Gait and movement disorders Flashcards
What is spasticity?
Continuous contraction of muscles with or without weakness.
How does spasticity affect walking?
Stiff and jerky walking
Catch toes on the ground
Short pace and narrow base
Clonus – involuntary extensor rhythmic leg jerking
Stiff, weak leg is circumducted and drags.
How does Parkinson’s affect gait?
Shuffling gait- short rapid steps
Diminished arm swinging
Difficulties turning
Why do people with Parkinson’s shuffle?
Rigidity in both flexors and extensors
What is a Cerebellar ataxia gait?
Broad based gait
Why does cerebellar ataxia cause a broad based gait?
Due to unsteadiness
What are some features of a cerebellar ataxic/broad based gait?
Veer to affected side
Fall backwards or sideways
What kind of gait does sensory ataxia give?
Stamping gait
What causes a sensory ataxia/stamping gait?
Sensory loss leaving loss of proprioception.
Describe a stamping gait
Broad based
High stepping
Stamping down.
What can make a stamping gait worse?
Removing visual input
How can you test for a stamping gait?
Romberg’s test
Describe Romberg’s test
Stand up with arms by side and close eyes.
Lose balance when do so is positive.
What kind of gait does a lower limb weakness give?
Slapping or waddling depending on affected area.
What causes a slapping gait?
Distal limb weakness
What can cause distal limb weakness?
Peroneal nerve palsy
What can cause a waddling gait?
Proximal limb weakness- pelvis is poorly supported by each leg
What can cause proximal limb weakness?
Polymyositis
Muscular dystrophy
What is gait apraxia?
Disorganised walking
Damage to which part of the brain causes gait apraxia?
Frontal lobe
Give some features of gait apraxia
Shuffling gait
Undue hesitancy
What does gait apraxia often occur with?
Urinary incontinence
Dementia
What two categories can movement disorders be split into?
Akinetic-rigid syndromes
Dyskinesias
Describe akinetic-rigid syndromes
Increased tone and slow movement
Describe dyskinesias
Additional and uncontrolled movements
Give an example of an akinetic-rigid syndrome
Wilson’s disease
What causes Wilson’s disease?
Copper deposits in basal ganglia, cornea and liver.
What can WIlson’s disease cause in the eyes?
Kayser-Fleischer rings
How do you treat Wilson’s disease?
Copper chelators
Give some examples of dyskinesias
Benign essential tremor
Chorea
Myoclonus
Dystonias
What is a benign essential tremor?
5-8Hz tremor generally in the upper limb.
Generally occurs when holding something like a spoon or pen
What can a benign essential tremor be confused with?
Parkinson’s
What can help a benign essential tremor?
Small amounts of alcohol
BB
What can make tremors worse?
Sympathomimetics (i.e. Salbutamol)
What is chorea?
Jerky, quasi-purposive, explosive fidgety movements
Give some examples of chorea
Huntington's disease Drugs Thyrotoxicosis SLE Sydenham’s chorea (St Vitus’ dance)
What is Sydenham’s chorea (St Vitus’ dance)?
Transient post infection chorea in children
What drugs can cause chorea?
Oral contraceptive
Levodopa
Phenytoin
Alcohol
What is myoclonus?
Sudden jerk of one muscle or muscle group
What conditions can myoclonus be associated with?
Benign essential myoclonus
Epilepsy
Encephalopathy
What is benign essential myoclonus?
Nocturnal myoclonus as dropping off to sleep- non-pathological.
Is myoclonus a major feature of epilepsy?
Yes it can be. Very classical
What can help for myoclonus in epilepsy?
Na Valporate
What are dystonias?
Movement caused by prolonged muscular contraction – part of the body is thrown into spasm.
What are some examples of dystonias?
Primary torsion dystonia
Dopamine-responsive dystonia
Spasmodic torticollis
Writer’s cramp
What is primary torsion dystonia?
Dystonia affecting gait and posture spreading to all parts of the body over one to four decades
What is dopamine-responsive dystonia?
Lower limb dystonia that is almost completely abolished by small doses of levodopa
What are spasmodic torticollis?
Dystonic spasms gradually develop around the neck, usually in the third to fifth decade that cause the head to turn or to be drawn backwards or forwards.
What is writer’s cramp?
Inability to perform a previously highly developed repetitive skilled movement (e.g. Writing)
