Gait Disorders and Fall prevention Flashcards
Cerebellar gait description
ataxic or staggering wide based
symptoms associated with ataxic (cerebellar) gait
dysdiadochokinesia, dysmetria, nystagmus, Romberg sign
Causes of cerebellar gait
cerbellar degeneration, stroke, drug/alcohol, vitamin B12 deficiency
Gait apraxia description
magnetic (Freezing) gait with start and turn hesitation,
Sometimes called frontal gait
What is frontal gait?
another name for gait apraxia or magnet gait
What is associated with gait apraxia?
dementia, incontinence, frontal lobe signs
what causes gait apraxia?
frontal lobe degeneration, normal pressure hydrocephalus
Description of Parkinsonian gait
short steps, shuffling
What is associated with Parkinsonian gait?
bradykinesia, resting tremor, postural instability and decreased arm swing
What causes Parkinsonian gait?
Parkinson’s dx
Description of steppage gait
foot drop, excessive hip and knee flexion while walking, slapping quality and falls
What is associated with steppage gait?
distal sensory loss and weakness
what is causes steppage gait
motor neuropathy
vestibular gait description
unsteady falling to one side
vestibular gait is associated with
normal sensation, reflexes and motor strength and nausea and vertigo
What causes vestibular gait?
acute labyrinthitis
meniere’s dx
What gait is foot drop associated with
steppage gait… and if has diminihsed senatio nof lateral leg and foot then consider common peroneal nerve injury.
Treatment of peroneal nerve palsy
PT, or ankle foot orthotic, but surgical decompression may be needed.
How do we diagnosis peroneal nerve palsy?
by clinical features.
foot drop and back pain can be caused by?
L4-L5 disc herniation but would see back pain with foot drop
Vitamin B12 deficency gait
ataxic wide based gait with impaired balance and neuropathy that is symmetric and slowly progressive. Not focal or acute.
how to prevent falls:
Home safety assessment, exercise, medication modification and vitamin D
what is done in a home safety assessment:
adequate lightening, hand rails, grab bars
slip resistant surfaces and shoes
medication modification to reduce risk for falls
stop or reduce benzos, hypnotics, tricyclics, eliminate non essential medications
Common (broad categories) causes of dizziness include:
vertigo
presyncope
disequilibrium
nonspecific
Vertigo’s common causes are:
Benign paroxysmal positional vertigo vestibular neuritis meniere's dx migraine vertebrobasilar stroke
presyncope’s common causes are
cardiac arrhythmias
aortic stenosis
orthostasis
vasovagal event
disequilibrium causes are:
peripheral neuropathy sensory disturbances neuromuscular disorders - arthritis muscle weakness cervical spondylosis CNS disorders -Parkinsonism, visual impairment
non specific causes of dizziness are:
anxiety and other psychiatric disorders
medications, substance abuse
metabolic disorders
disequilibrium is best treated
regular exercise, physical therapy, and occupational therapy
What must be screened for when someone has disequilibrium
need to make sure it’s not vertigo or a sense of spinning or presyncope.
Diagnosis of orthostatic hypotension
within 2-5 minutes of standing from supine position
drop in systolic BP >20
drop in diastolic BP >10
orthostatic hypotension
seen in volume depletion (hypovolumia from hemorrhage, hyperglycemia, and diuretics)
medication side effects (vasodilators and adrenergic blocking agents
autonomic dysfunction (Parkinson’s dx and Lewy Body dementia)
having orthostatic hypotension increases a patient’s
all cause mortality
also puts eldelry at increased risk for recurrnt falls and decline in cognitive function
