1. There are many types of neurological gait disorders that can arise from damage or dysfunction in different parts of the brain or nervous system. 2. Hemiplegic gait results from weakness on one side of the body, like after a stroke, causing the affected leg to drag and circumduct during walking. 3. Parkinsonian gait is slow, stiff, and shuffling, with loss of arm swing and difficulty initiating movement.

1. Neurological Sources of Gait
Dysfunction
“If you are going to talk the talk, you’ve got to walk the walk”

2. Phases of Gait

3. There is something divine in all human beings
by nature of the miracle of walking
• Feet are placed on two points=a line.
• Not a plane (that’s why people often benefit from canes ie 3 points)
• Modification must be made from microsecond to microsecond to
correct for changes in the center of gravity
• Environment
• Body position
• Forces
• NEWTON’S THREE LAWS OF MOTION
• Inertia
• Force=Mass X Acceleration
• Equal and opposite reaction

4. Hemiplegia Gait
• The patient stands with unilateral
weakness on the affected side, arm
flexed, adducted and internally rotated.
• Leg on same side is in extension with
plantar flexion of the foot and toes.
• When walking, the patient will hold his or
her arm to one side and drags his or her
affected leg in a semicircle
(circumduction) due to weakness of distal
muscles (foot drop) and extensor
hypertonia in lower limb.
• This is most commonly seen in stroke.
With mild hemiparesis, loss of normal
arm swing and slight circumduction may
be the only abnormalities.

5. Diplegic Gait
• Patients have involvement on both sides with
spasticity in lower extremities worse than
upper extremities.
• The patient walks with an abnormally narrow
base, dragging both legs and scraping the
toes.
• There is also characteristic extreme tightness
of hip adductors which can cause legs to cross
the midline referred to as a scissors gait.
• This gait is seen in bilateral periventricular
lesions, such as those seen in cerebral palsy
or bilateral stroke. High cervical cord UMN
pathology will also give a similar picture

6. Parkinson Gait
• Akinetic-rigid
• Rigidity, bradykinesia and loss of
associated movements
• Stooped head and neck forward with
knees flexed
• Upper extremities used flexed at the
elbow and wrist
• Slow, stiff and shuffling with short
stride
• Festination=involuntary acceleration
with decreased arm swing, enbloc
turning, start hesitation, freezing
when encountering an obstacle

7. Parkinson Gait
• Marked akinesia
• Loss of postural reflexes
• Improves when the automatic
component of gait is replaced by
conscious movement

8. Neuropathic or Steppage Gait
• Seen in patients with foot drop
(weakness of foot dorsiflexion), the
cause of this gait is due to an attempt
to lift the leg high enough during
walking so that the foot does not drag
on the floor.
• If unilateral, causes include peroneal
nerve palsy and L5 radiculopathy.
• If bilateral, causes include
amyotrophic lateral sclerosis, Charcot-
Marie-Tooth disease and other
peripheral neuropathies including
CIDP those associated with
uncontrolled diabetes.

9. Choreiform Gait
• This gait is seen with certain
basal ganglia disorders including
Sydenham's chorea,
Huntington's Disease and other
forms of chorea, athetosis or
dystonia.
• The patient will display irregular,
jerky, involuntary movements in
all extremities. Walking may
accentuate their baseline
movement disorder.

10. Ataxic Gait
• Most commonly seen in cerebellar disease,
this gait is described as clumsy, staggering
movements with a wide-based gait.
• While standing still, the patient's body may
swagger back and forth and from side to side,
known as titubation.
• Patients will not be able to walk from heel to
toe or in a straight line.
• The gait of acute alcohol or drug intoxication
intoxication will resemble the gait of
cerebellar disease.
• PCP is one of the few illicit drugs that will give
vertical nystagmus.
• Patients with more truncal instability are more
likely to have midline cerebellar disease at the
vermis.

11. Apractic Gait
• Damage to the frontal lobes, often produces a
curious kind of gait disturbance called “apraxia” of
gait.
• The patient tends to slide their foot along the floor
instead of lifting and placing normally. This has been
called a “glue-footed" or "magnetic" gait, and the
patient may be retropulsive if this is severe.
• Primitive reflexes such as grasp, snout, palmomental
and glabellar responses are likely to be disinhibited,
and the patient's personality or cognitive function are
often impaired.
• When severe, these kinds of frontal lobe conditions
may result in incontinence, which typically occurs
without warning.
• Conditions such as frontal lobe strokes, tumors or
normal pressure hydrocephalus should be
considered as possible causes, although
generalized dementing illnesses can also involve
frontal lobes.
• In patients with generalized dementia, such as
Alzheimer disease, gait disturbance is usually found in
the latter stages.

12. Myopathic Gait
• This young boy has pelvic girdle
weakness, which produces a
waddling type of gait.
• Note the lumbar hyperlordosis
with the shoulders thrust
backwards and the abdomen
being protuberant.
• This posture places the center of
gravity behind the hips so the
patient doesn't fall forward
because of weak back and hip
extensors.

13. Myopathic Gait
• With abductor weakness of the
hip, the affected side drops
• Commonly affected muscle is
the gluteus medius
• Etiologies include:
• Muscular dystrophy
• Avulsion of the gluteus medius
tendon following hip surgery
• L5 radiculopathy
• Superior gluteal nerve injury

14. Myopathic Gait
• “Winking Gait”
• Right hip drops suggesting hip
abductor weakness
• This patient would be expected
to have a right sided
Trendelenberg Sign

15. Astasia Abasia
• Astasia-abasia refers to the inability
to stand or walk despite possessing
good motor strength and
• conserved voluntary coordination
• Usually associate with psychogenic,
functional or conversion origin
• Symptomatic astasia-abasia has
been associated with lesions
affecting the pontomesencephalic
region, thalamus, corpus callosum,
or cingulate cortex.

16. Psychogenic Gait
• Variable in expression, duration
and appearance
• Really rather athletic in this
example
• Trust your eyes…if the gait
make you want to roll them,
it’s likely to be psychogenic

17. Silly Walks