Gait, Cerebellar Fxn and Movement Disorders Flashcards
Essential for normal walknig
Strength –>
Coordination –>
Postural control –>
Sensation –>
+ _____ , which allows us to “put into action” the concept of walking. A type of deficit, calle gait ______, patients are immobile when asked to walk, despite having all other essentials
Strength –> UMN, LMN, NMJs, muscle
Coordination –> cerebellar systems
Postural control –> extrapyramidal system
Sensation –> particularly proprioception
+ MEMORY/ CONCEPT OF WALKING, which allows us to “put into action” the concept of walking. A type of deficit, called GAIT APRAXIA patients are immobile when asked to walk, despite having all other essentials
_______ RHOMBER SIGN =
Due to lesion in the ________
How can this patient stand steadily with feet together?
POSITIVE RHOMBER SIGN, means the patient sway and topples when EYES ARE CLOSE
Due to POSTERIOR COLUMN / SENSORY NERVE LESION (IMPAIRED PROPRIOCEPTION)
THIS PATIENT CAN STAND STEADILY WITH FEET TOGETHER DUE TO VISUAL ORIENTATION COMPENSATING FOR IMPAIRED PROPRIOCEPTIVE INPUT
What two lesions could cause abnormal stance PRIOR TO WALKING?
- Posterior Column / sensory nerve –> positive Romberg
- Cerebellar Disease
A patient that cannot stand with feet together, regardless of whether eyes are open or closed is due to ______ disease; in comparision to a positive rhomberg sign, this patient’s _______ cannot compensate
A patient that cannot stand with feet together, regardless of whether eyes are open or closed is due to CEREBELLAR DISEASE; in comparision to a positive rhomberg sign, this patient’s VISUAL CLUES cannot compensate
A broad-based ataxic gait:
Feet –>
Gait is worse when ______
caused by lesions of
_______ or
_______ (which is worse with _____) or
__________
Broad-based ataxic gait:
Feet are s_pread wide apart_ for stability
Gait is worse when walking a straight line / tandem / heel to toe
Found with lesions @:
POSTERIOR COLUMNS
SENSORY/ PROPRIOCEPTIVE NERVES (WORSE WITH EYES CLOSED)
CEREBELLUM
Hemiplegic gait:
The affected lower limb is stiffly ______ and _____/circumducted
The affected ipsilateral upper limb is _____at the elbow and wrist with ______ [inc/dec] arm swing.
This is commonly observed in _____ patients
Hemiplegic gait:
The affected lower limb is stiffly EXTENDED and SWUNG/circumducted
The affected ipsilateral upper limb is FLEXED at the elbow and wrist with DECREASED arm swing.
This is commonly observed in STROKE PATIENTS
TABETIC GAIT
it is also know as the “foot ______” gait, where patient compensates for impaired _____ by forcibly _______ the feet down to _____ the floor
Occurs due to: ____/____ or severe _________
what other sx may be associated with tabetic gait?
TABETIC GAIT
it is also know as the “FOOT SLAPPING” GAIT, where patient compensates for impaired SENSATION by forcibly PLANTING the feet down to FEEL the floor
Occurs due to: NEUROSYPHILIS/TABES DORSALIS or
severe neuropathy
with neurosyphilis, argyl robinson pupils may also be noted
Steppage Gait:
caused by ______ drop or a weak _______
to prevent tripping over the toes, the hip is _____ even higher to elevate the ______, which is lowered to the floor toe first
Caused by: Lesions to the ______ nerve or
_____ root lesions or
severe _________
Steppage Gait:
caused by FOOT DROP or a weak DORSIFLEXION
to prevent tripping over the toes, the hip is FLEXED even higher to elevate the DROOPING FOOT, which is lowered to the floor toe first
Foot drop/weak dorsiflexion caused by:
Lesions to the PERONEAL NERVE or
L5 ROOT LESIONS or
SEVERE PERIPHERAL NEUROPATHY
Waddling Gait:
when walking, weak ____ or _____ muscles cannot support the body on “_____” while the opposite foot is lifted off the ground
Patient compensates by _____ or _____ to the left when the right foot is raised and vice versa, alternately tilting the pelvis from side to side, reminiscent of a _______.
Usually from _____ / muscle_____.
Waddling Gait:
when walking, weak PELVIC or HIP MUSCLES CANNOT SUPPORT THE BODY on “ONE LEG” while the opposite foot is lifted off the ground
Patient compensates by SWAYING or LEANING to the left when the right foot is raised and vice versa, alternately tilting the pelvis from side to side, reminiscent of a waddling duck.
Usually from MYOPATHY/ muscledisease.
Scissors Gait:
Although legs are _____, there is marked ____ and tighthess in the ____ muscles of the thighs, forcing the ____ stiffly together when walking –> legs tend to _____ like closing blades of a scissor
Due to:
Scissors Gait:
Although LEGS ARE WEAK, there is marked SPASMS and tighthess in the ADDUCTOR muscles of the thighs, forcing the KNEES sti_ffly together when walking_ –> legs tend to CROSS OVER like closing blades of a scissor
Due to: CST LESIONS (AFFECTING THE LEGS/ SPASTIC PARAPARESIS), AS IN CEREBRAL PALSY OR MS
CERVICAL SPINAL CORD INJURY, UMN WEAKNESS – SPASTICITY
Parkinsonian Gait:
Slow, _____ gait with a ______ posture, and a lack of a ______ arm swing
Festination =
Turning around is _____, requiring _______
Parkinsonian Gait:
SLOW, SHUFFLING GAIT with a “STOOPED FORWARD” posture, and a LACK OF NORMAL ARM SWING
Festination = leaning further and further forward to walk, the pt then runs to catch up with the center of gravity
Turning around is LABORIOUSLY SLOW, requiring multiple, small steps, foten with a tendancy to fall over
What are different ways to test cerebellar function of limb movements? (4)
Finger-nose-finger
Heel-shin-knee
Rapid alterations of hands
Rebound (antagonistic muscle) test
How would cerebellar dysfunction look like in realtion with…
speech?
eyes?
Speech –> CEREBELLAR DYSARTHRIA
due to left cerebellum dysfunction
SX: slurred, thick, scanning (erratic, jerky, explosive or hypernated quality)
Eyes –> nystagmus with erratic, jerky eye movements
What are abnormal limb control movements related with cerebellar disease? (4)
Kinetic Tremor - rhythmic oscillations during limb movment towards a target
Dysmetria - overshooting or undershooting a target
Decomposition of movement - a normally smooth movement becomes jerky “broken down”
Loss of check response (reboud) - sudden release of contracted biceps leads to striking the face; triceps does not normally “check/protect” this action due to imbalance of agonist-antagonist muscles
Cerebellar Syndromes:
Hemispheral Syndrome - predominately affects _______ limbs, leading to —-> (4)
causes: (4)
Cerebellar Syndromes:
Hemispheral Syndrome - predominately affects IPSILATERAL limbs, leading to —-> kinetic tremor, limb dysmetria, dysdiadochokinesia, rebound phenomenon
causes: ipsilateral infraction, hemorrhage, tumor, MS, (bilateral lesions in degenerative disease)
