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.

 B. Ataxia Gait
         There are 2 forms of ataxia gait, ie as a result of sensory ataxia and disorders relating to the coordination mechanism ( interference cerebellum ) .

• Gait in sensory ataxia
This Abnormality is most often caused by the occurrence of proprioceptive poles , the spinal medulla ( posterolateral sclerosis, multiple sclerosis, tabes dorsalis ) . Often referred to as gait  resulting from spinal ataxia . Can be obtained at danle peripheral neuropathy in the brain stem where there is conduction disturbances kinesthetic sensations . Harassment sense position and movement of the body ( joints , muscles and tendons of the foot and leg ) and loss of spatial orientation causes ataxia . The patient is unaware of the position of limbs in space , when not supported by the visual impulses . Patients can walk normally when the eyes open, but when closed eyes happen walking becomes irregular and jerking ( Jerky ), and patients walk with wide steps  Time walking cast and the first fall is the heel and then the fingers , this will cause a voice ( slapping sound or double tap )

• Gait  in  ataxia serebellar
Because of interference coordination mechanism and cerebellum , systems of contacts. Ataxia occurs, both when eyes closed or open . Lesion in vermis / center line of the road there is a form of gait sway, stagger, ireguler, tilt to one side and the other side, a sudden movement forward / to the side, and step width. Not capable of walkning tandem , or follow a straight line on the floor. Tremor and movement can be found in the whole body sway . In a localized abnormality in the cerebellum or poles of hemisfer their contacts, or vestibuler unilateral disease, recovered wobble or devial settled into the lesion side. In experiments to walk the straight line or a tandem , turning toward the side of the lesion. At the time of good walks around the chair in the same direction or in opposite directions with the clock, patients consistently fall toward the side of the lesion. At the moment a few steps backward and forward can there compass deviation.

C.  Spastic Gait
        There are 2 types of spastic, which is associated with impaired unilateral and bilateral corticospinal pathway.

• Gait in spastic hemiplegia
Most often due to cerebrovascular disease, but can also by a variety of lesions that cause outages pyramidal innervation on half of the body. There is hemiparese contralateral spastic, to the lesion, accompanied by increased tone and reflexes. Upper limbs are in a state of flexion and adduction at the shoulder, flexion at the elbow, wrist flexion and interphalangeal joint. Lower limbs are in a state of extension at the hip and knee, with plantar flexion of the foot and toes. Equinus deformity of the foot there. when walking, the arm on the affected side in a state of flexion and stiff and not swing normally. Extension and the leg is stiff, so the patient dragging their feet and toes scraping the floor. At every step of the pelvis is tilted forward to help lift a finger and the floor, and swung their legs forward, semicircular (circumduction). There is a distinctive sound that is generated due to scratches fingers, on the floor. Rotating on the paralyzed side is easier than to the healthy side. In the light can be found hemiparese loss of arm swing on the affected side, can be a significant diagnostic sign.
• Gait in spastic paraplegia
There is parese spastic in both lower extremities, can be found ekuinus foot position, shortening of the Achilles tendon, obturator spasm, adductor. Patient walking with stiff legs and dragged, with fingers scraping the floor. There can also be adduction of the thigh so that knees crossed each other at every step. This step produces scissors (scissors gait). Short and slow steps, it seems sticky feet to the floor.

D. Spastic – Ataxic Gait
          Spastic ataxic is Obtained on diseases of the pyramidal tract and lateral columns (posterolateral sclerosis), ie as in pernicious anemia and multiple sclerosis. May be ataxia type or ataxia spinal cerebellar ataxia (sensory). On pernicious anemia, a sensory ataxia, whereas ataxia in multiple sclerosis can be derived from cerebellar ataxia or sensory or could be a combination of both. in amyotrophic lateral sclerosis (ALS), there can be bilateral foot drop and also spasticity, this causes interference goes spastic ataxic gait similar. 

E. Parkinsonism Gait 
               In a variety of extra-pyramidal syndrome, particularly Parkinson's disease, parkinsonism and drug-induced post-encephalitis parkinsonism, gait abnormalities are characterized by rigidity, bradykinesia, and loss of motion simultaneously (associated movements). Slow, stiff (rigid) and dragged, the patient walked with small steps such as made-up. There is a typical posture associated with body deformities. Bending the body, with the head and neck forward, knees flexed, upper limb flexion at the shoulder, elbow and wrist, but the fingers are the extension at the interphalangeal joints. This bent position, causing the point to shift weight forward, causing a tendency to fall forward when walking (propulsion), and also increased walking speed (festination). It is difficult to start a movement, it appears when the patient stood up from the chair, and is about to start walking. Rigid patient motion and turning is done with slow, small steps and more. When the swing arm is missing and this affects the speed and balance. Tremor when walking became more apparent. In some cases that stand out is the ability akinesia with very little movement. Sometimes this manifestation is unilateral parkinsonism.

F. Marche a petit pas
         Walking style like parkinsonism gait, a slow movement, a very short step, dragged, like a made-up with irregular steps. Often accompanied by the loss of the same movement. Sometimes there are strange manifestations in the form of a dance or jump. There can be a thorough weakness of the lower extremities or the entire body, and the patient's fatigue. Found in patients with cerebral or spinal disorders are suspected as a result of arteriosclerotic changes.

G. Apraxia Gait
          Is the loss of the ability to use the lower limbs, as appropriate, when walking, although not found any sensory loss or motor weakness. Found in patients with extensive cerebral disorders, especially in the frontal lobe. Patients can not make a move aimed feet and legs, for example, make a circle or a shot at the imaginary ball. There is a difficulty to begin the movement at the time to get up, stand and walk, and the loss of sequences (sequences) compound movement. Patients slow and dragged with short steps. There is difficulty lifting the foot off the floor or stand but does not advance their  feet .

H. The steppage gait
             This Impaired gait is contained in and related with foot drop caused by weakness or paralysis of dorsiflexion of the foot and / or toes. when walking can be dragged or lifted high to compensate for foot drops. There is an excessive flexion of the hip and knee, foot thrown forward and the fingers down to the distinctive sound before the heel or the front foot on the floor. Patients can not stand on their heels. Gait can be unilateral or bilateral. The most common cause is the tibialis anterior paresis and / or extensor digitorum and hallucis longus, which is caused by lesions in the communist or deep peroneus nerve, lesions in segments L4-S1 or cauda equina. Steppage foot drops and can also be found on the gait poliomyelitis,. PSMA (progressive spinal muscular attrophy), ALS, disease Charcot-Marie-Tooth, and peripheral neuritis.

I. Dystrophic Gait (wadding gait)
            Present in various myopathies circumstances where there is a weakness in the muscles of the pelvic girdle. The most typical found in muscular dystrophy, but can also on miosists or disease spinal muscular. Stand and walk with excessive lordosis, while walking there is a real wobble effect of pelvic fixation difficulties. Patients walk with wide steps and looks excessive pelvic rotation, pelvic twisting or throwing from one side to the other at every step to move the weight. Collateral motion compensation is primarily due to weakness of the gluteal muscles. Patients have difficulty climbing stairs, if not assisted by an attractive hand up. There is difficulty standing from a lying down or sitting without assistance (up to himself). Waddling gait is also found in the dislocation of the hip.

J. Gait associated with paresis and paralysis
           Walking impairment can occur in a variety of paralysis. Paresis gastrocnemius and soleus, the patient can not stand on the toes, heel first when walking on the floor, and dragged feet hamstring muscle paresis, there is muscle weakness of knee flexion. Quadriseps femoris muscle paresis, weakness of knee extension, is not able to go up or down stairs or rising from a kneeling position without holding knee, when the knee must be kept straight, if  knees are bent, the patient tends to fall. Walking backwards is easier than forward. N.peroneus superficial paresis, weakness of eversion, patients walk using the outside of foot.

K. Gait in other circumstances
          At Huntington chorea. Can be obtained by walking as dancing. At athetosis movement at the distal body became more pronounced during the walk and with a grin. In the aftermath of encephalitis can be obtained when the jump elements. On a variety of psychological disorders circumstances, can be found the typical gait. In the state of depression, patients walk bent with a slow pace. In the state of mania patients to walk upright and overactive. N irritation. ischiadicus patients walk leaning to the side to prevent strain on the pain nerves, walking with small steps with half knee flexion, body bent forward and to the side of the hospital (neri sign).

         In the hysteria can be obtained objec walking impairment or even examination the patient is unable to stand up. coordinate and muscle tone while lying down may be normal. Strange limping, can not be confirmed by a specific pattern of organic disease. Irregular movement with elements spatisitas ataxia and various other types of disorders. Excessive movements to swing right or left, it seems like about to fall but can usually be prevented. When dropped, the fall in such a way that does not injure himself. Could resemble monoplegia limping, hemiplegia or paraplegia.

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