Abnormal gait واحدی هوشنگ دکترامیر

توانبخشی و فیزیکی متخصصطب

2قسمت

Hemiparetic gait Extension and circumduction of one legweakness on the affected sideHyper reflexiaextensor plantar responseFlexed armParaparetic gaitStiffness, extension, adduction and scissoring of

both legsBilateral leg weakness hyperreflexia, spasticity, and extensor plantar

response

Circumduction

Leg swings outward in an arc

Affected leg is always functionally longer

Weak dorsiflexorsWeak hip flexors

Conditions associated with a spastic gait

1. Brain tumor2. Brain abscess3. Sturge-Weber syndrome4. Cerebral palsy5. Cerebrovascular accident6. Multiple sclerosis

Conditions associated with a scissor gait

1. Arthrogryposis2. Spastic diplegia3. Pernicious anemia4. Cerebrovascular accident5. Cervical spondylosis with myelopathy6. Liver failure7. Multiple sclerosis8. Spinal cord trauma9. Spinal cord tumor10. Syphilitic meningomyelitis11. Syringomyelia12. Cerebral palsy

Neuropathic gait disorders

distal muscle weakness unilateral or bilateralif sensory alterations accompany weakness,

the diagnosis of peripheral neuropathy is more assured

produced by loss of proprioceptive input from the legs

Steppage gait

weakness of foot dorsiflexorsfoot dropexcessive flexion of hips and

knees when walking unilateral or bilateral atrophy

of distal leg musclesdecreased ankle reflex

Steppage gait (High stepping, Neuropathic gait) is a form of gait abnormality that is associated with a loss of dorsiflexion

Conditions associated with a steppage gait1. Polio2. Multiple sclerosis3. Guillain-Barré4. Spinal disc herniation5. Peroneal Muscle Atropy6. Peroneal nerve Injury7. Polyneuropathy

Steppage gait

CADENCE --------------------NormalSTEP LENGTH---------------Normal BASE ------------ ------------NormalOTHER ASSOCIATED SIGNS------- Overlifting

and slapping of feet

Myopathic gait (or waddling gait)The "waddling" is due to the weakness of the

proximal muscles of the pelvic girdle.The patient uses circumduction to compensate for

gluteal weakness.Conditions associated with a myopathic gait1.Pregnancy2.Congenital hip dysplasia3.Muscular dystrophy4.Spinal muscle atrophy5.myasthenia gravis

Waddling-myopathic

CADENCE ---------------------NormalSTEP LENGTH----------------Normal BASE --------------------------Slightly wide OTHER ASSOCIATED SIGNS-------Overlifting of

hip(s)

Gluteal lurch

Caused by hip extensor weakness

In stance phase trunk will bend backwards to try and keep CoG behind hip joint

Pulsive or retropulsive gait

Body's center of gravity appears to be either in front or behind the patient

who is struggling to keep his or her feet up to center of gravity

festinationhypokinesiamuscular rigiditypostural instability

ProConditions associated with a propulsive gait

1. Carbon monoxide poisoning2. Parkinson's disease 3. Manganese Toxicity4. Carbon monoxide poisoning5. Drug:metoclopramide;haloperidol

;phenothiazine

Parkinsonian festinating

CADENCE -------------------Slow until festinationSTEP LENGTH---------------Short BASE -------------------------NormalOTHER ASSOCIATED SIGNS-------Quickening

step, forward leaning, shuffling,may have trouble with gait initiation

Choreic gait

Irregular, dancelike gait slow and wide-based spontaneous knee flexion and leg raisingAthetotic and choreic movements of the

upper extremities

Stomping gait (sensory ataxia gait)Conditions associated 1. Friedreich's ataxia2. Pernicious anemia3. Tabes dorsalis4. Peripheral neuropathy5. Spinal cord disease6. Multiple sclerosis

Cerebellar ataxic

CADENCE ---------- ---------------IrregularSTEP LENGTH------- -------------Slightly short BASE ------------ ------------------WideOTHER ASSOCIATED SIGNS------- Erratic

shifting of weight

Sensory ataxic

CADENCE ----------------------NormalSTEP LENGTH-----------------Short BASE ---------------------------Slightly wideOTHER ASSOCIATED SIGNS-------Excessive

force in step resulting in stamping