Gait Disorders and Fall prevention

Question 1

Cerebellar gait description

Answer 1

ataxic or staggering wide based

Question 2

symptoms associated with ataxic (cerebellar) gait

Answer 2

dysdiadochokinesia, dysmetria, nystagmus, Romberg sign

Question 3

Causes of cerebellar gait

Answer 3

cerbellar degeneration, stroke, drug/alcohol, vitamin B12 deficiency

Question 4

Gait apraxia description

Answer 4

magnetic (Freezing) gait with start and turn hesitation,

Sometimes called frontal gait

Question 5

What is frontal gait?

Answer 5

another name for gait apraxia or magnet gait

Question 6

What is associated with gait apraxia?

Answer 6

dementia, incontinence, frontal lobe signs

Question 7

what causes gait apraxia?

Answer 7

frontal lobe degeneration, normal pressure hydrocephalus

Question 8

Description of Parkinsonian gait

Answer 8

short steps, shuffling

Question 9

What is associated with Parkinsonian gait?

Answer 9

bradykinesia, resting tremor, postural instability and decreased arm swing

Question 10

What causes Parkinsonian gait?

Answer 10

Parkinson’s dx

Question 11

Description of steppage gait

Answer 11

foot drop, excessive hip and knee flexion while walking, slapping quality and falls

Question 12

What is associated with steppage gait?

Answer 12

distal sensory loss and weakness

Question 13

what is causes steppage gait

Answer 13

motor neuropathy

Question 14

vestibular gait description

Answer 14

unsteady falling to one side

Question 15

vestibular gait is associated with

Answer 15

normal sensation, reflexes and motor strength and nausea and vertigo

Question 16

What causes vestibular gait?

Answer 16

acute labyrinthitis

meniere’s dx

Question 17

What gait is foot drop associated with

Answer 17

steppage gait… and if has diminihsed senatio nof lateral leg and foot then consider common peroneal nerve injury.

Question 18

Treatment of peroneal nerve palsy

Answer 18

PT, or ankle foot orthotic, but surgical decompression may be needed.

Question 19

How do we diagnosis peroneal nerve palsy?

Answer 19

by clinical features.

Question 20

foot drop and back pain can be caused by?

Answer 20

L4-L5 disc herniation but would see back pain with foot drop

Question 21

Vitamin B12 deficency gait

Answer 21

ataxic wide based gait with impaired balance and neuropathy that is symmetric and slowly progressive. Not focal or acute.

Question 22

how to prevent falls:

Answer 22

Home safety assessment, exercise, medication modification and vitamin D

Question 23

what is done in a home safety assessment:

Answer 23

adequate lightening, hand rails, grab bars

slip resistant surfaces and shoes

Question 24

medication modification to reduce risk for falls

Answer 24

stop or reduce benzos, hypnotics, tricyclics, eliminate non essential medications

Question 25

Common (broad categories) causes of dizziness include:

Answer 25

vertigo
presyncope
disequilibrium
nonspecific

Question 26

Vertigo’s common causes are:

Answer 26

Benign paroxysmal positional vertigo
vestibular neuritis
meniere's dx
migraine
vertebrobasilar stroke

Question 27

presyncope’s common causes are

Answer 27

cardiac arrhythmias
aortic stenosis
orthostasis
vasovagal event

Question 28

disequilibrium causes are:

Answer 28

peripheral neuropathy
sensory disturbances
neuromuscular disorders - arthritis muscle weakness
cervical spondylosis
CNS disorders
-Parkinsonism, visual impairment

Question 29

non specific causes of dizziness are:

Answer 29

anxiety and other psychiatric disorders
medications, substance abuse
metabolic disorders

Question 30

disequilibrium is best treated

Answer 30

regular exercise, physical therapy, and occupational therapy

Question 31

What must be screened for when someone has disequilibrium

Answer 31

need to make sure it’s not vertigo or a sense of spinning or presyncope.

Question 32

Diagnosis of orthostatic hypotension

Answer 32

within 2-5 minutes of standing from supine position
drop in systolic BP >20
drop in diastolic BP >10

Question 33

orthostatic hypotension

Answer 33

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)

Question 34

having orthostatic hypotension increases a patient’s

Answer 34

all cause mortality

also puts eldelry at increased risk for recurrnt falls and decline in cognitive function