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
A. Hemiplegic gait
B. Spastic gait
C. Neuropathic gait
D. Myopathic gait
E. Ataxic gait (cerebellar)
F. Choreiform gait
G. Parkinsonian gait
H. 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 upper 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/Cerebellar 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