Pathological Gait in Neuro: An Introduction PDF

Pathological Gait in Neuro An Introduction  Use neurological gait as a vehicle to identify the clinical Intended signs seen in: learning Stroke Parkinson’s Disease outcomes:...

Pathological Gait in Neuro An Introduction  Use neurological gait as a vehicle to identify the clinical Intended signs seen in: learning Stroke Parkinson’s Disease outcomes: Multiple Sclerosis Peripheral Nerve Injury to the common peroneal nerve Gait in Stroke Point Commonly observed problems Reasons in gait cycle Initial Reduced heel strike Decreased contact due to reduced active dorsi-flexion/increased motor control tone in extensors Muscle weakness Increased Loading Absence of knee flexion muscle tone respons Too much knee flexion (spasticity) Contracture/ e deformity Sensory Mid- Reduced weight transfer onto standing leg deficits stance lack of stability means that weight is not Balance transferred laterally/forward as expected Fear patient does not trust the limb to provide support. Compensation: Short, quick step through on other leg Termina Reduced forward propulsion l stance reduced plantar flexion force, results in and reduced forward propulsion of the centre of pre- mass and a shorter step on the opposite side Point in Commonly observed problems Reasons gait cycle Swing Decreased motor control of hip, knee and ankle flexors can Decreased motor phase combine with increased tone in extensor muscle groups, control effectively resulting in a functional leg length discrepancy Muscle weakness Compensatory strategies include: Increased muscle - Hip Hitching tone (spasticity) - Circumduction Contracture/ - Vaulting deformity Sensory deficits Balance Fear Parkinson's Disease (PD) Commonly observed problems Reasons Gait in Parkinson’s Disease Flexion of trunk and hips Bradykinesia Rigidity Reduced trunk rotation and arm swing Postural Instability Shuffling steps – reduced heel strike. Scuffing of foot in mid-swing shows reduced foot clearance Slow gait – short stride length, increased double support Freezing of gait = a sudden or gradual inability to take steps during walking and initiate subsequent steps despite having the intention to walk. Festination = involuntary progressive reduction in stride length, an increase in cadence, and a reduction in walking speed. Difficulty turning = turn slowly, take more steps, have poor foot clearance and may pause before executing a turn Multiple Sclerosis (MS) Commonly observed problems Reasons Variable picture  Fatigue  Spasticity  Flat foot on initial contact – ‘flapping foot’  Balance  Irregular foot placement  Proprioception  Unpredictable step length  Co-ordination  Wide base/narrow base/scissoring  Attentional demands  Jerky movements  Weakness  Midstance: Hyper – extension of the knee due to reduced eccentric quads activity  May overuse trunk to shift weight forwards, backwards and laterally, and to maintain balance Where spasticity pre-dominates, the picture will be different. Ataxia and spasticity are not mutually exclusive. Peripheral Nerve Injury; The common peroneal nerve Clinical presentation 1. Motor Loss including flaccid paralysis 2. Sensory Loss https://www.youtube.com/watch?v=STZszh4K1Fo Commonly observed Reasons problems  Loss of muscle control in the  Foot that drops (unable to hold lower legs and feet the foot up)  Atrophy of the foot or foreleg  "Slapping" gait (walking muscles pattern in which each step  Decreased sensation, makes a slapping noise) numbness, or tingling in the  Toes drag while walking top of the foot or the outer  Results in a high stepping gait part of the upper or lower leg Again, a type of functional leg length discrepancy with a very different compensatory strategy.