Gait Disorders Flashcards
hemiplegic gait - characteristics
*stiff leg
*leg rotated
*foot malpositioned
*arm against body
*arm bent
*thumb in fist
hemiplegic gait - mechanics
*upper motor neuron lesion
*spasticity (flexion of UE, extension of LE)
*distal > proximal weakness
*stiff leg = can’t flex hip
*weak ankle = “long leg”
hemiplegic gait - etiology
*infarction
*hemorrhage
(i.e. cortex issues)
hemiplegic gait - function/safety
*changes in sit/stand
*slowed
*wearing down shoes
*increased trips/falls
*stair safety
*transfer safety
hemiplegic gait - treatment
*physical therapy/gait training
*orthotics
*medication
*surgery
*brain-computer interface (BCI)
diplegic gait - characteristics
*LE > UE affected
*narrow-based
*flexion hip/knee
*plantarflex/inversion of ankle
*UE “low-guard” position
*UE not synchronized
*“scissoring”
diplegic gait - mechanics
*upper motor neuron lesion
*MOTOR CORTEX primarily (leukomalacia)
*corticospinal tract
*basal ganglia
*spasticity/contracture
*flexed at hip, knee, ankle
*adduction at thigh
diplegic gait - etiology
*cerebral palsy (periventricular leukomalacia)
*CVA/hemorrhage
*anoxic injury
*midline mass
diplegic gait - function/safety
*high energy expenditure
*pain
*muscle/joint breakdown
*pressure sores
*toileting/self care
*dressing
*transfers
*falls
diplegic gait - treatment
*physical therapy
*orthotics
*assistive devices (ex. walker, cane)
*medications
*injections/infusions
*surgery
neuropathic gait - characteristics
*“foot drop” (unable to dorsiflex the foot)
*high step to “clear the foot”
*“equine” gait (looks like how a horse walks)
neuropathic gait - etiology
*peripheral neuropathy (common fibular nerve)
*lumbar radiculopathy /plexopathy (L5)
*fibula fracture
*compartment syndrome
*post-op (TKA/knee arthroscopy)
*tibialis anterior rupture
neuropathic gait - function/safety
*increased trips/falls
*shoe wear
*social awareness
neuropathic gait - treatment
*orthosis
neuropathic gait - mechanics
*dysfunction of muscle
*dysfunction of nerve (root or peripheral)
myopathic gait - characteristics
*pelvic drop
*“waddling” or “Trendelenburg”
*widened base
*shifting and swinging of trunk
myopathic gait - mechanics
*proximal hip girdle weakness
*gluteus medius is responsible hip abduction (if weak, drop to the contralateral side)
*decreased stability
*torso lean to shift weight
myopathic gait - etiology
*muscular dystrophy
*lumbar radiculopathy
*spinal muscular atrophy
*avulsion of gluteus medius
*superior gluteal nerve injury
*hip dysplasia
*pregnancy
myopathic gait - function/safety
*falls
*energy expenditure
*social considerations
myopathic gait - treatment
*physical therapy (core strengthening)
*assistive devices
*orthotics
*medication/stopping statins (which can cause statin-induced myopathy)
choreiform gait - characteristics
*hyperkinetic (additional motion)
*choppy or dance-like
*additional movement/gestures
*BALANCE MAINTAINED
choreiform gait - mechanics
*intrusion of abnormal, erratic movements
*inability to inhibit movements
*vestibular function intact
*strength intact
*sensation intact
*balance preserved
choreiform gait - etiology
*autosomal dominant mutation (Huntington’s disease)
*repeat CAG = abnormal protein
*high levels of HTT in brain
-synaptic transmission altered
-basal ganglia dysfunction
-erratic
choreiform gait - function/safety
*not usually falls unless dystonia
*social implications
*energy expenditure (extremely high)
choreiform gait - treatment
*physical therapy (to make their additional movements into more “socially appropriate” gestures)
*medication (does not really work)
*education
ataxic gait - characteristics
*wide base
*unsteady trunk
*anterior/posterior movement
*lateral instability
*worse with tandem or running!!!!
*INCONSISTENCY in speed, etc
ataxic gait - mechanics
*vestibular dysfunction (inability to decipher 3D)
*cerebellar
-vermis = trunk instability/midline
-hemisphere = limb instability
-flocculonodular = visual integration/tone
*sensory
ataxic gait - etiology
*vestibular
-alcohol, drugs/toxins
-Meniere’s disease (unilateral)
*cerebellar
-infarction/hemorrhage (most common)
-infection/inflammation/demyelination
-hereditary
-drugs, alcohol, toxins
ataxic gait - function/safety
*falls
*energy expenditure
*legal
*social implications
parkinsonian gait - characteristics
*difficulty initiating movement
*small steps, slow speed (hypokinetic)
*“festinating” or “shuffling”
*stooped, forward-leaning
*associated tremor
*freezing, stiffness
parkinsonian gait - mechanics
*rigidity (lead-pipe, cog-wheel)
*decreased hip flexion, knee flexion
*anterior pelvic tilt
*truncal instability
*sequential movement hindered (visual cues can be helpful)
parkinsonian gait - etiology
*apoptosis in substantia nigra
*dopamine deficiency
-decreased ability to stop inhibition for intended movements
*less control over “static inhibition” of motor circuit, so more “involuntary” movement
parkinsonian gait - function/safety
*falls
*fractures
*slow walking speed
*challenges with ADLs
*social implications
parkinsonian gait - treatment
*physical therapy
*visual/auditory cueing
*medication (“dopas”)
antalgic gait - characteristics
*“limping”
*shifting
*hopping
*“heaviness”
antalgic gait - mechanics
*pain leads to weight shift
*stance time on affected/painful limb decreased
*shortened stride on painful side
antalgic gait - etiology
*bone pain (fracture/dislocation)
*muscle/tendon pain (strain)
*ligament pain (sprain)
*skin wounds (lacerations/puncture)
*burns
antalgic gait - function/safety
*falls
*decreased walking speed
*pain
antalgic gait - treatment
*treat underlying cause
