Gait: Difference between revisions
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===Sensory disequilibrium=== | ===Sensory disequilibrium=== | ||
There is conflict among inputs from the visual, proprioceptive, and vestibular pathways. Loss of two of these pathways, or loss of one without CNS adaptation, may lead to this becoming chronic. The gait is slow and cautious, and there is increased bipedal support.<ref name="biller></ref> | There is conflict among inputs from the visual, proprioceptive, and vestibular pathways. Loss of two of these pathways, or loss of one without CNS adaptation, may lead to this becoming chronic. The gait is slow and cautious, and there is increased bipedal support.<ref name="biller></ref> | ||
==Middle Level Gait Disorders== | |||
==Higher Level Gait Disorders== | |||
==Examination== | |||
==References== | ==References== |
Revision as of 10:12, 20 October 2020
A gait disturbance is a gait pattern that deviates from a "normal" gait. Synchrony, fluency, smoothness, and symmetry may be affected. A gait disturbance can be caused by problems at any level of the neuraxis, and they can be classified on an anatomical basis. This type of classification scheme categorises gait disturbances into low-level, middle-level, and high-level gait disorders. Particularly in the elderly, multiple factors may be in play causing a gait disturbance. [1]
Gait Disorder Classifications
Levels | Anatomical Level | Balance and Gait Pattern |
---|---|---|
Higher | Psychological / psychiatric | Variable: slow, buckling knees |
Higher | Cortical and subcortical | Different patterns: cautious, parkinsonian, ataxic, spastic, magnetic, gait ignition failure, disequilibrium |
Middle | Basal ganglia | Parkinsonian / dystonic / choreic |
Middle | Thalamus | Astasia / ataxia |
Middle | Cerebellum | Cerebellar ataxia |
Middle | Brain stem | Ataxia / spasticity |
Middle | Spinal cord | Spastic gait / tabetic gait |
Lower | Peripheral nerve Proprioception, vestibular visual |
Sensory ataxia / vestibular disequilibrium / visual disequilibrium |
Lower | Neuromuscular junction | Waddling |
Lower | Muscle | Waddling, steppage, Trendelenburg |
Lower | Skeleton | Antalgic / compensatory for deformities |
See below for a demonstration of neurological gait conditions (Hemiplegic, Parkinsonian, Cerebellar, Stomping, Scissoring, Trendelenburg, Foot-drop, Choreiform)
Lower Level Gait Disorders
Lower level gait disorders are caused by pathology of the muscles, skeleton, peripheral nerves, peripheral vestibular system, and anterior visual pathway.[1]
Steppage Gait
This is seen with weakness of food dorsiflexion, which may be due to peroneal nerve injury, radiculopathy, and demyelinating neuropathy. It may be unilateral or bilateral. The patient exaggerates knee and hip flexion to avoid tripping. The step is high and short, and at the end of each swing phase the foot may slap the floor.[1]
Waddling and Trendelenburg Gaits
A waddling gait pattern is seen with weakness of the bilateral hip girdle muscles as well as in bilateral hip joint osteoarthritis or other bilateral hip joint diseases. The gait is wide based, and has short steps. There is increased alternating lateral body sway, and excessive drop of the hips. By swaying laterally the patient places their weight down the centre of gravity through each hip to reduce pain. There may be increased arm abduction and an exaggerated lumbar lordosis. [1]
Trendelenburg gait manifests as ipsilateral lurching of the torso with a contralateral hip drop while standing on the affected side. It is caused by unilateral hip abductor weakness.[1]
Gluteus Maximus Lurching Gait
With Gluteus Maximus weakness, the torso lurches backwards at heel strike on the affected side. This is a compensatory mechanism to interrupt forward motion of the trunk due to a weakness of hip extension.
Sensory ataxia
The sensory ataxic gait is wide based with a variable step length and marked stride-to-stride variability. There is usually unsteadiness. Romberg sign is often positive. This gait pattern is not specific to any anatomical location, and may be seen in pathology of proprioception (sensory ataxia), cerebellum (cerebellar ataxia), pons, and thalamus.[1]
Visual disequilibrium
Acute visual distortion such as using new prescription glasses may cause a sense of loss of balance. There may be cautiousness in gait, with tentative steps and an increased base of support.
Vestibular disequilibrium
Acutely there may be vertigo, nystagmus, and a tendency to fall onto the affected side. Chronically, the symptoms may be less marked, but the gait is often still wide based and cautious. There is difficulty with Romberg test and tandem walking, but assistance is not required to walk.
Sensory disequilibrium
There is conflict among inputs from the visual, proprioceptive, and vestibular pathways. Loss of two of these pathways, or loss of one without CNS adaptation, may lead to this becoming chronic. The gait is slow and cautious, and there is increased bipedal support.[1]