Gait abnormalities

CNS Examinations, Abnormalities of gait, types of gaits

1. GAIT& ITS
ABNORMALITY
Presentation by:
Dr Indrajeet P. Shah
Dr Amit A. Bhasme

2. DEFINITION
GAIT
a manner of walking or moving on foot
a sequence of foot movements (as a walk, trot, pace, or
canter) by which a horse or a dog moves forward
a manner or rate of movement or progress<the
leisurelygaitof summer>

3. ESSENTIALSOFGAIT
There are four major criteria essential to walking.
Equilibrium:
The ability to assume an upright posture and maintain
balance.
Locomotion:
The ability to initiate and maintain rhythmic stepping
Musculoskeletal Integrity:
Normal bone, joint, and muscle function
Neurological Control:
Must receive and send messages telling the body how and
when to move.
(visual, vestibular, auditory, sensori-motor input)
Forces for gait:
Muscular force.
Gravitational force.
Forces of momentum.
Floor reaction force.

4. GAITCYCLE
The gait cycleis used to describe the complex
activity of walking, or our gait pattern. This cycle
describes the motions from initial placement of the
supporting heel on the ground to when the same
heel contacts the ground for a second time.

5. The stance period consistsof the first five
phases: initial contact, loading response, mid-
stance and terminal stance.

6. WHATCAUSESPEOPLETOHAVEABADGAIT?
Gaitandbalanceproblemscanbearesultof
pain,muscleweakness,muscletightnessor
spasticity,lossofbalance,orpoorposture.
Othercausesincludelimitedrangeofmotion,
numbness(sensorydeficit),andfatigue.Muscle
weaknesscanoccurinonelegorboth,and
makewalkingdifficult

7. HEMIPLEGICGAIT
Thepatientstandswithunilateral
weaknessontheaffectedside,armis
heldimmoblieandclosetotheside,
withelbow,wristandinterphalangeal
jointsflexed.Legonsamesideisin
extensionwithplantarflexionofthefoot
andtoes.
Whenwalking,thepatientwillholdhis
orherarmtoonesideanddragshisor
heraffectedleginasemicircle
(circumduction)duetoweaknessof
distalmuscles(footdrop)andextensor
hypertoniainlowerlimb.
Thisismostcommonlyseeninstroke.

8. DIPLEGICGAIT(SCISSORSGAIT)
Patientshaveinvolvementonbothsideswith
spasticityinlowerextremitiesworsethanupper
extremities.
Thepatientwalkswithanabnormallynarrowbase,
draggingbothlegsandscrapingthetoes.
Thisgaitisseeninbilateralperiventricularlesions,
suchasthoseseenincerebralpalsy.
Thereisalsocharacteristicextremetightnessofhip
adductorswhichcancauselegstocrossthe
midlinereferredtoasascissorsgait.

10. NEUROPATHICGAIT
(STEPPAGEGAIT)
Seeninpatientswithfootdrop(weaknessoffoot
dorsiflexion),thecauseofthisgaitisduetoanattempt
tolifttheleghighenoughduringwalkingsothatthe
footdoesnotdragonthefloor.
Thesepatientseitherdragtheirfeetorleftthemhigh,
withkneesflexed,andbringthemdownwithaslap
ontothefloor,thusapperaingtobewalkingupstairs.
Theyareunabletowalkontheirheels.
Unilateral,causesincludeperonealnervepalsyandL5
radiculopathy.
Bilateral,causesincludeamyotrophiclateralsclerosis,
Charcot-Marie-Toothdiseaseandotherperipheral
neuropathiesincludingthoseassociatedwith
uncontrolleddiabetes.

12. SENSORYGAIT
Asourfeettouchtheground,wereceivepropioreceptive
informationtotellustheirlocation.
Thesensoryataxicgaitoccurswhenthereislossofthis
propioreceptiveinput.
Inanefforttoknowwhenthefeetlandandtheirlocation,
thepatientwillslamthefoothardontothegroundinorder
tosenseit.Akeytothisgaitinvolvesitsexacerbation
whenpatientscannotseetheirfeet(i.e.inthedark).
Thisgaitisalsosometimesreferredtoasastompinggait
sincepatientsmaylifttheirlegsveryhightohittheground
hard.
Thisgaitcanbeseenindisordersofthedorsalcolumns
(B12deficiencyortabesdorsalis)orindiseasesaffecting
theperipheralnerves(uncontrolleddiabetes).

14. MYOPATHICGAIT
Hipgirdlemusclesareresponsibleforkeepingthepelvis
levelwhenwalking.Ifyouhaveweaknessononeside,this
willleadtoadropinthepelvisonthecontralateralsideof
thepelviswhilewalking(Trendelenburgsign).Withbilateral
weakness,youwillhavedroppingofthepelvisonbothsides
duringwalkingleadingtowaddling.Thisgaitisseenin
patientwithmyopathies,suchasmusculardystrophy.

16. CHOREIFORMGAIT
(HYPERKINETICGAIT)
Thisgaitisseenwithcertainbasalganglia
disordersincludingSydenham's chorea,
Huntington'sDiseaseandotherformsofchorea,
athetosisordystonia.Thepatientwilldisplay
irregular,jerky,involuntarymovementsinall
extremities.Walkingmayaccentuatetheirbaseline
movementdisorder.

17. PARKINSONIANGAIT
Inthisgait,thepatientwillhaverigidityand
bradykinesia.
Heorshewillbestoopedwiththeheadandneck
forward,withflexionattheknees.Thewholeupper
extremityisalsoinflexionwiththefingersusually
extended.Thepatientwalkswithslowlittlestepsknown
atmarcheapetitspas(walkoflittlesteps).Armswings
aredecreasedandthepatientturnsaroundstiffly-”allin
onepiece”
Patientmayalsohavedifficultyinitiatingsteps.The
patientmayshowaninvoluntaryinclinationtotake
acceleratingsteps,knownasfestination.
ThisgaitisseeninParkinson'sdisease

19. GAITOFOLDERAGE
Speed,balanceandagilitydecreasewithaging.
Stepsbecomeshort,uncertainandevenshuffling.
Thelegsmaybeflexedathipsandknees.Acane
maybolsterlostconfidence.
Duetoagingprocess.

20. DIAGNOSINGGAITANDBALANCEPROBLEMS
Aphysicalandneurologicalexaminationcan
diagnosegaitorbalanceproblems.Doctors
typicallyalsoaskquestionsaboutsymptomsand
severity.
Performancetestingcanthenbeusedtoassess
individualgaitdifficulties.Potentialfurtherteststo
identifycausesincludehearingtests,innerear
imaging,andvisiontestsincludingwatchingeye
movement.Magneticresonanceimaging(MRI)ora
computedtomography(CT)scancancheckthe
brainand/orbloodpressure/heartratestests.A
doctorwilllooktofindwhichpartofthenervous
systemiscontributingtothegaitandbalance
problems.

21. GAITANDBALANCEPROBLEMPROGNOSIS
Theprognosisofgaitandbalanceproblemsis
dependentontheunderlyingmedicalcondition.
Fallsinolderadults,duetogaitandbalance
problems,areacommoncauseofmortalityand
morbidityandcanleadtoinjury,lossof
independence,andchangeinlifestyle.

22. FORTHECOMPLIMENTS ANDCOMMENTS
[email protected]
[email protected]