Abnormal gait دکترامیر هوشنگ واحدی متخصص طب فیزیکی و توانبخشی قسمت 2

Hemiparetic gait  Extension and circumduction of one leg  weakness on the affected side  Hyper reflexia  extensor plantar response  Flexed arm Paraparetic gait  Stiffness, extension, adduction and scissoring of both legs  Bilateral leg weakness  hyperreflexia, spasticity, and extensor plantar response

 Circumduction  Leg swings outward in an arc  Affected leg is always functionally longer Weak dorsiflexors Weak hip flexors

 Conditions associated with a spastic gait 1.Brain tumorBrain tumor 2.Brain abscessBrain abscess 3.Sturge-Weber syndromeSturge-Weber syndrome 4.Cerebral palsyCerebral palsy 5.Cerebrovascular accidentCerebrovascular accident 6.Multiple sclerosisMultiple sclerosis

 Conditions associated with a scissor gait 1.ArthrogryposisArthrogryposis 2.Spastic diplegiaSpastic diplegia 3.Pernicious anemiaPernicious anemia 4.Cerebrovascular accidentCerebrovascular accident 5.Cervical spondylosis with myelopathyCervical spondylosis myelopathy 6.Liver failureLiver failure 7.Multiple sclerosisMultiple sclerosis 8.Spinal cord traumaSpinal cord trauma 9.Spinal cord tumorSpinal cord tumor 10.Syphilitic meningomyelitisSyphilitic meningomyelitis 11.SyringomyeliaSyringomyelia 12.Cerebral palsyCerebral palsy

Neuropathic gait disorders  distal muscle weakness  unilateral or bilateral  if sensory alterations accompany weakness, the diagnosis of peripheral neuropathy is more assured  produced by loss of proprioceptive input from the legs

 Steppage gait  weakness of foot dorsiflexors  foot drop  excessive flexion of hips and knees when walking  unilateral or bilateral atrophy of distal leg muscles  decreased ankle reflex

 Steppage gait (High stepping, Neuropathic gait) is a form of gait abnormality that is associated with a loss of dorsiflexiongait abnormalitydorsiflexion  Conditions associated with a steppage gait 1.PolioPolio 2.Multiple sclerosisMultiple sclerosis 3.Guillain-BarréGuillain-Barré 4.Spinal disc herniationSpinal disc herniation 5.Peroneal Muscle AtropyPeroneal Muscle Atropy 6.Peroneal nerve InjuryPeroneal nerve 7.Polyneuropathy

Steppage gait  CADENCE Normal  STEP LENGTH Normal  BASE Normal  OTHER ASSOCIATED SIGNS Overlifting and slapping of feet

 Myopathic gait (or waddling gait)  The "waddling" is due to the weakness of the proximal muscles of the pelvic girdle.pelvic girdle  The patient uses circumduction to compensate for gluteal weakness.circumduction gluteal  Conditions associated with a myopathic gait 1.Pregnancy 2.Congenital hip dysplasiahip dysplasia 3.Muscular dystrophy 4.Spinal muscle atrophy 5.myasthenia gravis

Waddling-myopathic  CADENCE Normal  STEP LENGTH Normal  BASE Slightly wide  OTHER ASSOCIATED SIGNS Overlifting of hip(s)

Gluteal lurch  Caused by hip extensor weakness  In stance phase trunk will bend backwards to try and keep CoG behind hip joint

Pulsive or retropulsive gait  Body's center of gravity appears to be either in front or behind the patient  who is struggling to keep his or her feet up to center of gravity  festination  hypokinesia  muscular rigidity  postural instability

 ProConditions associated with a propulsive gait 1.Carbon monoxide poisoningCarbon monoxide poisoning 2.Parkinson's diseaseParkinson's disease 3.Manganese ToxicityManganese Toxicity 4.Carbon monoxide poisoning 5.Drug:metoclopramide;haloperidol ;phenothiazine

Parkinsonian festinating  CADENCE Slow until festination  STEP LENGTH Short  BASE Normal  OTHER ASSOCIATED SIGNS Quickening step, forward leaning, shuffling,may have trouble with gait initiation

Choreic gait  Irregular, dancelike gait  slow and wide-based  spontaneous knee flexion and leg raising  Athetotic and choreic movements of the upper extremities

 Stomping gait (sensory ataxia gait) Conditions associated 1.Friedreich's ataxiaFriedreich's ataxia 2.Pernicious anemiaPernicious anemia 3.Tabes dorsalisTabes dorsalis 4.Peripheral neuropathyPeripheral neuropathy 5.Spinal cord disease 6.Multiple sclerosisMultiple sclerosis

Cerebellar ataxic  CADENCE Irregular  STEP LENGTH Slightly short  BASE Wide  OTHER ASSOCIATED SIGNS Erratic shifting of weight

Sensory ataxic  CADENCE Normal  STEP LENGTH Short  BASE Slightly wide  OTHER ASSOCIATED SIGNS Excessive force in step resulting in stamping