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2.

7
08 Sept
2014

GAIT and STATION


Alfredo Guzman, M.D.
Sana umulan ng common sense
Rustum Casia, Rain Song
TOPIC OUTLINE
Paulo Coelho
I. Gait Testing
II. Cerebellar Testing
III. Abnormalities of Gait and Posture
This trans came from upper batch trans + transcibers notes + Master
Bates :D

GAIT TESTING
The ability to stand and walk normally is dependent on input from
several systems, including:
o Visual
o Vestibular
o Cerebellar
o Motor
o Sensory
The precise cause of the dysfunction can be determined by
identifying which aspect of gait is abnormal and incorporating this
information with that obtained during the rest of the exam
o E.g. Difficulty getting out a chair and initiating movement =
Parkinsons Disease
o Lack of balance and a wide based gait would suggest a
cerebellar disorder
Ataxia

A gait that lacks coordination, with reeling (to move from side
to side as if youre going to fall) and instability

May be due to cerebellar disease, loss of position sense or


intoxication
See end of trans for disorders of posture and gait
Doc Guzman:

Remember that you can assess and see what the


pathology is based on how a person walks because the
gait will tell you a lot of things.

(+) Romberg = The patient loses balance, when eyes are closed
(hindi na alam ng tao kung nasan siya, kasi sarado na ang mata)
Loss of balance suggests impaired proprioception.
In disease of the cerebellum:
o Lateral lobe, falling is toward the affected side
o Frontal lobe, falling is to the opposite side
o Midline or vermis, falling indiscriminately
Doc Guzman:

ANG ROMBERGS TEST is NOT a test for cerebellar ataxia.

IT IS A TEST for PROPRIOCEPTION

Bakit? Kasi kapag cerebellar function ang nadali, the patient


would lose his balance, even if the eyes are open.
2. Ask the patient to stand from a chair, walk across the room, turn,
and come back towards you. Pay particular attention to:
o Difficulty getting up from a chair:
Can the patient easily arise from a sitting position?
Problems with this activity might suggest proximal muscle
weakness, a balance problem, or difficulty initiating
movements.
o Balance:
Do they veer off to one side or the other as might occur
with cerebellar dysfunction?
Dysfunction of a cerebellar hemisphere will cause the
patient to fall to the same side.
(e.g. tumor on L cerebellum patient will tend to fall to the
L)
Diffuse disease affecting both cerebellar hemispheres will
cause a generalized loss of balance.
o Rate of walking:
Do they start off slow and then accelerate, perhaps losing
control of their balance or speed?
Doc Guzman: Parkinsons sa condition na ito, walang
movement ng kamay. Naka-stoop pa siya, may tremors.
They cant stop-leading to shuffling gait hanggang sa
bumagsak siya.

PROCEDURE
Ask the patient to:
1.
2.
3.
4.
5.

6.
7.

8.

Doc Guzman:

Pag pumipilantik yung paa kapag naglalakad DISTAL


muscle weakness

Kapag may hawak na baso tapos nalalaglag either


there is some PROXIMAL weakness or SENSORY loss
TESTING OF STATION/ STANCE
(EQUILIBRATORY COORDINATION)
Cerebellar ataxia is not improved by visual orientation

1. Have the patient stand in one place.


o This is a test of balance, incorporating input from the visual,
cerebellar, proprioceptive, and
vestibular systems.

i.
ii.

Walk across the room


Turn and come back
Walk heel-to-toe in a straight line (TANDEM WALKING)
Walk on their toes in a straight line
Walk on their heels in a straight line

Walking on toes and heels may reveal DISTAL muscular


weakness in the legs

Inability to heel-walk CORTICOSPINAL DAMAGE


Hop in place on each foot
Do a shallow knee bend

Difficulty doing a shallow-knee bend PROXIMAL


muscular weakness(quadriceps and hip extensors)
Rise from a sitting position

Difficulty in rising from a sitting position PROXIMAL


muscular weakness (pelvic girdle and legs)

ROMBERG TEST
Have the patient stand still with
heels and toes together.
Ask the patient to close her eyes
and balance herself
o Closing the eyes removes
visual input

TRANSCRIBED BY:

Are they simply slow moving secondary to pain/limited


range of motion in their joints, as might occur with
degenerative joint disease? etc.
Doc Guzman: siyempre, pag masakit, hindi mo masyado
nilalagyan ng pressure. So ang tendency mo, madali lang
ang pressure na nilalagay mo sa affected foot

Attitude of Arms and Legs:


How do they hold their arms and legs?
Is there loss of movement and evidence of contractures?
(e.g. after stroke)
Heel to Toe Walking:
Tandem Gait: Tests balance
o Ask the patient to walk in a straight line, putting the
heel of one foot directly in front of the toe of the other
o This may be difficult for older patients (due to the
frequent coexistence of other medical conditions)
even in the absence of neurological disease.

Bates
TEST FOR PRONATOR DRIFT
Pronator drift
This is the pronation of one forearm.
It is both sensitive and specific for a corticospinal tract lesion
originating in the contralateral hemisphere
Downward drift of the arm with flexion of fingers and elbow
may also occur
CEREBELLAR TESTING
Functions of the cerebellum
o Fine tunes motor activity
o Assists with balance
Dysfunction results in a loss of coordination and problems with gait.
Ipsilateral control:
o The left cerebellar hemisphere controls the left side of the body
and vice versa.
Specifics of Testing
There are several ways of testing cerebellar function.
For the screening exam, using one modality will suffice.

Page 1 of 3

GAIT and STATION

If an abnormality is suspected or identified, multiple tests should


be done to determine whether the finding is durable. That is, if the
abnormality on one test is truly due to cerebellar dysfunction,
other tests should identify the same problem.

FINGER TO NOSE TEST


1. With the patient seated, position your index finger at a point in space
in front of the patient.
2. Instruct the patient to move their index finger between your finger
and their nose.
3. Reposition your finger after each touch.
4. Then test the other hand.
Interpretation: The patient should be able to do this at a reasonable
rate of speed, trace a straight path, and hit the end points accurately.
Missing the mark or overshooting the target, known as dysmetria, may
be indicative of cerebellar disease.

Hemiplegic Gait

Retropulsion

ABNORMALITIES OF GAIT AND POSTURE

Doc Guzman

Kapag nanginginig, pero nakaka-point pa rin INTENTION


TREMOR, a form of DYSMETRIA

Kapag lumalampas siya PAST POINTING

1.

RAPID ALTERNATING FINGER MOVEMENTS


Ask the patient to touch the tips of each finger to the thumb of the
same hand. Test both hands.

Interpretation: The movement should be fluid and accurate. Inability to


do this, known as dysdiadochokinesia, may be indicative of cerebellar
disease.

RAPID ALTERNATING HAND MOVEMENTS

1.

Direct the patient to touch first the palm and then the dorsal side of
one hand repeatedly against their thigh. Then test the other hand.

Spastic Hemiparesis
Caused corticospinal lesions (e.g. stroke)
Poor control of flezor muscles during swing phase
Affected arm is flexed, immobile and held close to the side, with
elbow, wrists, joints flexed
Affected leg extensors spastic
Patient may drag toe, circle leg stiffly outward and forward
(circumduction, yung dinemo ni sir)
May lean toward unaffected

Interpretation: The movement should be performed with speed and


accuracy. Inability to do this, known as dysdiadokinesia, may be
indicative of cerebellar disease.

1.

HEEL TO SHIN TEST


Direct the patient to move the heel of one foot up and down along
the top of the other shin. Test the other foot.

Interpretation: The movement should trace a straight line along the top
of the shin and be done with reasonable speed

Scissors Gait
Seen in spinal cord disease causing bilateral lower extremity
spasticity
Adductor spasm, abnormal proprioception
Gait is stiff, steps are short
Patients advance each leg slowly, and the thighs tend to cross
forward on each other at each step
They appear to be walking on water

Normal
posture, step size, and arm
swing

Tandem walking

TRANSCRIBED BY: NADARE, SAIHA, MADOKA, RUI, RESHI

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GAIT and STATION

Steppage Gait
Seen in foot drop
Patients either drag the feet or lift them high, with knees flexed,
and bring them down with a slap onto the floor
They cannot walk on their heels
Tibialis anterior and extensors are weak

Sensory Ataxia
Caused by loss of position sense in the legs
Unsteady and wide-based gait
They watch the ground for guidance when walking
They can stand steadily with feet together when eyes are open,
but not when closed (+) Romberg

Rain Song Rustum Casia


Sana umulan ng common sense.

I-require sa mga nagdududa,


walang opinyon at tatanga-tanga
na kahit ilang minuto,
magpa-ambon.
Sana umulan ng common sense.
Maligo tayong lahat.
Parkinsonian Gait
Caused by basal ganglia defects of Parkinsonism
Stooped posture
Flexed head, arms, hips, knees
Patients are slow getting started
Short, shuffling steps with festination (involuntary hastening)
Patients turned around stiffly

QUIZ TIME!!!

Answers:
1) A 2) C 3) D 4) B 5) Proprioception 6)
Heel-to-Toe Test 7) Rombergs Test 8)
Dysdiadochokinesia 9) Tandem Walking
10) Proximal Muscle Weakness

At ipagbawal ang sumilong


at ang pagdadala ng payong.

Matching Type:
A. Parkinsons Disease
B. Cerebellar Ataxia
C. Foot Drop
D. Spinal Cord Disease/ Lesion
_____1) Shuffling Gait
_____2) Steppage Gait
_____3) Scissors Gait
_____4) Wide-Based Gait
5) Rombergs Test is a test for?
6-7) Give two tests for GAIT
8) Inability to do rapid, alternating movements
9) The Heel-to-Toe test is also known as?
10) Difficulty doing a SHALLOW KNEE BEND suggests what
pathology?

Cerebellar Ataxia
Gait is staggering, unsteady,, wide-based, with exaggerated
difficulty on turns
Patients cannot stand steadily with feet together, whether eyes
are open or closed

TRANSCRIBED BY: NADARE, SAIHA, MADOKA, RUI, RESHI

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