Mahoney - Gait

Question 1

UMN lesion characteristics

Answer 1

often a stroke

• HYPERREFLEXIA
• clonus - normal supraspinal inhibition of antagonistic muscles is lost
• Spastic weakness of arm extensors and leg flexors
  
  • leg flexors are flexors of hip, knee, and ANKLE DORSIFLEXOR
• Discrete movement lost (de-differentiation or decortication of movement)

Question 2

Lower motor nerve lesion characteristics

Answer 2

• HypOreflexia
• muscle atrophy
• flaccid weakness
• fasciculations
  
  • fine movements of muscle seen under skin due to sensitiziation to acetylcholine (moves like a worm under the skin)

Question 3

Spastic Gait general

Answer 3

Hemiparetic/hemiplegic or STROKE GAIT

• Unilateral UMN lesions
  
  • spasticity - incraesed muscle tone due
  • Clonus due to exaggeration of stretch reflex
    
    • rate sensitive or velocity-dependent
      
      • if stretch slowly, the tone is normal; if stretched rapdily, icnreased tone results

Question 4

Spastic gait description

Answer 4

• Leg is extended and internally rotated
  
  • because leg flexors weakend
• Contralateral hip may tilt downwards to prevent toes from catching floor as leg advanced forward
• Ipsilateral arm flexes at elbow, adducts and internally rotates into trunk, and flexes wrist and fingers (cortical fist –> clenched around thumb)
  
  • due to weakness of arm extensors and de-differentiation

Question 5

Scissor gait

Answer 5

Paraparetic/spastic DIPLEGIC or CP GAIT

• Bilateral upper motor nerve lesion
  
  • Cerebral palsy gait (can’t make diagnosis until after 2 years old because brian is not fully myelinated)
• Spastic diplegia –> bialteral cerebral cortex

Question 6

Scissor gait description

Answer 6

• Legs are extended and thighs are tightly adducted
• Legs are circumducted
• Legs slightly flexed at hips and knees (couching)
• arms midly flexed
• mimicked by running in knee-deep water

Swinging gait of both sides with the knees bent slightly

Question 7

Cerebellar ataxic gait

Answer 7

DRUNK GAIT

• cerebellar lesion
• Broad-based, speed and legnth of stride varies irregularly from step to step
• Posture is erect, feet are separated
• Difficulty walking tandem
• difficulty standing with feet together, even with eyes open (closing eyes make situation worse) (NEGATIVE ROMBERG)

Normal in children < 2 years of age

Question 8

Sensory ataxic Gait

Answer 8

• Ressemble drunk gait
• Problemw ith proprioceptors or peripheral nerve
• however, can maintain balance with eyes open, but LOSE BALANCE WHEN EYES CLOSED (POSITIVE ROMBERG TEST)
• commonly seen in diabetics with loss of position sense who need to look at floor to tell them where their foot is lcoated in space

Question 9

Vestibular Gait

Answer 9

• Pathology located in INNER EAR
• FALLING TO AFFECTED SIDE whether standing or walking
• ASYMMETRIC NYSTAGMUS
• nromal proprioception and muscle strength exclude sensory ataxia and hemiparesis

Question 10

Steppage gait

Answer 10

• DROPFOOT GAIT or neuropathic gait
• If unilateral: L5 radiculopathy, sciatic neruopathy, peroneal neuropathy
• IF BILATERAL: distal polyneuropathy (DIABETES), lumbosacral polyradiculopathy
• Weakness of ankle dorsiflexion (inability to dorsiflex), leg lifted higher (by flexing hip and knee) than normal during swing phase to prevent toes from catching on floor (slaps down)

Question 11

Waddling gait

Answer 11

Trendelenberg or gluteus medius limp or duck walk or MYOPATHIC GAIT

• Proximal lower limb weakness (hip girdle, primary gluteus medius which is hip abductor) due to myopathy, NMJ disease, proximal symmetric spinal muscle atrophy
• When muscle too weak to keep the pelvis level when the UNAFFECTED food is picked up, the pelvis will drop down on the UNAFFECTED SIDE, producing pelvic rocking
• Trunk tilts towards the affected side of lif thip or unaffected side and provide extra distance between the foot and the floor

Question 12

Parkinsonian gait

Answer 12

• Extrapyramidal disease
• HYPOKINETIC GAIT
• Forward rigid stoop with head and neck bent forward, with modest flexion at hips and knees
• arms flexed at elbows and adducted at shoulders, with resting pronation-supination tremor
• Trouble arising from chair
• tend to fall backwards, Festinations (body tries to catch up to their center of gravity)
• Gait initiated with short, shuffling steps which is exacerbatd when turning (pedestal turns) MUST STOP BEFORE TURNING

Question 13

Choreoarthetotic gait

Answer 13

• Worm like gait
• wildly ataxic gait/HYPERKINETIC gait
  
  • gait interrupted by abrupt large amplitude involuntary movements
  • similar movements seen in arms, neck, face
  • BALANCE IS NOT AFFECTED

Question 14

Antalgic gait

Answer 14

• Patient favors (dose not put normal weight) on painful extremity which usually result in..
  
  • limited knee flexion and less prominent heel strike and toe off, Shorted stance phase and smaller steps

Question 15

Equinus gait

Answer 15

Toe-walking gait

• usually secondary to congenitally tight gastroc-soleus or sudden growth spurt
• Always consider neurological disorder like spastic cerebral palsy, myelomeningocele, spastic hemiplegia