Disorders Of Stance And Gait

The normal gait is characterised by an erect posture, moderately sized steps and the medial malleoli of the tibia 'tracing' a straight line.

Co-ordination ensures fluidity of movement. Antigravity reflexes maintain the erect posture. They depend upon spinal cord and brain stem connections to produce extension.

ASSESSMENT OF STANCE AND GAIT

In a patient complaining of disturbance of walking, careful assessment indicates the likely site of the causative lesion. Watch the patient:

- walking

- performing tandem gait - heel to toe walking,

- standing with heels together with (a) eyes open, (b) eyes closed - this (Romberg's test) distinguishes cerebellar from sensory ataxia.

Eyes open Eyes closed

A step forward requires:

— ankle dorsiflexion

A step forward requires:

— ankle dorsiflexion

Sensory ataxia

Stance normal

Stance unsteady

Proprioception

Stance unsteady

I Vision compensates for proprioceptive loss.

Proprioception

(Romberg 'positive')

Cerebellar ataxia

Stance unsteady

Unsteadiness marginally increased

Proprioception

Stance unsteady

Proprioception

—S Cerebellar / deficit marginally helped by visual input.

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