Pathological Gait in Neurology

Pathological Gait in Neuro

• Neurological gait is used to identify clinical signs in various conditions.
• Specific conditions include stroke, Parkinson's Disease, Multiple Sclerosis, and peripheral nerve injury to the common peroneal nerve.

Gait in Stroke

• Initial Contact: Reduced heel strike due to decreased dorsiflexion and increased tone in extensor muscles. Absence of knee flexion or too much knee flexion.
• Loading Response: Reduced weight transfer onto the supporting leg. Patients struggle with lateral/forward weight transfer and may not trust the limb to provide support, leading to compensation with a short, quick step on the other leg.
• Mid-Stance: Reduced weight transfer leads to instability.
• Terminal Stance and Pre-Swing: Reduced forward propulsion due to reduced plantar flexion force. Results in a shorter step on the opposite side.

Reasons for Gait Issues (Stroke)

• Decreased motor control
• Muscle weakness
• Increased muscle tone (spasticity)
• Contractures or deformities
• Sensory deficits
• Balance problems
• Fear

Gait in Stroke: Swing Phase

• Decreased motor control of hip, knee, and ankle flexors coupled with increased tone in extensor muscles.
• Functional leg length discrepancy can result from these issues.
• Compensatory strategies include hip-hitching, circumduction, and vaulting.

Parkinson's Disease (PD)

• Commonly Observed Problems:

  • Flexion of trunk and hips
  • Reduced trunk rotation and arm swing
  • Shuffling steps with reduced heel strike and scuffing of foot during mid-swing.
  • Short stride length, and increased double support.
  • Freezing of gait (sudden or gradual inability to start or continue walking).
  • Festination (involuntary progressive reduction in stride length, increasing cadence, and reduced walking speed).
  • Difficulty turning (slow turns, more steps, poor foot clearance, pause before turning).

• Reasons: Bradykinesia, rigidity, postural instability.

Multiple Sclerosis (MS)

• Commonly observed problems:
  • Flat foot on initial contact ("flapping foot").
  • Irregular foot placement.
  • Unpredictable step length.
  • Wide-base or narrow-base/scissoring gait.
  • Jerky movements.
  • Midstance: knee hyper-extension from reduced eccentric quad activity
  • Weight shifting forward, backward, and laterally, and potentially reliance on trunk for balance.
• Reasons: Fatigue, spasiticity, balance, proprioception, coordination, attentional demands, and potential weakness.

Peripheral Nerve Injury: Common Peroneal Nerve

• Clinical presentation:
  • Motor loss, including flaccid paralysis.
  • Sensory loss (diagram of nerve, location of motor and sensory loss).

Commonly Observed Problems (Peripheral Nerve Injury)

• Foot that drops (unable to hold foot up).

• "Slapping" gait.

• Toes drag while walking.

• High stepping gait.

• Functional leg length discrepancy (requires compensation).

• Reasons: Loss of muscle control in lower legs/feet, atrophy of foot/lower leg muscles, decreased sensation (numbness/tingling).

This quiz explores the pathological gait associated with neurological conditions such as stroke, Parkinson's Disease, and Multiple Sclerosis. It highlights key features of gait assessment, focusing on initial contact, loading response, and mid-stance phases, particularly in stroke patients. Test your understanding of the clinical signs and underlying reasons for gait issues.