FPN – Gait

Nov 1, 2019 admin KỸ NĂNG LÂM SÀNG, THẦN KINH 0

Gait

Aka: Gait, Abnormal Gait, Gait Abnormality, Antalgic Gait, Cautious Gait, Cerebellar Gait, Choreic Gait, Dystonic Gait, Frontal Gait, Gait Apraxia, Hemiparetic Gait, Paraparetic Gait, Parkinsonian Gait, Psychogenic gait, Sensory Ataxia Gait, Vestibular Ataxia Gait, Waddling Gait, Pelvic Rotational Wink

II. Physiology

  1. Gait has 2 phases (walk cycle)
    1. Stance Phase (foot in contact with ground)
      1. Sub-phase 1: Initial double-limb support (20%)
      2. Sub-phase 2: Subsequent single-limb stance (60%)
      3. Sub-phase 3: Return to double-limb support (20%)
    2. Swing Phase (foot in air)
      1. Each foot is in the air 40% of the time of the walk cycle
  2. Age-related changes
    1. Mature gait is established by age 3 years, and is adult-like by age 7 years
    2. With age comes increased walk velocity, step length and duration of single-limb stance

III. Types: Abnormal

  1. See Nonantalgic Gait in Children
  2. Antalgic Gait
    1. Limited joint range of motion with an inability to bear full weight on affected extremity
    2. Stance phase duration shortens to compensate pain in the affected leg
    3. Results in limp with slow and short steps
    4. Causes: Joint Pain due to Degenerative Joint Disease or injury, Stress Fractures, Septic Arthritis
  3. Cautious Gait
    1. Careful gait, slow and wide based with abducted arms, similar to that of walking on ice
    2. Causes: Prior falls, deconditioning, sensory deficit (e.g. low sight)
  4. Cerebellar Gait
    1. Staggering, wide-based gait
    2. Associated cerebellar signs (Dysarthria, dysmetria, Intention Tremor, Nystagmus, positive rhomberg)
    3. Causes: Vitamin B12 Deficiency, Multiple Sclerosis, Cerebellar CVA, Thiamine deficiency
  5. Choreic Gait
    1. Wide-based gait, with slow leg raising and simultaneous knee flexion
    2. Associated with similar Choreoathetosis involving upper extremities
    3. Causes: Huntington’s Chorea, Levodopa-induced Dyskinesia
  6. Dystonic Gait
    1. Hyperflexed hips with dragging of foot, exacerbated by walking
  7. Frontal Gait (Gait Apraxia)
    1. Hesitation on starting to walk and on turning
    2. Causes: Dementia, Frontal Lobe degeneration, Normal Pressure Hydrocephalus
  8. Hemiparetic Gait
    1. Weak and spastic limb extended and circumducted
    2. Associated with Hemiparesis, hyperreflexia
    3. Causes: CVA with Hemiparesis
  9. Paraparetic Gait
    1. Stiff, scissor-like walk with leg adduction and extension
    2. Associated with bilateral leg weakness, hyper-reflexia, spasticity
    3. Causes: Spinal cord lesion, bilateral Cerebral Hemisphere abnormalities
  10. Parkinsonian Gait
    1. Shuffling gait with short steps
    2. Causes: Parkinsonism
  11. Pelvic Rotational Wink
    1. Pelvis rotates >40 degrees in axial plane towards the affected hip
    2. Maladaptive gait allows for terminal hip extension on walking
    3. Causes: Intraarticular hip disorder, hip flexure contracture
  12. Psychogenic gait
    1. Bizarre, non-physiologic, lurching gait
    2. Associated with normal Neurologic Exam (especially with distraction)
    3. Causes: Somatoform Disorder, Malingering
  13. Sensory Ataxia Gait
    1. Unstead gait, worse with impaired vision or at night
    2. Associated with decreased distal sensation, positive rhomberg
    3. Causes: Dorsal column dysfunction, Vitamin B12 Deficiency, Diabetic Neuropathy
  14. Steppage Gait
    1. Hyper-flexed hips and knees on ambulation compensating for foot-drop
    2. Associated with distal leg atrophy and loss of Achilles Reflex
    3. Causes: Distal motor Neuropathy
  15. Trendelenburg Gait
    1. See Trendelenburg Gait
    2. Causes: Abductor weakness (esp. Gluteus Medius) or Intrinsic Hip Pathoplogy
  16. Vestibular Ataxia Gait
    1. Unsteady gait with a falling to one side
    2. Causes: See Vertigo, Ataxia
  17. Waddling Gait
    1. Swaying, symmetric, wide-based gait with toe walking
    2. Associated with proximal Muscle Weakness in lower extremities
    3. Causes: Muscular Dystrophy, Pregnancy, Athletes, Osteitis Pubis

IV. References

  1. Zawora in Arenson (2009) Reichel’s Care of the Elderly, 6th ed, Cambridge University Presss, p. 143

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