Gait and movement disorders

Question 1

What is spasticity?

Answer 1

Continuous contraction of muscles with or without weakness.

Question 2

How does spasticity affect walking?

Answer 2

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.

Question 3

How does Parkinson’s affect gait?

Answer 3

Shuffling gait- short rapid steps
Diminished arm swinging
Difficulties turning

Question 4

Why do people with Parkinson’s shuffle?

Answer 4

Rigidity in both flexors and extensors

Question 5

What is a Cerebellar ataxia gait?

Answer 5

Broad based gait

Question 6

Why does cerebellar ataxia cause a broad based gait?

Answer 6

Due to unsteadiness

Question 7

What are some features of a cerebellar ataxic/broad based gait?

Answer 7

Veer to affected side

Fall backwards or sideways

Question 8

What kind of gait does sensory ataxia give?

Answer 8

Stamping gait

Question 9

What causes a sensory ataxia/stamping gait?

Answer 9

Sensory loss leaving loss of proprioception.

Question 10

Describe a stamping gait

Answer 10

Broad based
High stepping
Stamping down.

Question 11

What can make a stamping gait worse?

Answer 11

Removing visual input

Question 12

How can you test for a stamping gait?

Answer 12

Romberg’s test

Question 13

Describe Romberg’s test

Answer 13

Stand up with arms by side and close eyes.

Lose balance when do so is positive.

Question 14

What kind of gait does a lower limb weakness give?

Answer 14

Slapping or waddling depending on affected area.

Question 15

What causes a slapping gait?

Answer 15

Distal limb weakness

Question 16

What can cause distal limb weakness?

Answer 16

Peroneal nerve palsy

Question 17

What can cause a waddling gait?

Answer 17

Proximal limb weakness- pelvis is poorly supported by each leg

Question 18

What can cause proximal limb weakness?

Answer 18

Polymyositis

Muscular dystrophy

Question 19

What is gait apraxia?

Answer 19

Disorganised walking

Question 20

Damage to which part of the brain causes gait apraxia?

Answer 20

Frontal lobe

Question 21

Give some features of gait apraxia

Answer 21

Shuffling gait

Undue hesitancy

Question 22

What does gait apraxia often occur with?

Answer 22

Urinary incontinence

Dementia

Question 23

What two categories can movement disorders be split into?

Answer 23

Akinetic-rigid syndromes

Dyskinesias

Question 24

Describe akinetic-rigid syndromes

Answer 24

Increased tone and slow movement

Question 25

Describe dyskinesias

Answer 25

Additional and uncontrolled movements

Question 26

Give an example of an akinetic-rigid syndrome

Answer 26

Wilson's disease

Question 27

What causes Wilson's disease?

Answer 27

Copper deposits in basal ganglia, cornea and liver.

Question 28

What can WIlson's disease cause in the eyes?

Answer 28

Kayser-Fleischer rings

Question 29

How do you treat Wilson's disease?

Answer 29

Copper chelators

Question 30

Give some examples of dyskinesias

Answer 30

Benign essential tremor Chorea Myoclonus Dystonias

Question 31

What is a benign essential tremor?

Answer 31

5-8Hz tremor generally in the upper limb. | Generally occurs when holding something like a spoon or pen

Question 32

What can a benign essential tremor be confused with?

Answer 32

Parkinson's

Question 33

What can help a benign essential tremor?

Answer 33

Small amounts of alcohol | BB

Question 34

What can make tremors worse?

Answer 34

Sympathomimetics (i.e. Salbutamol)

Question 35

What is chorea?

Answer 35

Jerky, quasi-purposive, explosive fidgety movements

Question 36

Give some examples of chorea

Answer 36

``` Huntington's disease Drugs Thyrotoxicosis SLE Sydenham’s chorea (St Vitus’ dance) ```

Question 37

What is Sydenham’s chorea (St Vitus’ dance)?

Answer 37

Transient post infection chorea in children

Question 38

What drugs can cause chorea?

Answer 38

Oral contraceptive Levodopa Phenytoin Alcohol

Question 39

What is myoclonus?

Answer 39

Sudden jerk of one muscle or muscle group

Question 40

What conditions can myoclonus be associated with?

Answer 40

Benign essential myoclonus Epilepsy Encephalopathy

Question 41

What is benign essential myoclonus?

Answer 41

Nocturnal myoclonus as dropping off to sleep- non-pathological.

Question 42

Is myoclonus a major feature of epilepsy?

Answer 42

Yes it can be. Very classical

Question 43

What can help for myoclonus in epilepsy?

Answer 43

Na Valporate

Question 44

What are dystonias?

Answer 44

Movement caused by prolonged muscular contraction – part of the body is thrown into spasm.

Question 45

What are some examples of dystonias?

Answer 45

Primary torsion dystonia Dopamine-responsive dystonia Spasmodic torticollis Writer’s cramp

Question 46

What is primary torsion dystonia?

Answer 46

Dystonia affecting gait and posture spreading to all parts of the body over one to four decades

Question 47

What is dopamine-responsive dystonia?

Answer 47

Lower limb dystonia that is almost completely abolished by small doses of levodopa

Question 48

What are spasmodic torticollis?

Answer 48

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.

Question 49

What is writer's cramp?

Answer 49

Inability to perform a previously highly developed repetitive skilled movement (e.g. Writing)