Gait Impairment

A. Impaired Gait by Weakness
         Impaired Gait due to weakness caused by the severe and chronic  disease which  causing extensive atrophy. This gait is not specifically indicate a neurologic disease or focal damage the nervous system. Form of gait disturbance imbalance (unsteadiness) and expect help. Patients seemed to sway to one side and the other, like ataxia. Patients want to lean on the chair looks to acquire holdings or against the wall. The movements are slow and seemed trembling knees.

Examination of Impaired Walking or Gait

During an investigation on pasen with impaired walking, required a thorough examination and assessment stage by stage .

It should be noted :
• symmetry and smoothness of movement
• stride length and width
• pace
• parts of the body, head, shoulders, arms, waist, hip, knee, heel and toe
• movement with related of the eyes, head and body
• noise generated from the road
• patient's job .

Physiology of Walking

A. WALK CYCLE
One cycle walking / gait from heel starts one foot on the floor (heel strike) until the next heel strike of the same leg, called the 100% total walking cycle. Certain points in the cycle can be observed.
a. 0%: heel strike at the beginning phase of standing (stance phase)
b. 15%: front foot touches the floor, also known as flat foot
c. 30%: the heel off the floor (heel off)
d. 45%: knee and hip flexed to accelerate the leg forward, in anticipation of the swing phase (swing phase) called a knee band
e. 60%: fingers off the floor, the end of the phase of the standing to initiate the swing phase, called the toe off. In mid-swing required dorsiflexion of the foot to prevent fingers touching the floor.
f. 100%: back heel touches the floor.
During the total run cycle, phase stands covering 60% and 40% of total cycle is swing phase.

Neurological Aspect of Walking

          In the process of walking / gait there is a complex process that is influenced by a number of mechanisms of the body, and is the result of the collaboration of the various types of reflex. Walk normally usually do not attract attention . Walking impairment can be found in a variety of circumstances . Mechanical factors such as diseases of the muscles, bones, tendons, and joints play an important role in the occurrence of walking impairment .

Medical Treatment and Therapy for Extrapyramidal Syndrome

           General medical treatment and therapy for the extrapyramidal syndrome is patients treated with antihistamines such as difenhidramine , sulfas anticholinergics such as atropine or trihexyphenidil ( ( THP ) , 4 - 6mg per day for 4-6 weeks . Thereafter the dose reduced gradually , ie 2 mg every week , to see if the patient has developed a tolerance to the side effects of extrapyramidal syndrome . severe acute dystonia When the reaction had to be addressed quickly Beztropin generally given IV or IM diphenhydramine . awarded for acathisia anticholinergic and amantadine , and giving propanolol and benzodiazepines such as clonazepam and lorazepam .