Gait abnormalities

Physiology of gait abnormalities is the most common type of question one will be asked for exams.

1. Gait Abnormalities And Physiological Basis Dr. G.T. Wijesinghe Dip. in med. Physiology

2. Different types Hemiplegic gait Spastic gait Neuropathic gait Myopathic gait Ataxic gait (cerebellar) Choreiform gait Parkinsonian gait Non neurological gaits

3. Hemiplegic gait Arm flexed, adducted and internally rotated - Flexion hypertonia Leg extended, plantar flexed Pelvis lifted - extensor hypertonia in lower limb - weakness in distal muscles – (foot drop) - Circumduction – semi circle walking Unilateral u pper motor neuron lesion stroke

4. Spastic gait/ Diplegic gait Bilateral involvement Stiff legs (spasticity more in lower extremities) Narrow base – adducted limbs Drag both legs features: Scissoring Toe walking Bilateral periventricular lesions involving UMN Eg : Cerebral palsy

5. Neuropathic gait Steppage gait, Equine gait Foot drop (weakness of foot dorsiflexion) Lift the knee high enough, not to drag the foot on the floor Unilateral or bilateral LMN palsies Unilateral : Peroneal nerve palsy L5 radiculopathy Bilateral : Amyotrophic lateral sclerosis Diabetic neuropathy

6. Myopathic gait Hip girdle muscle weakness Gluteus Medius Drop in the pelvis on contralateral side Unilateral : Trendelenburg sign Bilateral lesions : dropping of pelvis both sides ( Waddling gait ) Myoplathies Muscular dystrophy

7. Ataxic/ C erebellar gait Wide based gait Clumsy, staggering movements Can not walk in a straight line Resemble gait of acute alcohol intoxication Titubation Cerebellar lesion

8. Sensory Ataxic gait Stomping/stamping gait Loss of proprioceptive inputs Lift knees higher to slam the foot hard on the floor to get sensory inputs Exacerbate in dark Resemble cerebellar ataxia in severe forms Romberg test - positive Sensory neuron lesions Dorsal column lesions Vit B12 deficiency Diabetic neuropathy

9. Choreiform gait Hyperkinetic Irregular jerky, involuntary movements in all extremities Walking may accentuate the baseline movement disorder Basal ganglia disorder Indirect pathway lesion

10. Parkinsonian gait Rigidity, bradykinesia Stooped with head and neck forward Knee flexion Upper extremity flexed with fingers extended Short steps Slow, difficult initiation Shuffling gait Basal ganglia disorder (direct pathway) Substantia nigra lesion Parkinson’s disease

11. Non neurologic gaits Antalgic gait Associated with pain in lower limbs, back etc Psycogenic gait Voluntary

12. Thank you