Gait Flashcards
Describe labrynthitis/ vestibular neuritis
Vestibular neuritis is most likely a vestibular neuropathy caused by reactivation of latent type 1 herpes simplex virus in the vestibular ganglion often preceding URTI vertigo unsteady gait N+V hearing loss tinnitus
vestibular neuritis vs labrynthitis vs BPPV
Labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear (can include vestibular nerve - vest neuritis is just more specific)
Vestibular neuritis is inflammation of the vestibular nerve – the nerve in the inner ear that sends messages to the brain
vertigo due to benign paroxysmal positional vertigo (BPPV) is episodic and triggered by movement
What are differentials for Normal P Hydrocephalus?
parkinsons, alzheimers
describe the different abnormal gaits?
Hemispastic gait; Unilateral extension and circumduction
Paraspastic gait; Bilateral extension and adduction, stiff
Ataxic gait; Broad base, lack of coordination
Sensory ataxic gait; Cautious, worsening without visual input
Cautious gait; Broad based, cautious, slow, anxious
Freezing gait; Blockage, e. g. on turning
Propulsive gait; Centre of gravity in front of body, festination
Astasia; Primary impairment of stance/balance
Dystonic gait; Abnormal posture of foot/leg
Choreatic gait; Irregular, dance-like, broad-based
Steppage/ foot drop gait; Weakness of foot extensors
Waddling gait; Broad-based, swaying, drop of swinging leg
Antalgic gait; Shortened stance phase on affected side
Vertiginous gait; Insecure, tendency to fall to one side
Psychogenic gait disorder; Bizarre, rarely falls
What may cause a waddling gait? Plus describe it
Weakness of the hip girdle and upper thigh muscles, for instance in myopathies, leads to an instability of the pelvis on standing and walking.
Description: Broad-based, swaying, drop of swinging leg
Patients usually have difficulties standing up from a sitting position. Due to weakness in the gluteus medius muscle, the hip on the side of the swinging leg drops with each step - Trendelenburg sign
What may cause a high steppage gait? Plus describe it
Cause: weakness of muscles that cause dorsiflexion eg if unilat - peripheral neuropathy; if bilat - MND or charcot marie tooth
Describe: When the muscles that lift the foot are paretic the patient must lift the leg higher than usual during the swing phase.
Patients are unable to stand or walk on their heels.
They cannot perform toe walking
Describe and explain a spastic hemiparetic/ plegic gait.
Spastic hemiparetic gait
Tone up in UL flexor muscles -> arm adducted + pronate
knee cannot extend fully, foot inverted and plantar flexed.
asymmetrical, less weight bearing on paretic side.
Paretic leg swings (circumduction)
(ie arm bent inwards and leg extended on one side)
Cause: damage to corticospinal tract above medulla caused by eg stroke, infection, CP
Describe and explain a spastic paraparetic/ plegic gait.
Spastic paraparetic gait
Legs bent, adducted, knees extended, feet plantar flecion, circumduction legs, stiff, legs dragged fowards,
If the muscle tone in the adductors is marked, the resulting gait disorder is referred to as scissor gait.
causes: inherited
Describe a sensory ataxic gait
Cause: Disturbances of proprioceptive function may occur in sensory polyneuropathy or dorsal column lesions.
In sensory ataxia:
stance and gait appear broad based and slower than cerebellar ataxia.
The step length is shortened. Gait is slower and more cautious compared to cerebellar ataxia. The feet are sometimes lifted high and gait may have a stomping quality.
The patients use visual control to compensate for the loss of proprioception -> loss of visual function causes marked worsening of ataxia. This may become evident during clinical testing (Romberg’s test, walking with closed eyes)
What does PD gait look like?
The cardinal motor signs of PD are bradykinesia, rigidity, rest tremor and impaired postural stability.
In the majority of patients, the symptoms initially affect only unilat and then spread to the other side.
In hemiparkinsonism, physiological arm swing is reduced and the leg may be slightly dragged on the affected side.
As the disease progresses, the typical rigid akinetic gait impairment develops, which includes slow gait with a short step length, a narrow base and a stooped posture involving neck, shoulders and trunk. Arm swing is reduced and in more advanced stages the arms are held in an adducted and bent position. The feet are lifted less high than normally, which may lead to shuffling gait. When asked to walk faster, patients increase the step frequency rather than step length.
Performing other tasks simultaneously, such as walking while talking, worsens the gait. Commonly, patients with PD find it easier to climb up stairs than to walk on a level surface.
Freezing- Difficulties with gait initiation and freezing typically occur on turning or when approaching obstacles or narrow passages such as doors.
Describe progressive and multiple system atrophy gaits and what are they are a differential for?
Differentials for parkinsons
The atypical parkinsonian syndromes, such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) typically lead to early problems with balance and gait.
What is high steppage gait
due to foot drop:
weakness tabialis anterior muscle due to
motor problems with common peroneal nerve - cant lift up, so foot is dragged along - may see one shoe scuffed
can be caused by
hx for acoustic neuroma
The classical history of vestibular schwannoma includes a combination of vertigo, hearing loss, tinnitus and an absent corneal reflex
