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GAIT DISORDERS,[object Object],Supervised by: Dr Tan Li Ping,[object Object]
Gait
EXAM: STEPS,[object Object],Make sure the patient’s legs are clearly visible,[object Object],Ask the patient to walk normally, turn around and walk back.,[object Object], Observe:    ,[object Object],i) Posture  ii) Balance iii) Position & swinging of the arms  iv) Movement of the legs,[object Object],Perform tandem gait (heel-to-toe),[object Object],EXPOSURE,[object Object],OBSERVE,[object Object],PERFORM,[object Object]
ROOMBERG’S TEST,[object Object], ask patient to stand with the heels together,,[object Object],         first with eyes open ,then with eyes closed,[object Object],Unsteadiness,[object Object]
EXAM: OTHER,[object Object],5.Other examinations:,[object Object],    a)Walk on toes-S1 lesion,[object Object],    b)Walk on heels-high stepping gait(foot drop) ,[object Object],    c)Test for proximal myopathy,[object Object],        (squat and then stand up)-waddling gait,[object Object],    d)Lie down and imagine pedaling a bicycle,[object Object],        -apraxic gait,[object Object],6. End examination by looking for additional signs. Example;,[object Object],        -Parkinsonism signs,[object Object],        -Cerebellar signs,[object Object]
1. HEMIPLEGIC GAIT,[object Object],Thus the foot is swung in a lateral arc and pelvis is elevated on that side to avoid the affected foot from scraping the floor.,[object Object],Characteristics of hemiplegic gait,[object Object]
2. SCISSORS GAIT,[object Object],Spastic Paraperesis,[object Object],		Knee appear to be stuck together,[object Object],		Feet stuck to the floor,[object Object],Characteristics of scissors gait,[object Object]
3. CEREBELLAR GAIT,[object Object],Characteristics of cerebellar gait,[object Object]
4. PARKISONIAN GAIT,[object Object],Characteristics of Parkisonian gait,[object Object]
5. WADDLING GAIT,[object Object],Characteristics of waddling gait,[object Object]
6. HIGH STEPPING GAIT,[object Object],Characteristics of foot drop,[object Object]
7. STAMPING GAIT,[object Object]
8. APRAXIC GAIT,[object Object],Impaired ability to plan and execute sequential movements due bilateral frontal lobe disease,[object Object]
9. PSYCHOGENIC/HYSTERICAL GAIT,[object Object],Gait does not conform to any one of typical gait disorders,[object Object],A.k.aAstasia-abasia (inabililty to stand or walk in a normal manner) ,[object Object],Characteristics:,[object Object],-Normal coordination of leg movements in bed or while sitting,[object Object],-Unable to stand or walk without assistance,[object Object],-If distracted, stationary balance is sometimes maintained and several steps are taken normally, followed by a dramatic demonstration of imbalance with a lunge toward the examiner's arms or a nearby bed. ,[object Object]
IMAGING,[object Object],MRI BRAIN,[object Object],SPINAL X-RAY,[object Object],SPINAL MRI,[object Object],EMG(Electromyography),[object Object],CXR/CT THORAX,[object Object]
BLOOD INVESTIGATION,[object Object],FBC & PBF,[object Object],ESR,[object Object],Syphilis serology,[object Object],Serum B12,[object Object],U & E,[object Object],Prostate Specific Antigen,[object Object],Serum Creatinephosphokinase,[object Object]
OTHER INVESTIGATIONS,[object Object],Lumbar puncture,[object Object],Muscle biopsy,[object Object]
group,[object Object],10,[object Object],THANK YOU & GOOD LUCK,[object Object],MBBS IIIA FINALS,[object Object]

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Gait

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Editor's Notes

  1. Normal gait: erect posture, moderately sized steps, arms swing
  2. UNSTEADINESS AND BROAD BASED GAIT- CEREBELLAR, VESTIBULAR, & PROPRIOCEPTIVE DISORDERSVision compensates for proprioceptive lossVestibular disorder- nystagmus & no other cerebellar signsProprioceptive disorder-cerebellar signs may be present & are typically worse when the eyes are closed
  3. Bear in mind, not everyone may be able to walk on their toes or heels-especially the elderly.
  4. Likened to a drunken sailor gait
  5. One of the causes of multiinfarct dementia, in which there are many infarcts and lacunae in the white matter, with relative sparing of the cortex and basal ganglia.
  6. MRI BRAIN/SPINE- MS (PERIVENTRICULAR WHITE MATTER LESIONS OR HIGH SIGNAL INTENSITIES),SPINAL XRAY-LOOK FOR FRACTURE CAUSING MYELOPATHYSPINAL MRI-LOOK FOR CORD COMPRESSION DUE TO TUMOUR, PROLAPSED DISC, INFECTION OR TRAUMACXR/CT THORAX-BRONCHOGENIC CA CAUSING PARANEOPLASTIC SYNDROME LEADING TO CEREBELLAR SYNDROME
  7. FBC-leucocytosis, megaloblastic anemia due to B12 deficiencyESR- raised in inflammatory condition eg: SLE (vasculitis) transverse myelitisSyphilis serology- +ve may indicate myelopathy or tabesdorsalisSerum B12 deficiency subacute combined degeneration of the cord loss of vibration and joint position sense ataxic gaitU & E- severe hypokalaemia can cause muscle weakness, hypocalcaemia cause myopathyPSA- secondary met to spine is the commonest cause of cord compression.Serum Creatinephosphokinase- elevated in many dystrophies/muscle disease
  8. Lumbar puncture elevated granulocytes bacterial meningitis or encephalitis cerebellar syndromeIncreased lactate can occur the presence of cancer of the CNS, multiple sclerosis, traumatic brain injury, cerebral ischemia, brain abscess, hydrocephalus or bacterial meningitis. Changes in total protein content of cerebrospinal fluid- meningitis, neurosyphilis, brain abscesses, subarachnoid hemorrhage, polio or Guillain-Barré syndromeMuscular biopsy-muscular disorders