This document provides an overview of gait disorders, including normal gait cycle components and subdivisions, physiological and anatomical aspects of gait, common causes and types of abnormal gait, clinical symptoms and examination of gait. Key points covered include definitions of stance and swing phases, centers of pressure and gravity, neurological structures involved in locomotion, epidemiology of gait disorders in older adults, gait abnormalities due to weakness, spasticity, sensory deficits and imbalance. Classification of gait patterns such as myopathic, neurogenic, sensory ataxia, vestibular imbalance and spastic hemiparetic gaits are described.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
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این ارائه در کارگاه تخصصی تقلید و آپراکسی سرنخ هایی برای مداخلات مبتنی بر شواهد توسط دکتر هاشم فرهنگ دوست تدریس شده است.
برای مطالعه مطالب بیشتر در این زمینه به وب سایت فروردین مراجعه کنید.
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Steppage gait (High stepping, Neuropathic gait) is a form of gait abnormality characterised by foot drop or ankle equinus due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking
CONCEPT OF NODOPATHIES AND PARANODOPATHIES.pptxNeurologyKota
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Peripheral neuropathies are traditionally categorized into demyelinating or axonal.
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antibodies targeting node and paranode of myelinated nerves have been increasingly detected in patients with immune mediated neuropathies.
have clinical phenotype similar common inflammatory neuropathies like Guillain Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy
they respond poorly to conventional first line immunotherapies like IVIG
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
Entrapment Syndromes of Lower Limb.pptxNeurologyKota
This presentation contains information about the various Entrapment syndromes of Lower limb in descending order of topography. It also contains information about etiology, clinical features and management of each of these entrapment syndromes with special emphasis on electrodiagnostic confirmation.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
How to Give Better Lectures: Some Tips for Doctors
Clinical aproach to gait disorders
1. CLINICAL APROACH TO
GAIT DISORDERS
DR. SUMIT KAMBLE
DM SENIOR RESIDENT
DEPT. OF NEUROLOGY
GMC, KOTA
MODERATOR
DR. DILIP MAHESHWARI
ASSOCIATE PROFF. NEUROLOGY
2. NORMALGAIT CYCLE
• Single gait cycle or stride is defined:
• Period when 1 foot contacts the ground to when that same foot contacts
the ground again
• Each stride has 2 phases:
• Stance Phase
• Foot in contact with ground
• Swing Phase
• Foot not in contact with ground
5. PHYSIOLOGICAL AND BIOMECHANICAL
ASPECTS OFGAIT
• Posture- based on mechanical musculoskeletal linkages and
neurological control detecting and correcting body sway.
• Postural response
1. Automatic righting reflexes keeping head upright on trunk
2. Supporting reactions controlling antigravity muscle tone
3. Anticipatory (feed-forward) postural reflexes occurring
before limb movement
4. Reactive (feedback) postural adjustments counteracting body
perturbations during movement.
6. • Initiation of gait - heralded by a series of shifts in the center of
pressure beneath the feet—first posteriorly, then laterally toward
the stepping foot, and finally toward the stance foot to allow the
stepping foot to swing forward.
• Center of Gravity (CG)
• Midway between the hips
• Few cm in front of S2
7. ANATOMICAL ASPECTS OFGAIT
• Neuroanatomical structures responsible for equilibrium and
locomotion -
1. Brainstem (subthalamic, midbrain)
2. Cerebellar locomotor regions
project through descending reticulospinal pathways from the
pontomedullary reticular formation into ventromedial spinal cord.
8. • Prefrontal cortex - modulates midbrain and cerebellar locomotor
regions
• Parietal cortex - integrates sensory inputs indicating position
and orientation in space, the relationship to gravitational forces,
the speed and direction of movement.
• Cerebellum - modulates the rate, rhythm, amplitude, and force
of stepping.
9. EPIDEMIOLOGYAND IMPACT
• Gait disorders affect up to 15% of people > 60 years of age
• >80% who are >85 years.
• Patients hospitalized with neurologic disorders, 60% have gait
disturbance.
1. Sensory deficits, 18%
2. Myelopathy, 17%
3. Multiple infarcts, 15%
4. Unknown cause, 14%
5. Parkinsonism, 12%
6. Cerebellar degeneration, 7%
7. Hydrocephalus, 7%
8. Miscellaneous, 5%
9. Psychogenic, 3 %
10.Toxic/metabolic, 2.5%
11. HISTORY: COMMON SYMPTOMSAND
ASSOCIATIONS
WEAKNESS
• Hemiplegia or foot drop caused by weakness of ankle
dorsiflexion - Catching or scraping a toe on the ground and a
tendency to trip
• Weakness of knee extension - sensation that the legs will give
way while standing or walking down stairs.
12. • Weakness of ankle plantar flexion - interferes with ability to
stride forward, resulting in a shallow stepped gait.
• Proximal muscle weakness- Difficulty in climbing stairs or
rising from a seated position.
• Axial muscle weakness - interfere with truncal mobility
13. SLOWNESS
• Slowness of walking
1. Normal reaction to unstable or slippery surfaces
2. Elderly
3. Those who feel their balance is less secure because of any
musculoskeletal or neurological disorder
4. Parkinson disease (PD) and other basal ganglia diseases
14. STIFFNESS
• Presenting symptoms of a spastic paraparesis or hemiparesis.
• Drag their legs, catch the toes of their shoes on any surface
irregularity and their legs suddenly give way, causing stumbling
and falls.
• Leg muscle tone in some upper motor neuron syndromes and
dystonia may be normal when the patient is examined in the
supine position but is increased during walking.
15. • In childhood, an action dystonia of the foot is a common initial
symptom of primary dystonia with stiffness, inversion, and
plantar flexion of the foot and walking on the toes only
becoming evident after walking or running.
• Patients with dopa-responsive dystonia typically develop
symptoms in the afternoon (“diurnal fluctuation”).
16. IMBALANCE
1. Cerebellar ataxia
2. Sensory ataxia
3. Vestibulopathy
4. Vascular lesions of thalamus, and basal ganglia.
5. Wide-based unsteady gait is also feature of frontal lobe
diseases
6. Imbalance in subcortical cerebrovascular disease and basal
ganglia disorders manifests when turning while walking,
stepping backwards, bending over to pick up something, or
performing several tasks simultaneously,
17. FALLS
1. Collapsing falls(Tone is lost )- syncope or seizures.
2. Toppling falls (Muscle tone is retained) - impaired static and
dynamic postural responses that control body equilibrium
during standing and walking.
18. Toppling falls (Muscle tone is retained)
• Tripping - foot drop or shallow steps, may also be a
consequence of carelessness secondary to inattention, dementia,
or poor vision.
• Proximal muscle weakness- legs giving way and falls.
• Unsteadiness and poor balance
• Impairment of postural responses.
• Spontaneous falls, especially backward, are an important clue to
diagnoses such as multiple system atrophy and progressive
supranuclear palsy
19. SENSORY SYMPTOMS AND PAIN
• Distribution of any accompanying sensory complaints provides
clue to the site of the lesion producing walking difficulties.
• Radicular pain or paresthesias,
• Sensations of tight bands around the trunk
• Distal symmetrical paresthesias of the limbs
• Neurogenic claudication of the cauda equina
• Vascular intermittent claudication
• Skeletal pain due to degenerative joint disease
20. URINARY INCONTINENCE
• Spinal cord lesion
• Parasagittal cerebral lesions such as frontal lobe tumors
(parasagittal meningioma), frontal lobe infarction caused by
anterior cerebral artery occlusion, and hydrocephalus.
• Urinary urgency and urge incontinence are also common in
parkinsonism and subcortical white-matter ischemia.
21. COGNITIVE CHANGES
• Slowing of gait may be a marker of impending cognitive
impairment and dementia.
• Executive dysfunction including inattention, impaired
multitasking, and set switching may predict later development
of falls in older adults without dementia or impaired mobility
• Dementia with disinhibition and impulsivity are associated with
reckless gait problems and falls.
22. EXAMINATION OFPOSTUREAND WALKING
ARISING TO STAND FROM SEATED POSITION
1. Proximal muscle strength
2. Organization of truncal and limb movements
3. Stability
4. Stance base
STANDING
1. Posture
2. Stance base
3. Body sway
4. Romberg test
5. Postural reflexes (pull test)
23. WALKING
1. Initiation of stepping
2. Speed
3. Stance base
4. Step length
5. Cadence
6. Step trajectory (shallow, shuffling, or high stepping)
7. Associated trunk and arm movements
8. Trunk posture
TURNING WHILE WALKING
1. Number of steps to turn
2. Stabilizing steps
3. En bloc (truncal and limb movement)
4. Freezing
OTHER MANEUVERS
1. Tandem walking
2. Walking backwards
3. Running Walking on toes, heels
24. CLASSIFICATION OFGAIT PATTERNS
A. MYOPATHIC GAIT (waddling gait)
• Weakness of proximal leg and hip-girdle muscles interferes with
stabilizing the pelvis and legs on the trunk.
• Exaggerated rotation of the pelvis with each step and a
waddling gait.
• Hips are slightly flexed as a result of weakness of hip extension,
and an exaggerated lumbar lordosis occurs.
• Gower’s sign.
25.
26. NEUROGENIC WEAKNESS (STEPPAGE GAIT)
• Seen in patients with foot drop (weakness of foot dorsiflexion),
• Lift the leg high enough during walking so that the foot does
not drag on the floor.
• Unilateral- Peroneal and Sciatic nerve palsy and L5
radiculopathy.
• Bilateral - amyotrophic lateral sclerosis, Charcot-Marie-Tooth
disease and other peripheral neuropathies and scapuloperoneal
syndromes.
27. • Weakness of ankle plantar flexion produces a shallow stepped
gait.
• Femoral neuropathy produces weakness of knee extension and
buckling of the knee when walking or standing. This may first
be evident when walking down stairs.
28.
29. SENSORY ATAXIA (SLAPPING/STAPMING GAIT)
• Adopt a wide base and advance cautiously, taking slow steps
under visual guidance.
• Feet are thrust forward with variable direction and height.
• Sole of the foot strikes floor forcibly with a slapping sound
(slapping gait).
• Walking on uneven surfaces and dark is particularly difficult.
• Romberg test.
• Large-diameter peripheral neuropathies, posterior root or dorsal
root ganglionopathies, and dorsal column lesions.
30. VESTIBULAR IMBALANCE AND GAIT
• Acute peripheral vestibular disorders result in leaning and
unsteady veering to the side of the lesion
• Unsteadiness and veering while running may be less evident
than when walking in acute vestibulopathy.
• In chronic vestibular failure, gait may be normal, though
unsteadiness can be unmasked during eye closure and rotation
of the head from side to side while walking.
31. SPASTIC HEMIPARETIC GAIT
• Arm is adducted, internally rotated at the shoulder, and flexed at
the elbow, with pronation of the forearm and flexion of the wrist
and fingers.
• Leg is slightly flexed at the hip and extended at the knee, with
plantar flexion and inversion of the foot.
• Swing phase of each step is accomplished by slight lateral
flexion of the trunk toward the unaffected side and
hyperextension of the hip on that side to allow slow
circumduction of the extended paretic leg as it swings forward
from the hip, dragging the foot or catching the toe on the ground
beneath.
32.
33. SCISSORS GAIT
• Bilateral spastic paresis of legs
• Legs move slowly and stiffly and the thighs are strongly
adducted such that the legs may cross as the patient walks
34.
35. CEREBELLAR ATAXIA
• Midline cerebellar structures, vermis, and anterior lobe - loss of
truncal balance, increased body sway, dysequilibrium, and gait
ataxia.
• Stance- Wide-based
• Lurching and staggering quality that is more pronounced when
walking on a narrow base or during heel-to-toe walking,
resembling acute alcohol intoxication.
• Anterior lobe atrophy develop a 3-Hz anteroposterior sway of
the trunk and a rhythmic truncal and head tremor (titubation)
that is superimposed on the gait ataxia.
36. • Flocculonodular lobe - exhibit multidirectional body sway,
dysequilibrium, and severe impairment of body and truncal
motion. Standing and even sitting can be impossible, although
when lying down, the heel-shin test may appear normal, and
upper limb function may be relatively preserved.
• Limb ataxia due to involvement of the cerebellar hemispheres is
characterized by a decomposition of normal leg movement.
Steps are irregular and variable in timing (dyssynergia), length,
and direction (dysmetria).
37.
38. HYPOKINETIC (PARKINSONIAN) GAIT
• Posture - stooped, with flexion of the shoulders, neck, trunk,
and knees.
• Asymmetrical reduction of arm swing and slowing in gait,
particularly when turning
• Start hesitation before breaking into a more normal stepping
pattern with small, shallow steps on a narrow base.
• Freezing
• Festination.
• Retropulsion and propulsion
39.
40. FRONTAL LOBE GAIT DISORDERS
• Cautious gait, a consequence of compensatory adjustments in
response to real or perceived disequilibrium
• Isolated gait ignition failure, characterized by difficulty
initiating or maintaining locomotion, and caused by lesions in
the frontal lobe, white matter connections, or basal ganglia
• Frontal gait disorder(Magnetic gait) characterized by variable
base (narrow to wide), decreased foot clearance, short shuffling
steps, disequilibrium, and start and turn hesitation, and caused
by lesion in the frontal lobe and white matter
41.
42. CHOREIC GAIT
• Random movements of chorea are often most noticeable during
walking.
• Superimposition of chorea on the trunk and leg movements of
the walking cycle gives the gait a dancing quality owing to the
exaggerated motion of the legs and arm swing.
• Chorea can also interrupt the walking pattern, leading to a
hesitant gait.
43.
44. DYSTONIC GAIT
• Childhood-onset primary torsion dystonia - sustained abnormal
posturing of the foot (typically plantar flexion and inversion) on
attempting to run.
• Walking forward or backward or even running backward may
be normal at an early stage.
• Early stages - tonic extension of the great toe (striatal toe) when
walking.
• Birdlike (peacock) gait - excessive flexion of the hip and knee
and plantar flexion of the foot in a during the swing phase.
45.
46. PSYCHOGENIC GAIT DISORDERS (ATASIA-ABASIA)
• 1. transient fluctuations in posture while walking,
• 2. knee buckling without falls,
• 3. excessive slowness and hesitancy,
• 4. crouched, stooped or other abnormal posture of the trunk,
• 5. complex postural adjustments with each step,
• 6. exaggerated body sway or excessive body motion especially
brought out by tandem walking, and
• 7. trembling, weak legs.
50. REFERENCES
• Bradleys Neurology in Clinical Practice 7th edition
• DeJongs The Neurological Examination 7th edition
• Uptodate. Com
• Jacquelin perry, GAIT ANALYSIS normal and pathological
function
• Gait Disorders Evaluation and Management Jeffrey M.
Hausdorff