Gait Disorders Flashcards
What is gait?
The pattern
Of limb movement
During active locomotion
Humans have a bipedal gait
What is balance?
Control of correct posture
By 4 reflexes
Antigravity
Postural
Righting
Rescue
Mediated by sensory, integrative and motor function
(Vestibules, Vision, Proprioception, cerebellum)
What is walking?
A complex motor activity
Composed of gait and balance
What are the features of normal bipedal gait?
Cyclical activity
Stance phase 60%
Contact (heel strike to flat foot)
Midstance (flat foot to heel lift)
Propulsion (heel lift to toe off)
Swing phase 40% Early swing (dorsiflexed toes for clearance) Middle swing (step forward) Late swing (dorsiflexed foot)
How is walking produced?
Cerebellar locomotor center feed forwards posture and equilibrium to sensory cortex
Sensory cortex integrates sensory input from cerebellum, vision, vestibules
- body position and spatial orientation
- gravity
- speed and direction of current movement
- terrain and environment
Motor cortex, premotor cortex and basal ganglia plan and execute signals for locomotion based on sensory inputs
Descending tracts connect muscles
- anterior corticospinal
- reticulospinal
- vestibulospinal (antigravity)
- tectospinal (general light reflexes)
Dorsal column relays proprioception to cerebellum
Continuous feed forward cycling
What are the types of abnormal gaits?
Scissor (bilateral circumduction)
Hemiplegic (unilateral circumduction)
Shuffling festinant
Wide based drunken (cerebellar ataxia)
Stomping (sensory ataxia)
Waddling
High stepping (foot drop)
Apraxic
Hyperkinetic (basal ganglia dysfunction)
Antalgic gait
How is gait evaluated?
SL CAP
Separation of feet Length of stride Clearance of toes Arm swing Pelvic tilt
What is ataxia?
Incoordination or clumsiness of movement
That is not the result of muscular weakness
3 types, vestibular, cerebellar, sensory
Vestibular = nystagmus + gravity dependent ataxia
Cerebellar = rate, rhythm, amplitude , force irregularities + TEN cerebellar signs
Sensory = Romberg sign, JPS and vibration lost
What are the important features of gait disorders?
Can’t walk- Apraxia
Can’t tandem walk - ataxia
Small stride length - Parkinsonism, apraxia
Small separation of feet - scissor gait
Broad based gait - ataxia, apraxia
High stepping - foot drop
Waddling - proximal myopathy
Reduces arm swing - Parkinsonism
Difficulty to turn round - Parkinsonism, ataxia
Can’t toe/heel walk - foot drop, radiculopathy
Romberg sign - sensory ataxia
Stamping - sensory ataxia
