Gait disorders.pptx
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This document describes different types of gait disorders including spastic, ataxic, parkinsonian, dyskinetic, tabetic, paretice, and painful gait. Each type is defined by its localization in the nervous system, description of abnormalities, and common causes. Spastic gait is caused by upper motor neuron lesions and involves stiff-legged walking. Ataxic gait results from cerebellar lesions and is wide-based and staggering. Parkinsonian gait is caused by basal ganglia dysfunction and appears slow and shuffling.
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03 01-06 approach to ataxia
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2. Parkinson's disease commonly starts around age 60 but can begin earlier, and family history and certain genetic mutations or toxic exposures may play a role in its development.
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Gait disorders.pptx
- 2. Gait disorders • can be 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
- 3. SPASTIC GAIT
- 4. LOCALIZATION • Unilateral or bilateral 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: • Cerebellar vermis or other midline cerebellar structures
- 8. ATAXIC GAIT
- 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 • Toxins such as alcohol; medications; • tumors of cerebellar vermis; • infarcts or ischemia of cerebellar pathways • cerebellar degeneration
- 11. PARKINSONIAN GAIT LOCALIZATION • Substantia nigra or other regions of basal ganglia
- 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’s disease; other parkinsonian syndromes, such as progressive palsy, or use of neuroleptic drugs
- 15. DYSKINETIC GAIT LOCALIZATION • Subthalamic nucleus, or other regions of basal ganglia
- 16. DYSKINETIC GAIT
- 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’s disease; • infarct of subthalamic nucleus or striatum; • side effect of levodopa; • other familial or drug-induced dyskinesias
- 19. TABETIC GAIT LOCALIZATION • Posterior columns or sensory nerve fibers
- 20. TABETIC GAIT
- 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 • Posterior cord syndrome; • Severe sensory neuropathy
- 23. PARETIC GAIT LOCALISATION • Nerve roots • peripheral nerves • Neuromuscular junction, or muscles
- 24. PARETIC GAIT
- 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 peripheral nerve and muscle disorders
- 27. PAINFUL (ANTALGIC) GAIT LOCALIZATION • Peripheral nerve or orthopedic injury
- 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