Presentation is loading. Please wait.

Presentation is loading. Please wait.

Abnormal gait Seeing a patient walk can be very revealing for neurological diagnosis and is an important element of assessing disability. Patterns of weakness,

Similar presentations


Presentation on theme: "Abnormal gait Seeing a patient walk can be very revealing for neurological diagnosis and is an important element of assessing disability. Patterns of weakness,"— Presentation transcript:

1 Abnormal gait Seeing a patient walk can be very revealing for neurological diagnosis and is an important element of assessing disability. Patterns of weakness, loss of coordination and proprioceptive sensory loss produce a range of abnormal gaits.

2 Abnormal gait Neurogenic gait disorders need to be distinguished from those due to skeletal abnormalities, usually characterised by pain producing an antalgic gait, or limp. Gaits that do not fit either pattern may be due to psychiatric disorders and are usually incompatible with any anatomical or physiological deficit.

3 Pyramidal gait Upper motor neuron (pyramidal) lesions cause a gait in which the upper limb is held in flexion and the ankle joint in the lower limb kept relatively extended. This causes a tendency for the toes to strike the ground while walking and in an attempt to overcome this, the leg is swung outwards at the hip (circumduction), but the affected foot still scuffs along the ground and the shoe on the affected side may be worn at the toes as evidence of this type of gait. In a hemiplegia, the asymmetry between the affected and normal sides is obvious in walking. In a paraparesis, both lower limbs swing slowly from the hips in extension and dragged stiffly over the ground.This can often be heard as well as seen.

4 Foot drop In normal walking, toe strike follows heel strike during the gait cycle. If there is a lower mootor neuron lesion affecting the lower limb, weakness of ankle dorsiflexion disrupts this pattern. The result is a less controlled descent of the foot making a slapping noise. If the distal weakness is more severe, the foot will have to be lifted higher at the knee to allow room for the inadequately dorsiflexed foot to swing through, producing a high stepping gait.

5 Myopathic gait During walking, alternate transfer of the body's weight through each leg requires careful control of hip abduction by the gluteal muscles. In proximal muscle weakness, usually caused by muscle disease, the hips are not properly fixed by these muscles and trunk movements are exaggerated, producing a rolling or waddling gait.

6 Ataxic gait An ataxic gait can occur as the result of lesions in the cerebellum, vestibular apparatus or peripheral nerves

7 Ataxic gait Patients with lesions of the central parts of the cerebellum (the vermis) walk with a characteristic broad-based gait, 'like a drunken sailor' (cerebellar function is particularly sensitive to alcohol). Patients with acute vestibular disturbances walk in a similar broad-based fashion, though the accompanying vertigo distinguishes them from those with cerebellar lesions. Less severe degrees of cerebellar ataxia can be detected by asking the patient to walk heel to toe; patients with vermis lesions are unable to do this.

8 Sensory ataxia Impairment of joint position sense makes walking unreliable, especially in poor light. The feet tend to be placed on the ground with greater emphasis, presumably in an attempt to increase what proprioceptive input is available. This results in a 'stamping' gait which is often combined with foot drop when caused by a peripheral neuropathy, but it can occur in disorders of the dorsal columns in the spinal cord

9 Extrapyramidal gait Patients with Parkinson disease and other extrapyramidal diseases have difficulty initiating walking and difficulty controlling the pace of their gait. Patients may get stuck while trying to start walking or when walking through doorways (freezing ).Once started they may shuffle and have problems controlling the speed of their walking and sometimes have difficulty stopping. This produces the Festinant gait ; initial stuttering steps that quickly increase in frequency while decreasing in length.

10 INVOLUNTARY MOVEMENTS

11 Rest tremor This is pathognomonic of Parkinson disease. It is characteristically pill rolling and usually presents asymmetrically. Tremor of the head is not a rest tremor, since this a postural tremor disappearing when the h ead is supported

12 Physiological tremor This the most common type of action trmor and occurs at a frequency of 8-12 Hz. It is common in normal subjects and exaggeration occurs in anxiety and in other situations.

13 CAUSES OF EXAGGERATED PHYSIOLOGICAL TREMOR Anxiety Fatigue Thyrotoxicosis,cushing disease, pheochromocytoma, hypoglycemia Endocrine B-agonists,theophylline,caffeine,lithium, dopamine agonists,sodium valproate,tricyclics,phenothiazines, amphetamines Drugs Mercury,lead, arsenicToxins Alcohol withdrawal

14 Essential tremor Essential tremor is distinct from a physiological tremor, although resembling it superficially. It is slower and may become quite disabling. The condition is often inherited, and in some families most obvious during certain specific actions such as writing or holding a glass. Alcohol often suppresses it, sometimes to the extent that the patient becomes depedent. Centrally acting β- adrenoceptor antagonists (β-blockers) such as propranolol are often effective in treatment.

15 Intention tremor This is characterised by oscillation at the end of a movement and typically occurs in cerebellar disease, due to the breakdown of feedback control of targeted movements. A more dramatic intention trmor occurs with lesions in the superior cereballar peduncle (the site of the cerebellar outflow to the red nucleus).

16 Asterixis (flapping tremor) Asterixis, the 'flapping' tremor seen in metabolic disturbances, is the result of intermittent failure of the parietal mechanisms required to maintain a posture. Thus, when a patient is asked to hold out the arms with the hands extended at the wrists, this posture is periodically dropped, allowing the hands to drop transiently before the posture is taken up again. Occasionally, unilateral asterixis can be seen in an acute parietal lesion, usually vascular.

17 Causes of asterixis Renal failure Liver failure Drug toxicity Hypercapnia Acute focal parietal or thalamic lesion

18 Chorea, athetosis, ballism These are due to disturbance of balance of activity in the basal ganglia. Chorea (the Greek for 'dance') : Jerky, small-amplitude, purposeless involuntary movements. In the face, grimaces; they suggest disease in the caudate nucleus (as in Huntington's disease. Hemiballismus: More dramatic ballistic flying violent movements of the limbs usually occur unilaterally in vascular lesions of the subthalamic structures. Athetosis : Slower writhing movements of the limbs. These are often combined with chorea (and have a similar list of causes) and are then termed 'choreo-athetoid' movements.

19 CAUSES OF CHOREA Huntington's disease, Wilson's disease, Neuroacanthocytosis,, Porphyria, Paroxysmal choreoathetosis Hereditary kernicterus Cerebral birth injury Cerebral trauma Levodopa Dopamine agonists Phenothiazines Tricyclics Oral contraceptive Drugs Pregnancy, Oral contraceptive, Thyrotoxicosis Hypoparathyroidism Hypoglycaemia Endocrine Post-streptococcal (Sydenham's chorea) Henoch-Sch ö nlein purpura Creutzfeldt-Jakob disease Antiphospholipid antibody syndrome SLE Infective / inflammatory Lacunar infarction Arteriovenous malformation Vascular


Download ppt "Abnormal gait Seeing a patient walk can be very revealing for neurological diagnosis and is an important element of assessing disability. Patterns of weakness,"

Similar presentations


Ads by Google