Medical Archive

Prevalence, morbidity, and mortality

Anatomy and physiology

Disorders of gait

Etiology	No. of Cases	Percent
Sensory deficits	22	18.3
Myelopathy	20	16.7
Multiple infarcts	18	15.0
Parkinsonism	14	11.7
Cerebellar degeneration	8	6.7
Hydrocephalus	8	6.7
Toxic/metabolic causes	3	2.5
Psychogenic causes	4	3.3
Other	6	5.0
Unknown causes	17	14.2
Total	120	100

Cautious gait

Stiff-legged gait

Caused by pyramidal tract or corticospinal tract lesions

The gait appears stiff or rigid with circumduction and plantar flexion of the affected limb.

Parkinsonism, freezing gait, and other movement disorders

Short steps, shuffling

Frontal gait disorder

Caused by frontal lobe degenration, NPH
Associated with dementia, incontinence, frontal lobe signs.

“Gait apraxia”, “Bruns ataxia”
Difficulty in initiation of forward movement of the feet
Magnetic(freezing): start & turn hesitation.

Cerebellar gait ataxia

Lesions of the vermis – truncal ataxia
Lesions of the hemispheres – limb ataxia

Staggering and swaying from side to side, impaired tandem gait and titubation (truncal tremor)

Sensory ataxia

Caused by loss of proprioception d/t sensory neuronopathy

“Slap gait”: to help them know where their lower limbs are relative to the ground.

Feature	Cerebellar Ataxia	Sensory Ataxia	Frontal Gait
Base of support	Wide-based	Narrow base, looks down	Wide-based
Velocity	Variable	Slow	Very slow
Stride	Irregular, lurching	Regular with path deviation	Short, shuffling
Romberg test	+/–	Unsteady, falls	+/–
Heel ? shin	Abnormal	+/–	Normal
Initiation	Normal	Normal	Hesitant
Turns	Unsteady	+/–	Hesitant, multistep
Postural instability	+	+++	++++ Poor postural synergies rising from a chair
Falls	Late event	Frequent	Frequent

Neuromuscular disease

1. L5 radiculopathy(m/c) or neuropathy of the common peroneal nerve.
2. Weakness in foot dorsiflexion
3. Foot drop
4. “Steppage” gait
   • Flex the hip and knee to raise the foot and avoid dragging the toe with each step

Toxic and metabolic disorders

Functional gait disorders

Approach to the patient

Disorders of balance