Gait abnormalities

GAIT & ITS ABNORMALIT

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Presentation by:

Dr Indrajeet P. ShahDr Amit A. Bhasme

DEFINITION GAIT

a manner of walking or moving on foot a sequence of foot movements (as a walk, trot,

pace, or canter) by which a horse or a dog moves forward

a manner or rate of movement or progress <the leisurely gait of summer>

ESSENTIALS OF GAIT

There are four major criteria essential to walking. Equilibrium: The ability to assume an upright posture and maintain balance.

Locomotion: The ability to initiate and maintain rhythmic stepping

Musculoskeletal Integrity: Normal bone, joint, and muscle function

Neurological Control: Must receive and send messages telling the body how and

when to move. (visual, vestibular, auditory, sensori-motor input)

Forces for gait: Muscular force. Gravitational force. Forces of momentum. Floor reaction force.

GAIT CYCLE

The gait cycle is used to describe the complex activity of walking, or our gait pattern. This cycle describes the motions from initial placement of the supporting heel on the ground to when the same heel contacts the ground for a second time.

The stance period consists of the first five phases: initial contact, loading response, mid-stance and terminal stance.

WHAT CAUSES PEOPLE TO HAVE A BAD GAIT?

Gait and balance problems can be a result of pain, muscle weakness, muscle tightness or spasticity, loss of balance, or poor posture. Other causes include limited range of motion, numbness (sensory deficit), and fatigue. Muscle weakness can occur in one leg or both, and make walking difficult

HEMIPLEGIC GAIT The patient stands with unilateral

weakness on the affected side, arm is held immoblie and close to the side, with elbow, wrist and interphalangeal joints flexed. 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.

DIPLEGIC GAIT (SCISSORS 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.

This gait is seen in bilateral periventricular lesions, such as those seen in cerebral palsy.

There is also characteristic extreme tightness of hip adductors which can cause legs to cross the midline referred to as a scissors gait.

NEUROPATHIC GAIT(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.

These patients either drag their feet or left them high, with knees flexed, and bring them down with a slap onto the floor, thus apperaing to be walking up stairs. They are unable to walk on their heels.

Unilateral, causes include peroneal nerve palsy and L5 radiculopathy.

Bilateral, causes include amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease and other peripheral neuropathies including those associated with uncontrolled diabetes.

SENSORY GAIT

As our feet touch the ground, we receive propioreceptive information to tell us their location.

The sensory ataxic gait occurs when there is loss of this propioreceptive input.

In an effort to know when the feet land and their location, the patient will slam the foot hard onto the ground in order to sense it. A key to this gait involves its exacerbation when patients cannot see their feet (i.e. in the dark).

This gait is also sometimes referred to as a stomping gait since patients may lift their legs very high to hit the ground hard.

This gait can be seen in disorders of the dorsal columns (B12 deficiency or tabes dorsalis) or in diseases affecting the peripheral nerves (uncontrolled diabetes).

MYOPATHIC GAIT

Hip girdle muscles are responsible for keeping the pelvis level when walking. If you have weakness on one side, this will lead to a drop in the pelvis on the contralateral side of the pelvis while walking (Trendelenburg sign). With bilateral weakness, you will have dropping of the pelvis on both sides during walking leading to waddling. This gait is seen in patient with myopathies, such as muscular dystrophy.

CHOREIFORM GAIT(HYPERKINETIC 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.

PARKINSONIAN GAIT In this gait, the patient will have rigidity and

bradykinesia. He or she will be stooped with the head and neck

forward, with flexion at the knees. The whole upper extremity is also in flexion with the fingers usually extended. The patient walks with slow little steps known at marche a petits pas (walk of little steps). Arm swings are decreased and the patient turns around stiffly-”all in one piece”

Patient may also have difficulty initiating steps. The patient may show an involuntary inclination to take accelerating steps, known as festination.

This gait is seen in Parkinson's disease

GAIT OF OLDER AGE Speed, balance and agility decrease with

aging. Steps become short, uncertain and even shuffling. The legs may be flexed at hips and knees. A cane may bolster lost confidence.

Due to aging process.

DIAGNOSING GAIT AND BALANCE PROBLEMS

A physical and neurological examination can diagnose gait or balance problems. Doctors typically also ask questions about symptoms and severity.

Performance testing can then be used to assess individual gait difficulties. Potential further tests to identify causes include hearing tests, inner ear imaging, and vision tests including watching eye movement. Magnetic resonance imaging (MRI) or a computed tomography (CT) scan can check the brain and/or blood pressure/heart rates tests. A doctor will look to find which part of the nervous system is contributing to the gait and balance problems.

GAIT AND BALANCE PROBLEM PROGNOSIS

The prognosis of gait and balance problems is dependent on the underlying medical condition.

Falls in older adults, due to gait and balance problems, are a common cause of mortality and morbidity and can lead to injury, loss of independence, and change in lifestyle.

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