Neurological Examination - Gait

Question 1

What would you observe

Answer 1

Speed

Stride length

Arm swing

Base
-wide base = balance issue?

Steady
-unsteady = balance issue?

Initiation, turning, freezing
-PD?

Abnormal movements or postures

Question 2

Heel toe walking

Answer 2

Can you walk like you’re on a tightrope, making sure that your heel on 1 foot touches your toes on the other foot?

Assess balance

Question 3

Romberg’s test

Answer 3

Diagnose sensory ataxia (abnormal proprioception)

Ask patient to stand and close eyes
-if proprioception affected => patient falls

Question 4

Hemiplegic gait

• source of lesion
• causes
• presentation in gait

Answer 4

CNS

• Unilateral cerebral - stroke, trauma, SOL, MS
• SC hemisection - trauma

Unilateral weakness
Spastic flexion of UL
Spastic extension of LL => circumduction of leg to prevent dragging

Question 5

Diplegic gait

• source of lesion
• causes
• presentation in gait

Answer 5

CNS

• Bilateral cerebral - cerebral palsy, MS, bilateral infarcts
• SC lesion
• MND - if UMN+LMN findings

Bilateral, more severe hemiplegia presentation

• flexed, abducted hips, knees
• extended, adducted ankles
• adductor spasticity => scissor legs
• UL flexor posturing
• no arm swing

Question 6

Parkinsonian gait

• source of lesion
• causes
• presentation in gait

Answer 6

Basal ganglia - SBPC
-festination - rigidity, bradykinesia

Parkinsons, mimics

Failure of gait initiation, hesitancy
Reduced stride length - shuffling to maintain balance
Reduced arm swing - unilateral => bilateral with disease progression
Resting tremor
Turning hesitancy - unstable balance

True Parkinsons has the classic triad and most gait problems

Question 7

Ataxic gait

• source of lesion
• causes
• presentation in gait

Answer 7

Cerebellar - alcohol, B12def, drugs, genetics, MS
-DANISH

Vestibular - labyrinthitis, Meniere’s, acoustic neuroma
-vertigo, N+V

Proprioceptive loss - sensory ataxia

• no cerebellar signs
• Romberg
• poor proprioception, vibration sense

Broad stance
Unsteady gait
-if unilateral lesion => veer towards side of lesion
Difficulty turning

Question 8

Neuropathic gait

• source of lesion
• causes
• presentation in gait

Answer 8

High steppage gait - distal limb muscle weakness

• foot drop, dragging toes
• excessive hip, knee flexion

Common peroneal nerve compression
L5 radiculopathy
Polyneuropathy - diabetic, MND, Charcot Marie Tooth

Question 9

Myopathic gait

• source of lesion
• causes
• presentation in gait

Answer 9

Waddling/Trendelenburg - weak hip abductors => inability to stabilise pelvis when on 1 leg

Pelvis tilts towards unsupported side
-compensation by lateral flexion away from affected side + circumduction

Difficulty rising from chair without use of arms

Thyroidism
Cushings, acromegaly
Polymyalgia rheumatica
Poly/dermatomyositis
DMD, BMD, MD

Question 10

Choreiform gait

• source of lesion
• causes
• presentation in gait

Answer 10

Involuntary movements accentuated by walking

• grimacing, lip smacking
• chorea in UL, LL

Basal ganglia disease

• HD, Wilsons
• dopaminergic medications

Question 11

Antalgic gait

• source of lesion
• causes
• presentation in gait

Answer 11

Abnormal gait as a result of pain => limping

Any causes of lower limb pain

• OA
• inflammatory joint disease
• LL#
• nerve entrapment