Movement and Gait - Ojemann

Question 1

Saying LaLaLaLa” rapidly tests___?

Answer 1

CN 12

Question 2

Saying PaPaPaPaPa rapidly tests ____?

Answer 2

CN 7

Question 3

Saying KaKaKaKa rapidly tests ____?

Answer 3

CN 10

Question 4

What is the Romberg test?

Answer 4

Testing station and gait includes the Romberg test, in which the patient stands with feet together, eyes closed, and the examiner behind him or her (ready to catch if the patient sways or falls!). The Romberg is subjective and is deemed “positive” if the patient shows unsteadiness.

[If the patient sways with eyes open, the Romberg test is not applicable]

Question 5

Walking heel-toe on a straight line (like a sobriety test) will bring out what type of deficit?

Answer 5

Patients with truncal ataxia caused by damage to the cerebellar vermis or associated pathways will have particular difficulty with this task, since they tend to have a wide-based, unsteady gait, and become more unsteady when attempting to keep their feet close together.

Question 6

Describe a Hemiparetic gait.

What disorders are associated with this gait?

Answer 6

Plantar flexion of the affected side forces swinging of the leg in a semicircle (circumduction). The arm may be adducted, curled, with a fist on the affected side.

UMN injury (eg hemispheric stroke)

Question 7

Describe a Diplegic gait.

What disorders are associated with this gait?

Answer 7

• -> Tightness of adductors (scissoring)
• -> Bilateral dragging of feet
• -> Lower extremity spasticity

Cerebral palsy.

[Guy with a walker]

Question 8

Describe a Neuropathic gait (Steppage Gait, Equine Gait).

What disorders are associated with this gait?

Answer 8

• -> Foot drop (no dorsiflexion)
• -> High stepping to compensate

Unilateral: L5 radic, peroneal nerve palsy

Bilateral: ALS, CMT, Diabetes

Question 9

Describe a Myopathic Gait.

What disorders are associated with this gait?

Answer 9

• ->Trendelenberg.
• ->Belly out, shoulders back.
• ->Due to proximal muscle weakness.

Myopathies: muscular dystrophy

[Hip girdle muscles are responsible for keeping the pelvis level when walking. If you have weakness on one side, this will lead to a drop in the pelvis on the contralateral side of the pelvis while walking (Trendelenburg sign). With bilateral weakness, you will have dropping of the pelvis on both sides during walking leading to waddling. ]

Question 10

Describe a Bradykinetic gait .

What disorders are associated with this gait?

Answer 10

Posture is often stooped with the head and neck forward, with flexion at the knees. The whole upper extremity is also in flexion with the fingers usually extended. The patient walks with slow little steps known at marche a petits pas (walk of little steps). Patient may also have difficulty initiating steps. The patient may show an involuntary inclination to take accelerating steps, known as festination.

This gait is seen in Parkinson’s disease or any other condition causing parkinsonism, such as side effects from drugs.

Question 11

Describe a Choreiform gait .

What disorders are associated with this gait?

Answer 11

The patient will display irregular, jerky, involuntary movements in all extremities. Walking may accentuate their baseline movement disorder. This is also sometimes called a “dancing” or “Prancing” gait.

Is seen with certain basal ganglia disorders including Huntington’s Disease and other forms of chorea, athetosis or dystonia.

Question 12

Describe an ataxic gait .

What disorders are associated with this gait?

Answer 12

“Drunken”. This gait is described as clumsy, staggering movements with a wide-based gait. While standing still, the patient’s body may swagger back and forth and from side to side, known as titubation. Patients will not be able to walk from heel to toe or in a straight line. Patients with more truncal instability are more likely to have midline cerebellar disease at the vermis.

Most commonly seen in cerebellar disease.

Question 13

Describe a sensory gait .

What disorders are associated with this gait?

Answer 13

Loss of proprioceptive input–> the patient will slam the foot hard onto the ground in order to sense it.

A key to this gait involves its exacerbation when patients cannot see their feet (i.e. in the dark). This gait is also sometimes referred to as a stomping gait since patients may lift their legs very high to hit the ground hard.

This gait can be seen in disorders of the dorsal columns (B12 deficiency or tabes dorsalis) or in diseases affecting the peripheral nerves (uncontrolled diabetes).

Question 14

Name the alpha-synucleinopathies.

Answer 14

Parkinsons
Lewy Body Dementia
Multiple System Atrophy (MSA)

Question 15

Name the tau-opathies

Answer 15

Alzheimer’s Dementia
Pick’s dementia (FrontoTemporal Dementia - FTD)
Progressive Supranuclear Palsy (PSP)
Corticobasal degeneration (CBD)

Question 16

Succinctly describe Friedrich’s Ataxia.

Answer 16

Autosomal recessive triplet repeat leading to
degeneration of the sensory neurons in the DRG and the DCML.

Limb disarthrias, ataxia.

Question 17

Succinctly describe Huntington’s disease. What structures degenerate?

Answer 17

Autosomal dominant
Chorieform movement disorder caused by
Degeneration of the CAUDATE and PUTAMEN
due to

(Huntingtin protein aggregation).

Mutation is CAG repeat on chromosome 4.

Question 18

Succinctly describe CBD

Answer 18

Corticobasal Degeneration (CBD).

Tau inclusions–> substantia nigra
characterized by Parkinsonian features.
“Alien limb” sometimes.

Onset in 50s and 60s

Question 19

Succinctly describe PSP

Answer 19

Progressive Supranuclear Palsy

Tau aggregation in the pallidum, subthalamic nucleus, substantia nigra, or pons leads to Parkinsonian symptoms.

Onset in the 50s to 70s.

Question 20

What does Tau normally do?

Answer 20

The protein “Tau” normally binds to and stabilizes microtubules.

May be toxic directly (getting in the way) or by absence (not fulfilling function) or both.

Question 21

Briefly describe MSA.

Answer 21

Multiple System Atrophy (Formerly Shy-Drager)

Clinically manifests as overlapping Parkinsonism, Progressive ataxia, and Dysautonomia

Characterized by GLIAL alpha-synuclein inclusions in the basal ganglia.

Question 22

Briefly describe Diffuse Lewy Body Disease

Answer 22

Diffuse Lewy Body Disease is a disorder pathologically related to PD characterized by more diffuse Lewy body distribution in brain, can be associated with dementia.

Frontal/Temporal lobes.

Question 23

What differentiates Dementia with Lewy Bodies (DLB) from Parkinson’s Disease with Dementia (PLD)?

Answer 23

Dementia with Lewy bodies (DLB) is a condition characterized by the onset of dementia within a year of onset of parkinsonism.

PD with dementia (PDD): onset of dementia more than a year (often up to 10 years) after onset of parkinsonism

Question 24

Briefly describe Parkinson’s disease.

Answer 24

Pathologically, In addition to loss of pigmented cells in the substantia nigra, eosinophilic intra- neuronal cytoplasmic inclusions, called Lewy bodies, are characteristic.

Movement characteristics due to loss of dopamine.

Question 25

What defines spasticity on a clinical exam?

Answer 25

Spasticity is a velocity dependent change in muscle tone when it is lengthened. Slowly …nothing, but quickly might elicit a catch or stick. If you hold the position, the tone will collpase suddenly.

Question 26

What defines rigidity on a clinical exam?

Answer 26

rigidity is a state of steady, heightened, muscular tension equally present in opposing muscle groups. “lead pipe” or “cogwheel” feeling