Neurological Examination : Posture And Gait

Question 1

Step of Romberg’s test :

Answer 1

Place feet together, eyes closed patient
Stand behind the patient arms on either side without touching them
- positive test => tendency to fall for 1 min

Watch out for increasing muscle tensing and direction of fall.
Can also be combined with Barré test

Question 2

What do you inspect in the gait ?

Answer 2

Step length
Base of the gait
Contact phase foot
Arm movement
Smoothness of starting stopping and turning

Question 3

What should you ask the patient to do for a gait assessment ?

Answer 3

Walk on their heels then on their toes
Rise form squatting position
Trendelenburg’s test if suspicion of hip abductor weakness
Heel to toe test (walk on imaginary line)

Question 4

What postural abnormalities is caused by CVA ?

Answer 4

CVA or stroke in the past, damage the pyramidal tract.
Affected arm is hold in wing like position and the affected leg is extended.

=> circumlocution gait : affected leg describe a outward semicircle due to hypertonia

Question 5

What does the gait of a patient with hypo kinetic disorder look ?

Answer 5

Disorder in the extrapyramidal system like Parkinson : trunk hold in flexed position
- reduced step length, non swinging arm
- difficulty starting walking and stopping
- hypokinesia, micrography and mask face

Question 6

What is the clinical significance of Romberg’s test ?

Answer 6

Fall tendency with eye open => cerebellar disorder

Fall tendency with eye closed, on the same side with rotational vertigo => vestibular disorder

No fall tendency but swaying and falling in all direction => proprioceptive disorder
- sensory peripheral leg nerve disorder
- dorsal column disorder

Question 7

What does unsteady walking signify ?

Answer 7

A sensory impairment of the foot. Compensation is possible in the light but more difficult in the dark.

Question 8

What does an impaired heel and toe walk signify ?

Answer 8

Weakness of the foot flexor and extensor => perineal and tibial nerve

Question 9

What does a difficulty to rise from squatting signify ?

Answer 9

Weakness of hip muscle.

Question 10

Other : what is neuroenhancement ?

Answer 10

An intervention in the brain indicated for severe chronic depression.

Question 11

Other : what are the 6 deadly D’s of neurology

Answer 11

Dysphasia = difficulty swallowing
Dysphonia = impairment of voice production
Dysarthria = motor speech disorder, weakened or paralysed voice muscle
Diplopia = double vision
Dysesthesia = abnormal physical touch sensation without outside cause
Dysmetria = inability to control distance, speed, range of motion necessary for coordinated movement