Gait disturbance/impaired balance

Question 1

What are the 8 basic pathological gaits that can be attributed to neurological conditions?

Answer 1

Hemiplegic gait

(Spastic) diplegic gait

Neuropathic

Myopathic gait

Parkinsonian gait

Choreiform gait

Ataxic (cerebellar) gait

Sensory gait

Question 2

What is the most common cause of a hemiplegic gait?

Answer 2

Stroke

Question 3

How would a pt with hemiplegic gait stand?

Answer 3

They have unilateral weakness on one side (the affected side)

Arm flexed, adducted and internally rotated.

Ipsilateral leg is in extension with plantar flexion of foot and toes (pointed kind of)

Question 4

How does a pt with hemiplegic gait walk?

Answer 4

Pt holds affected arm flexed, adducted and internally rotated to their chest.

They drag the affected leg in a semicircle (circumduction) due to foot drop (weakness in distal muscles)
Leg is stiff due to extensor hypotonia in lower limb.

Mild hemiparesis may only have loss of normal arm swing and slight circumduction

Question 5

In what condition may you observe a Diplegic gait (spastic gait)

Answer 5

Cerebral Palsy

( gait seen in pts with bilateral periventricular lesions)

Question 6

What part of the body is affected in a Diplegic (spastic) gait?

Answer 6

Bilateral involvement

Spasticity is worse in the lower extremities than the upper

Question 7

What do you observe in a patient with Diplegic (spastic) gait?

Answer 7

Pt walks with abnormally narrow base

Dragging both legs and scraping the toes

Extreme tightness of hip adductors can cause legs to cross midline “scissors gait”. pts with cerebral palsy can have hip adductor release surgery

Question 8

In which pts do you observe Neuropathic Gait?

also called: Steppage/Equine

Answer 8

Pts with foot drop.

Weakness of dorsiflexion is cause of gait > pts lift leg high enough so that foot does not drag on floor.

Question 9

What are the causes of unliateral neuropathic gait?

also called: Steppage/Equine

Answer 9

Peroneal nerve damage

L5 radiculopathy

Question 10

What are the causes of bilateral neuropathic gait?

also called: Steppage/Equine

Answer 10

Charcot-Marie- Tooth disease

Peripheral neuropathies -including ones associated with controlled diabetes

Question 11

What conditions cause a Myopathic / waddling gait?

Answer 11

Myopathies e.g. muscular dystrophy

Question 12

What causes a Myopathic / waddling gait?

Answer 12

Unilateral : Trendelenburg sign as (hip girdle muscles e.g. gluteus medius) is weak > contralateral drop in pelvis

Bilateral: dropping of both sides of pelvis leading to waddling gait e.g. muscular dystrophy

Question 13

What conditions cause a Choreiform gait?

also called hyperkinetic gait

Answer 13

Basal ganglia disorders e.g. Huntingdon’s disease, chorea, dystonia

Question 14

Describe the features of a Choreiform gait

also called hyperkinetic gait

Answer 14

Pt has irregular, jerky, involuntary movements in all extremities.

Walking accentuates their baseline movement disorder

Question 15

Describe a Ataxic (cerebellar) gait?

Answer 15

clumsy, staggering movements with a wide based gait.

Patient will be unable to walk heel to toe / in a straight line

Question 16

How would a pt with an ataxic (cerebellar) gait stand?

Answer 16

When standing still pt with swagger back and forth from SIDE to SIDE.

this is called: Titubation

Question 17

What causes an ataxic (cerebellar) gait?

Answer 17

Cerebellar disease

If pt is more unstable in the trunk - more likely to be midline cerebellar disease at the vermis

Alcohol intoxication will look the same

Question 18

What causes a Parkinsonian Gait?

Answer 18

Parkinsons
Side effects from drugs e.g. antipsychotics, antiemetics, CCBs, antiepileptics

Question 19

What is the term for when a pt with a Parkinsonian gait has an involuntary inclination to take accelerating steps?

Answer 19

Festination

Question 20

Describe a Parkinsonian gait

Answer 20

Gait: characterised by rigidity and bradykinesia

Posture: stopped with head and neck bent forward and flexion at knees. Upper extremity in flexion with fingers extended

Walking: slow little steps , with difficulty initiating steps. Festination. Turning ‘en bloc’

Question 21

Why does sensory (ataxia) gait occur?

Answer 21

Loss of proprioception feedback when feet touch ground

Question 22

Why does a sensory (ataxia) gait look like and why?

Answer 22

Stomping gait, as pt slam feet down to floor to sense location.

Pt may lift legs very high to slam down to floor hard

Question 23

What makes a sensory gait worse ?

Answer 23

In the dark when pts cannot see feet exacerbated the stomping

Question 24

What causes a sensory gait?

Answer 24

B12 deficiency - disorders of the dorsal column

Diabetes affecting peripheral nerves

Very severe- resembles cerebellar ataxic gait