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GAIT DISORDERSSupervised by: Dr Tan Li Ping

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GAIT DISORDER

HEMIPLEGIC GAIT

SCISSORS GAIT

CEREBELLAR GAIT

PARKISONIAN GAIT

WADDLING GAIT

HIGH STEPPING

GAIT

STAMPING GAIT

FRONTAL LOBE

GAIT/APRAXIC GAIT

PSYCHOGENIC GAIT/

HYSTERICAL GAIT

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EXAM: STEPS

Make sure the patient’s legs are clearly visible

Ask the patient to walk normally, turn around and walk back.

Observe:

i) Posture ii) Balance iii) Position & swinging of the arms iv) Movement of the legs

Perform tandem gait (heel-to-toe)

EXPOSURE

OBSERVE

PERFORM

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ROOMBERG’S TEST

ask patient to stand with the heels together,

first with eyes open ,then with eyes closed

Eye closed

Loss of Proprioception

Positive [about to fall]

Eye opened

Cerebellar / Vestibular dysfunction

Negative

Unsteadiness

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EXAM: OTHER

5.Other examinations:

a)Walk on toes-S1 lesion

b)Walk on heels-high stepping gait(foot drop)

c)Test for proximal myopathy

(squat and then stand up)-waddling gait

d)Lie down and imagine pedaling a bicycle

-apraxic gait

6. End examination by looking for additional signs. Example;

-Parkinsonism signs

-Cerebellar signs

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1. HEMIPLEGIC GAIT

• Thus the foot is swung in a lateral arc and pelvis is elevated on that side to avoid the affected foot from scraping the floor.

Characteristics of hemiplegic gait

• Stroke with hemiparesisSeen in:

•Upper Motor Neuron (pyramidal) Disorder•Flexed elbow•extended knee•plantar flexed ankle

Characteristic-

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2. SCISSORS GAIT

Knee appear to be stuck together

Feet stuck to the floor

Spastic Paraperesis

Characteristics of scissors gait

• Cerebral palsy and Myelopathy

Seen in:

• Equinous position of the feet• Adductor spasm

Characteristic-

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3. CEREBELLAR GAIT

Characteristics of cerebellar gait

• Cerebellar disorderSeen in:

• broad-base gait• unable to perform tandem gait• clumsy/unsteady• patient reels toward the affected

side(unilateral hemisphere lesion)

Characteristic-

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4. PARKISONIAN GAIT

Characteristics of Parkisonian gait

• Parkinsonism

Seen in:

• short and shuffling gait• stooped posture• ‘gait ingnition failure(difficulty in initiating walking)• festinates (hurries to catch himself)• turning en-bloc • loss of arm swinging

Characteristic-

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5. WADDLING GAIT

Characteristics of waddling gait

• Myopathy (dystrophy)

Seen in:

•Cowboy gait•Posture : pelvis tilted from side to side

Characteristic-

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6. HIGH STEPPING GAIT

Characteristics of foot drop

• Unilateral• L5 radiculopathy• sciatic neuropathy• Peroneal neuropathy

• Bilateral• Distal polyneuropathy• Lumbosacral polyradiculopathy.

Seen in:

•weakness of ankle dorsiflexion foot drop•Foot is lifted high when walking

Characteristic-

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7. STAMPING GAIT

• proprioceptive disorders

Seen in:

• Broad based• Foot Stamping on the Floor• Romberg’s sign: +ve

Characteristic-

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8. APRAXIC GAIT

• Impaired ability to plan and execute sequential movements due bilateral frontal lobe disease

• Normal pressure hydrocephalus• Alzheimer’s disease• Binswanger’s disease

Seen in:

• Difficulty in initiating gait- ‘feet glued to the ground’• Short and shuffling steps but is not maintained-walking stops after

one or several steps are taken, repeats itself• Upright posture with normal swing• Moves easily when supine- able to imagine cycling

Characteristic-

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9. PSYCHOGENIC/HYSTERICAL GAIT

• Gait does not conform to any one of typical gait disorders

• A.k.a Astasia-abasia (inabililty to stand or walk in a normal manner)

• Characteristics:

-Normal coordination of leg movements in bed or while sitting

-Unable to stand or walk without assistance

-If distracted, stationary balance is sometimes maintained and several steps are taken normally, followed by a dramatic demonstration of imbalance with a lunge toward

the examiner's arms or a nearby bed.

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IMAGING

• MRI BRAIN• SPINAL X-RAY• SPINAL MRI• EMG(Electromyography)• CXR/CT THORAX

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BLOOD INVESTIGATION

• FBC & PBF• ESR• Syphilis serology• Serum B12• U & E• Prostate Specific Antigen• Serum Creatine phosphokinase

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OTHER INVESTIGATIONS

• Lumbar puncture• Muscle biopsy

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MBBS IIIA FINALSTHANK YOU & GOOD LUCK

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