Gait distrubances-neurology Dr Costello- BW3

Question 1

Dr Costello GAIT disturbnce:

Answer 1

Need to know how to do GAIT assessment:

Question 2

Gait is made up of several factors:

Today lecture:

Normal gait

Assessing GAIT

common Neurological Gait disorders

Question 3

Wht makes up normal GAIT - Steps? Stride? Phases?

Answer 3

Question 4

Outline the GAIT cycle

Answer 4

Question 5

Gait cycle: Stances Phases:

Answer 5

Question 6

Swing Phase of GAIT:

Answer 6

Question 7

How do you correctly assess GAIT:

Answer 7

• Obsereve from all direction (left and right sides)
• Walk a long corridor -width, shortened (shortening common in neurological GAIT) phases, Arm swing, Dorsi flexion

Your feet should roughly be shoulder width apart.

other important to consider

1. LEngth of steo
2. arm swing
3. Dorsiflexion (no heel strick)

Other things to think:

1) Hip flexion

2)

Question 8

Types of GAIT: Disturbances

Answer 8

Question 9

Hemiplegic GAIT

Answer 9

• Flexion hypertonia in Upper limb
• Extension hypertonia Lower limb
• Distal> Proximal weakness
• Swings (around)
• Circumduction (one sided gait (think poofree)

Question 10

Parkinsons GAIT:

Explain:

List 6 features of it:

Answer 10

Universal flexion:

Tiny steps (March petit pas) - Walk of little steps

Overtime there Heel strike will become closer

Then it will progress- to shuffle GAIT

Associated with tremor (tremor gets worse with walking)

Universal flexion- thus reduced arm swing (one side() May lok for other EP- rigidity/bradykinesia

Turning is very difficult - Takes many side steps

Classic: Small steps

Question 11

Diplegic Gait: Cerebral palsy/MS

“Spastic paraparesis”

Answer 11

• Abductor spasms (tight abductors) - stop normal gait cycle
• Think buff
• Will appear tip toe
• Abductor spasms show scissorign GAIT
• Knees are coming in together (knocked knee)
• Dos not heel strike - tip toes

Question 12

Myopathic Gait- Waddling Gait

• Most common affect quadriceps weakness

Answer 12

• Trendelenburg sign - Hip drops on opposing side
• Myopathic waddling

Question 13

Myopahtic gait: Proximal myopathy (in quads) think

Answer 13

• The reason you sway side to side- due to weakness of quads on each side
  *

Question 14

Cerebellar Gait: (stroke/SOL/MS)

OUtline characteristics: Whats it look like?

Answer 14

• No clearance
• goes off to side of lesion
• Broad wide base
• MAy also sway- Closes eyes gets worse

RHombergs is for peripheral neuropathy- Test of proprioception:

Sway- due to needing more proprioception input + activating of in the seicircular (gyroscopes) - to keep balance

Question 15

Rhombergs test

Answer 15

Question 16

High stepping Gait - Peripheral neuropathy-

What you lose is dorsiflexion; high stepping gait, lose of dorsiflexion+heelstrike!

Answer 16

• Key feature no heel striking
• looks like horse kinda
• Rhombergs positive in this patients \

B12 deficieny- loose myelin- thus