular disease,
can be brought out by having the_________
patient walk around
a chair.
More delicate tests of gait are walking a straight
line heel to toe (“tandem walking test”),_______
walking backward, and having the patient arise quickly from a chair, walk briskly, stop and turn suddenly, walk back, and sit down again
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___________
inadequacy of corrective
actions.
The main features are a wide base (separation of legs),
unsteadiness, irregularity of steps, and lateral veering.
Cerebel l a r G a it
This is characteristic of inebriation with alcohol, sedative
drugs, and antiepileptic drugs
Reel i n g G a it of I ntoxication
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 _______
correcting his balance if he sways or lurches too far to one side.
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.
G a it of Sensory Ataxia
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 ________
brusqueness of movement of the legs and stamping of
the feet as the foot is forcibly brought down onto the
floor
“stamp and stick.
The most specific feature is that
in sensory ataxia, ataxia is markedly exaggerated___________
when the patient is
deprived of visual cues, as in walking in the dark.
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.
Steppage or Eq u i n e G a it ( Foot-Drop Ga it)
peroneal
nerve or fifth lumbar root damage
slapping
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 ________
(scissor-like gait)
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_________
parkinsonian gait
A normal person readily retains his stability or adjusts to modest displacement of the trunk with a single step, but the parkinsonian patient may ________
lean backward with the upper torso and then stagger or fall unless someone stands by to prevent it.
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 :
lower-half parkinsonism.
progressive supranuclear palsy, a basal ganglionic
degeneration, normal pressure hydrocephalus, or widespread
subcortical vascular damage
Diseases characterized by involuntary movements and
dystonic postures seriously affect gait
Choreoathetotic a n d Dyston i c G a its
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,
congenital athetosis or Huntington
chorea s
__________ 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 (
Stiff-person syndrome,
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
camptocormia
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.
Wad d l i n g ( G l utea l, o r Trendelen b u rg ) Gait
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.
glutei
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.
(“pelvic ptosis”)
__________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
Toppling,
lateral medullary syndrome
dystonia of the neck is combined
with paralysis of vertical gaze and pseudobulbar features,
unexplained falling is often an early and prominent
feature
PSP
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
being pushed (pulsion)
In reaction to a perception
of severe imbalance, which is characteristic of the
disorder, the patient assumes a widened and often stifflegged
stance.
Pri m a ry Orthostatic Trem o r
Its main featuresslowed
cadence, widened base and short steps-are the
natural compensations observed in patients with all manner
of gait disorders.
NPH
in NPH, Tone in the leg muscles of the NPH patient is often slightly increased, with a tendency to ______
cocontraction of flexor and extensor muscle groups
patients with NPH often have ______
and have short steps that are helped by marching to a
cadence or in step with the examiner.
difficulty initiating gait
characteristic of NPH gait
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.
lesions of frontal lobe causing gait disturbance
particularly their
medial parts and their connections with the basal ganglia.
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
“apraxia of gait”
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.
at the cortical
and basal ganglionic levels,
