Videos!
Clinical Evaluation & Treatment of Gait Abnormalities
††† For the absolutely devoted only. Based on multiple sclerosis. It's 20 minutes long (a.k.a. lecture).
Hemiplegic Gait (Spastic)
Demonstration:
††† The patient has unilateral weakness and spasticity with the upper extremity held in flexion and the lower extremity in extension. The foot is in extension so the leg is "too long" therefore, the patient will have to circumduct or swing the leg around to step forward. This type of gait is seen with a UMN lesion.
Patient:
††† Circumduction gait due to upper motor neuron lesion (hemiplegia).
Diplegic Gait (Spastic/Scissor)
Demonstration:
††† The patient has spasticity in the lower extremities greater than the upper extremities. The hips and knees are flexed and adducted with the ankles extended and internally rotated. When the patient walks both lower extremities are circumducted and the upper extremities are held in a mid or low guard position. This type of gait is usually seen with bilateral periventricular lesions. The legs are more affected than the arms because the corticospinal tract axons that are going to the legs are closest to the ventricles.
Patient:
††† This man has an UMN lesion affecting both lower extremities. He has spasticity and weakness of the legs and uses a walker to steady himself. There is bilateral circumduction of the lower extremities.
Myopathic Gait (Waddling)
Demonstration:
††† Myopathic Gait Demonstration With muscular diseases, the proximal pelvic girdle muscles are usually the most weak. Because of this the patient will not be able to stabilize the pelvis as they lift their leg to step forward, so the pelvis will tilt toward the non-weight bearing leg which results in a waddle type of gait.
Patient:
††† 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.
Neuropathic Gait (High Stepping/Steppage)
Demonstration:
††† Neuropathic Gait Demonstration This type of gait is most often seen in peripheral nerve disease where the distal lower extremity is most affected. Because the foot dorsiflexors are weak, the patient has a high stepping gait in an attempt to avoid dragging the toe on the ground.
Patient:
Choreiform Gait
Demonstration:
††† This is a hyperkinetic gait seen with certain types of basal ganglia disorders. There is intrusion of irregular, jerky, involuntary movements in both the upper and lower extremities.
Patient:
††† Note the involuntary, irregular, jerky movements of this woman's body and extremities, especially on the right side. There are also choreiform movements of the face. A lot of her movements have a writhing, snake-like quality to them, which could be called choreoathetoisis.
Parkinsonian Gait
Demonstration:
††† This type of gait is seen with rigidity and hypokinesia from basal ganglia disease. The patient's posture is stooped forward. Gait initiation is slow and steps are small and shuffling; turning is en bloc like a statue.
Patient:
††† Shuffling gait.
Ataxic Gait
Demonstration:
††† The patient's gait is wide-based with truncal instability and irregular lurching steps which results in lateral veering and if severe, falling. This type of gait is seen in midline cerebellar disease. It can also be seen with severe lose of proprioception (sensory ataxia).
Patient:
††† This woman's gait is wide-based and unsteady. She has to use a walker or hold on to someone in order to maintain her balance (note how hard she has to work with the hand that she's holding on with in order to maintain her balance). Her ataxia is even more apparent when she tries to turn.
Clinical Evaluation & Treatment of Gait Abnormalities
††† For the absolutely devoted only. Based on multiple sclerosis. It's 20 minutes long (a.k.a. lecture).
Hemiplegic Gait (Spastic)
Demonstration:
††† The patient has unilateral weakness and spasticity with the upper extremity held in flexion and the lower extremity in extension. The foot is in extension so the leg is "too long" therefore, the patient will have to circumduct or swing the leg around to step forward. This type of gait is seen with a UMN lesion.
Patient:
††† Circumduction gait due to upper motor neuron lesion (hemiplegia).
Diplegic Gait (Spastic/Scissor)
Demonstration:
††† The patient has spasticity in the lower extremities greater than the upper extremities. The hips and knees are flexed and adducted with the ankles extended and internally rotated. When the patient walks both lower extremities are circumducted and the upper extremities are held in a mid or low guard position. This type of gait is usually seen with bilateral periventricular lesions. The legs are more affected than the arms because the corticospinal tract axons that are going to the legs are closest to the ventricles.
Patient:
††† This man has an UMN lesion affecting both lower extremities. He has spasticity and weakness of the legs and uses a walker to steady himself. There is bilateral circumduction of the lower extremities.
Myopathic Gait (Waddling)
Demonstration:
††† Myopathic Gait Demonstration With muscular diseases, the proximal pelvic girdle muscles are usually the most weak. Because of this the patient will not be able to stabilize the pelvis as they lift their leg to step forward, so the pelvis will tilt toward the non-weight bearing leg which results in a waddle type of gait.
Patient:
††† 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.
Neuropathic Gait (High Stepping/Steppage)
Demonstration:
††† Neuropathic Gait Demonstration This type of gait is most often seen in peripheral nerve disease where the distal lower extremity is most affected. Because the foot dorsiflexors are weak, the patient has a high stepping gait in an attempt to avoid dragging the toe on the ground.
Patient:
Choreiform Gait
Demonstration:
††† This is a hyperkinetic gait seen with certain types of basal ganglia disorders. There is intrusion of irregular, jerky, involuntary movements in both the upper and lower extremities.
Patient:
††† Note the involuntary, irregular, jerky movements of this woman's body and extremities, especially on the right side. There are also choreiform movements of the face. A lot of her movements have a writhing, snake-like quality to them, which could be called choreoathetoisis.
Parkinsonian Gait
Demonstration:
††† This type of gait is seen with rigidity and hypokinesia from basal ganglia disease. The patient's posture is stooped forward. Gait initiation is slow and steps are small and shuffling; turning is en bloc like a statue.
Patient:
††† Shuffling gait.
Ataxic Gait
Demonstration:
††† The patient's gait is wide-based with truncal instability and irregular lurching steps which results in lateral veering and if severe, falling. This type of gait is seen in midline cerebellar disease. It can also be seen with severe lose of proprioception (sensory ataxia).
Patient:
††† This woman's gait is wide-based and unsteady. She has to use a walker or hold on to someone in order to maintain her balance (note how hard she has to work with the hand that she's holding on with in order to maintain her balance). Her ataxia is even more apparent when she tries to turn.
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