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Gait disorders
- Prof. Kailash Bhatia,
Gait disorders Prof. Kailash Bhatia, Institute of Neurology, Queen - - PowerPoint PPT Presentation
Gait disorders Prof. Kailash Bhatia, Institute of Neurology, Queen - - PowerPoint PPT Presentation
Gait disorders Prof. Kailash Bhatia, Institute of Neurology, Queen Square, London Gait disorders can be tricky Gait disorders are common Abnormalities of gait and balance can be caused by peripheral &/or CNS disorders, from motor
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Gait disorders are common
- Abnormalities of gait and balance can be
caused by peripheral &/or CNS disorders, from motor weakness & sensory loss, to loss
- f automaticity, cognitive decline
- Consequences - fear of falling’ and need for
assistive devices, resulting in social isolation and reduced activity
- Falls are most common cause for injury
related hospital admissions
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Outline of this talk
- Classification of gait disorders
- Approach to a patient with gait disorder
- Pathophysiology of higher order gait
disorder
- Examples of different forms of gait
disorders
- Recognition of particular forms of gait
disorders
- Concluding summary
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Classification of gait disorders
- Nervous system complexity level - lower,
middle, and higher level
- Anatomic lesion location (i.e. cerebellar,
frontal lobe etc.)
- By etiology (i.e. vascular disease,
degenerative parkinsonism, spinocerebellar ataxias)
- Clinical phenomenology (i.e. ataxia,
parkinsonism, dyskinesia) - sub-classified as continuous or episodic
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Approach in a patient with gait problem
As always good history & physical and neurological exam – Most importantly
- Watching the gait- stance, cadence, steppage,
arm swing, postural reflexes
- Look out for associated features: are there
features of parkinsonian, cerebellar, spasticity,
- r weakness or sensory loss.
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Higher level gait disorders
- The term higher‐level gait disorders (HLGD)
defines a category of balance and gait disorders that are not explained by deficits in strength, tone, sensation, or coordination. HLGD are characterized by various combinations of disequilibrium and impaired locomotion- Nutt 2013
- Various terms used gait apraxia, frontal
- ataxia, marche a petits pas, lower-half
parkinsonism, and many more
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Etiologies of HLGD
- Degenerative disorders,
- Large-vessel strokes,
- Microvascular disease with white matter
lesions, and microinfarcts,
- Tumours,
- Hydrocephalus.
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Characteristic features of HLGD
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Mid level
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Freezing and cycling
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Trunkal and gait ataxia
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Spastacin gene mutation gait
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Some particular gait disorders
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Bouncy leg gait of post anoxic myoclonus
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Lordotic gait In stiff person syndrome
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MdJ 2001
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Video – gait is a give away
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Episodic gait disorders
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Man with dystonic foot – who walks backwards better then forwards
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Episodic gait disorders : The dancing lady
- This lady would get
these episodes after walking or exerting – Marsden diagnosed her as possible functional – somatization
- Later her son
developed epilepsy at a young age – there was no other family history
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Neurology 2020
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The Criss –Cross gait is a hint to GLUT-1 deficiency
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Concluding commentary
- Studying gait is one of the most important aspects
- f the clinical examination in a movement
disorders patient to help with the diagnosis and note the systems involved
- Gait disorders can be classified in different forms
- Important to note the associated features
- Important to recognise particular forms of gaits
- Management depends on the particular form but