3. EXAM: STEPS Make sure the patient’s legs are clearly visible Ask the patient to walk normally, turn around and walk back. Observe: i) Posture ii) Balance iii) Position & swinging of the arms iv) Movement of the legs Perform tandem gait (heel-to-toe) EXPOSURE OBSERVE PERFORM
4. ROOMBERG’S TEST ask patient to stand with the heels together, first with eyes open ,then with eyes closed Unsteadiness
5. EXAM: OTHER 5.Other examinations: a)Walk on toes-S1 lesion b)Walk on heels-high stepping gait(foot drop) c)Test for proximal myopathy (squat and then stand up)-waddling gait d)Lie down and imagine pedaling a bicycle -apraxic gait 6. End examination by looking for additional signs. Example; -Parkinsonism signs -Cerebellar signs
6. 1. HEMIPLEGIC GAIT Thus the foot is swung in a lateral arc and pelvis is elevated on that side to avoid the affected foot from scraping the floor. Characteristics of hemiplegic gait
7. 2. SCISSORS GAIT Spastic Paraperesis Knee appear to be stuck together Feet stuck to the floor Characteristics of scissors gait
13. 8. APRAXIC GAIT Impaired ability to plan and execute sequential movements due bilateral frontal lobe disease
14. 9. PSYCHOGENIC/HYSTERICAL GAIT Gait does not conform to any one of typical gait disorders A.k.aAstasia-abasia (inabililty to stand or walk in a normal manner) Characteristics: -Normal coordination of leg movements in bed or while sitting -Unable to stand or walk without assistance -If distracted, stationary balance is sometimes maintained and several steps are taken normally, followed by a dramatic demonstration of imbalance with a lunge toward the examiner's arms or a nearby bed.
Normal gait: erect posture, moderately sized steps, arms swing
UNSTEADINESS AND BROAD BASED GAIT- CEREBELLAR, VESTIBULAR, & PROPRIOCEPTIVE DISORDERSVision compensates for proprioceptive lossVestibular disorder- nystagmus & no other cerebellar signsProprioceptive disorder-cerebellar signs may be present & are typically worse when the eyes are closed
Bear in mind, not everyone may be able to walk on their toes or heels-especially the elderly.
Likened to a drunken sailor gait
One of the causes of multiinfarct dementia, in which there are many infarcts and lacunae in the white matter, with relative sparing of the cortex and basal ganglia.
MRI BRAIN/SPINE- MS (PERIVENTRICULAR WHITE MATTER LESIONS OR HIGH SIGNAL INTENSITIES),SPINAL XRAY-LOOK FOR FRACTURE CAUSING MYELOPATHYSPINAL MRI-LOOK FOR CORD COMPRESSION DUE TO TUMOUR, PROLAPSED DISC, INFECTION OR TRAUMACXR/CT THORAX-BRONCHOGENIC CA CAUSING PARANEOPLASTIC SYNDROME LEADING TO CEREBELLAR SYNDROME
FBC-leucocytosis, megaloblastic anemia due to B12 deficiencyESR- raised in inflammatory condition eg: SLE (vasculitis) transverse myelitisSyphilis serology- +ve may indicate myelopathy or tabesdorsalisSerum B12 deficiency subacute combined degeneration of the cord loss of vibration and joint position sense ataxic gaitU & E- severe hypokalaemia can cause muscle weakness, hypocalcaemia cause myopathyPSA- secondary met to spine is the commonest cause of cord compression.Serum Creatinephosphokinase- elevated in many dystrophies/muscle disease
Lumbar puncture elevated granulocytes bacterial meningitis or encephalitis cerebellar syndromeIncreased lactate can occur the presence of cancer of the CNS, multiple sclerosis, traumatic brain injury, cerebral ischemia, brain abscess, hydrocephalus or bacterial meningitis. Changes in total protein content of cerebrospinal fluid- meningitis, neurosyphilis, brain abscesses, subarachnoid hemorrhage, polio or Guillain-Barré syndromeMuscular biopsy-muscular disorders
