Specific Disorders Of Stance And Gait

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ATAXIC GAIT

1. Cerebellar The feet are separated widely when standing or walking.

Steps are jerky and unsure, varying in size. The trunk sways forwards. In mild cases: Tandem gait (heel-toe walking) is impaired; the patient falling to one or both sides.-------v QXI^) CK33

2. Sensory

Disturbed conscious or unconscious proprioception due to interruption of afferents in peripheral nerves or spinal cord (posterior columns, spinocerebellar tracts).

The gait appears normal when the eyes are open although the feet usually 'stamp' on the ground. Examination reveals a positive Romberg's test and impaired joint position sensation.

HEMIPLEGIC GAIT

The leg is extended and the toes forced downwards. When walking, abduction and circumduction at the hip prevent the toes from catching on the ground.

In paraplegia, strong adduction at the hips can produce a scissor-like posture of the lower limbs. In mild weakness, the gait may appear normal, but excessive wear occurs at the outer front aspect of the patient's shoe sole.

PARKINSONIAN (festinating) GAIT

The patient adopts a flexed, stooping posture. To initiate walking, he leans forwards and then hurries (festinares) to 'catch up' on himself. The steps are short and shuffling.

MYOPATHIC (waddling)

Hemiplegie gait

Hemiplegie gait

STEPPAGE GAIT

Lower motor neuron weakness of pretibial and peroneal muscles produces this gait disorder. The patient lifts the affected leg high so that the toes clear the ground.

When bilateral, it resembles a high-stepping horse.

FRONTAL LOBE GAIT

GAIT

Characteristic of muscle disease. Trunk and pelvic muscle weakness result in a sway-back, pot-bellied appearance with difficulty in pelvic 'fixation' when walking.

Disturbance of connections between frontal cortex, basal ganglia and cerebellum produces this characteristic disturbance. The gait is wide based (feet wide apart). Initiation is difficult, the feet often seem 'stuck' to the floor. There is a tendency to fall backwards. Power and sensation are normal.

HYSTERICAL GAIT

Characterised by its bizarre nature.

Numerous variations are seen. The hallmark is inconsistency supported by the lack of neurological signs. Close observation is essential.

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