Please enable JavaScript.
Coggle requires JavaScript to display documents.
GAIT ABNORMALITIES, Credit to
geekymedics.com
Sunil Aggarwal - Coggle…
GAIT ABNORMALITIES
NORMAL
GAIT
CYCLE
Stance phase
- limb with foot on ground
- start - heel strike
- end - toe-off
- hip abductors contract
stabilise pelvis
Heel strike
- heel contacts ground
- usually slightly inverted
-
Propulsion
- foot leaves ground
- usually from tip of
hallux or 2nd toe
HEMIPLEGIC
GAIT
Gait
- asymmetrical - one limb affected
- knee extension, foot plantar flexed
- toes may drag
- leg circumducts in swing phase
Associated
clinical features
- increased tone - clasp-knife spasticity
- hyperreflexia with/without clonus
- +ve Babinski reflex (upgoing plantars)
- reduced power
- upper limb may have flexor posturing
elbows, wrist
& with shoulders & finger adductin
-
-
DIPLEGIC
GAIT
Gait
- similar to hemiplegic but bilateral
- limbs are stiff, held in extension, feet inverted & internally rotated
- hips drawn together - excessive adductor tone
- legs forced together due to spacticity
= leg overlap when walking
- circumduction in swing phase
- symmetrical movements of lower limbs
-
ATAXIC
GAIT
Gait
- broad-based
- unsteady
- foot stamping
- may require support
eg walking frame
If unilateral cerebellar lesion
may veer to side of lesionHeel-toe walking
may help elicit ataxia
if gait appears normal
Associated
Clinical
Features
Ataxia gait implies either
- Cerebellar
- Vestibular
- Sensory
impairment
If cerebellar
- other signs & symptoms present
- if unilateral S&S present
on the same side as lesion
Cerebellar Ataxia
- Nystagmus (on affected side)
- Ataxia dysarthria
- Dysmetria
(past-pointing or under-shooting)
- Intentional tremor (on same side)
- Dysdiadokokinesia (on same side)
Sensory Ataxia
- sensory neuropathy gives appearance
due to impaired limb sensation
- Signs include
- =ve Romberg's sign
- impaired proprioreception
- impaired vibration sense
- absence of cerebellar signs
(eg dysmetria, nystagmus, dysarthria)
Vestibular Ataxia
- vestibular disturbance
can give similar gait
- associated with
vertigo, nausea, vomiting
Differential DiagnosisUnilateral
- ischaemic or haemorrhagic stroke
(vascular events produce hyperacute symptoms)
- space occupying lesion
Bilateral
- Multiple Sclerosis
- Alcoholism
- B12 deficiency
- Drugs
- Phenytoin
- Carbamazepine
- Barbiturates
- Lithium
NEUROPATHIC GAIT
aka High Steppage Gait
- weakness of dorsiflexor muscles
tibialis anterior
- pathology of nerve supply
Gait
- foot drop due to weak dorsiflexion
- hip & knee flex excessively
to prevent toes dragging
- feet stamp on floor
Associated
Clinical
Features
- ankle-foot orthoses (AFO)
Unilateral foot drop
- common peroneal nerve disease
usually with sensory loss
dorsum of foot
- L5 nerve route disease
usually with sensory loss
L5 dermatome
Bilateral foot drop
distal muscle weakness
- peripheral neuropathies
- motor neurone disease
- pes cavus appearance
- inverted 'champagne bottle calf'
appearance of
hereditory motor
& sensory neuropathies
Reflexes
Peripheral neuropathies
Motor Neuron Disease
- brisk upgoing plantars with fasciculations
(mixed upper & lower motor neuron signs)
Differential Diagnosis
Foot drop indicates
weak muscles ankle dorsiflexors
- tibialis anterior
supplied by common peroneal nerve
- L4, L5, S1 nerve root
Due to either
- Isolated common peroneal nerve palsy
- L5 radiculopathy (weakened foot inversion)
Or
- more generalized polyneuropathy
of multiple nerves
Bilateral Foot Drop
with neurological features
(muscle wasting
reduced reflexes
impaired sensation)
Seen in diffuse disease
eg
Polyneuropathies
- Diabetic neuropathy
- Hereditary Motor & Sensory Neuropathy
(Charcot-Marie-Tooth Disease)
- Vasculitis
- Guillain-Barre Syndrome
Motor Neurone Disease
Associated with upper & lower
neurone findings
Unilateral Foot Drop
when no other
nerves or muscles involved
suggests
isolated
common peroneal palsy
(foot inversion preserved)
(trauma or compression
especially at head of fibula)
or
L5 radiculopathy
(usually unilateral
but can be
bilateral)
SENSORY GAIT
aka Stomping Gait
- peripheral sensory nerve impairment
- unable to sense where foot is
(impaired proprioeception)
- not aware when foot hits ground (foot slap)
- appear ataxic with sensory impairment
(sensory ataxia)
Associated
Clinical
Features
- Romberg Test +ve
- stomping exacerbated in dark
- impaired sensation of feet
to confirm diagnosis
- usually spinal dorsal column disease
Features may be present
- diminished ankle reflexes
- peripheral motor weakness
Features of
Subacute degeneration
of the cord
may be see in B12 deficiency
- diminished proprioception & vibration sense
- with absent ankle reflexes
- exaggerated knee reflex
- upgoing (+ ve) Babinski reflex
Differential
Diagnosis
Dorsal column disease
- B12 deficiency
- Tabes Dorsalis (Syphilis)
Peripheral Nerve Disease
- Diabetes
- Vasculitis
- B12 deficiency
- Hereditary Motor & Sensory neuropathies
(Charcot-Marie-Tooth Disease)
- Guillain-Barre Syndrome
- Post-infection
-
-
-
-