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Gait disorders.pptx
- 1.
- 2. Gait disorders • canbe caused by abnormal function of almost any part of the nervous system, as well as by some orthopedic conditions • Careful examination of gait is therefore one of the most sensitive tests of subtle neurologic dysfunction • However, gait disorders alone often do not provide enough information for localization, and they must be analyzed in the context of a complete history and neurologic exam
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- 4. LOCALIZATION • Unilateral orbilateral corticospinal tracts
- 5. DESCRIPTION OF GAIT ABNORMALITIES •Unilateral or bilateral. Stiff-legged, circumduction, sometimes with scissoring of the legs and toe-walking (from increased tone in calf muscles),decreased arm swing, unsteady, falling toward side of greater spasticity
- 6. COMMON CAUSES • Cortical,subcortical, or brain stem infarcts affecting upper motor neuron pathways • cerebral palsy; • Degenerative conditions; • Multiple sclerosis; • spinal cord lesions
- 7. ATAXIC GAIT LOCALIZATION: • Cerebellarvermis or other midline cerebellar structures
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- 9. DESCRIPTION OF GAIT ABNORMALITIES •Wide based, unsteady, staggering side to side, and falling toward side of worse pathology. Subtle deficit can be detected with tandem (heel-to-toe, or “drunk walk”) gait testing
- 10. COMMON CAUSES • Toxinssuch as alcohol; medications; • tumors of cerebellar vermis; • infarcts or ischemia of cerebellar pathways • cerebellar degeneration
- 11. PARKINSONIAN GAIT LOCALIZATION • Substantianigra or other regions of basal ganglia
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- 13. DESCRIPTION OF GAIT ABNORMALITIES •Slow, shuffling, narrow based. Difficulty initiating walking. Often stooped forward, with decreased arm swing, and “en bloc turning.”Unsteady, with “retropulsion,” taking several rapid steps to regain balance when pushed backward.
- 14. COMMON CAUSES • Parkinson’sdisease; other parkinsonian syndromes, such as progressive palsy, or use of neuroleptic drugs
- 15. DYSKINETIC GAIT LOCALIZATION • Subthalamicnucleus, or other regions of basal ganglia
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- 17. DESCRIPTION OF GAIT ABNORMALITIES •Unilateral or bilateral dancelike (choreic), flinging (ballistic), or writhing (athetoid) movements occur during walking and may be accompanied by some unsteadiness
- 18. COMMON CAUSES • Huntington’sdisease; • infarct of subthalamic nucleus or striatum; • side effect of levodopa; • other familial or drug-induced dyskinesias
- 19. TABETIC GAIT LOCALIZATION • Posteriorcolumns or sensory nerve fibers
- 20.
- 21. DESCRIPTION OF GAIT ABNORMALITIES •High-stepping, foot-flapping gait with particular difficulty walking in the dark or on uneven surfaces • Patients sway and fall in attempts to stand with feet together and eyes closed (Romberg sign).
- 22. COMMON CAUSES • Posteriorcord syndrome; • Severe sensory neuropathy
- 23. PARETIC GAIT LOCALISATION • Nerveroots • peripheral nerves • Neuromuscular junction, or muscles
- 24.
- 25. DESCRIPTION OF GAIT ABNORMALITIES •Exact appearance depends on location of lesion. With proximal hip weakness there may be a waddling, Trendelenburg gait. Severe thigh weakness may cause sudden knee buckling. Foot drop can cause a high-stepping, slapping gait, with frequent tripping
- 26. CAUSES • Numerous peripheralnerve and muscle disorders
- 27. PAINFUL (ANTALGIC) GAIT LOCALIZATION •Peripheral nerve or orthopedic injury
- 28.
- 29. DESCRIPTION OF GAIT ABNORMALITIES •Pain may be obvious based on patient’s report or facial expression • Patients tend to avoid putting pressure on affected limb.
- 30. CAUSES • Herniated disc; •Peripheral neuropathy; • muscle strain contusions; • fractures