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Abnormal gait

Abnormal gait . دکترامیر هوشنگ واحدی متخصص طب فیزیکی و توانبخشی قسمت 2. Hemiparetic gait Extension and circumduction of one leg weakness on the affected side Hyper reflexia extensor plantar response Flexed arm Paraparetic gait

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Abnormal gait

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  1. Abnormal gait دکترامیر هوشنگ واحدی متخصص طب فیزیکی و توانبخشی قسمت 2

  2. Hemiparetic gait • Extension and circumductionof one leg • weakness on the affected side • Hyper reflexia • extensor plantar response • Flexed arm Paraparetic gait • Stiffness, extension, adduction and scissoring of both legs • Bilateral leg weakness • hyperreflexia, spasticity, and extensor plantar response

  3. Circumduction • Leg swings outward in an arc • Affected leg is always functionally longer Weak dorsiflexors Weak hip flexors

  4. Conditions associated with a spastic gait • Brain tumor • Brain abscess • Sturge-Weber syndrome • Cerebral palsy • Cerebrovascular accident • Multiple sclerosis

  5. Conditions associated with a scissor gait • Arthrogryposis • Spastic diplegia • Pernicious anemia • Cerebrovascular accident • Cervical spondylosis with myelopathy • Liver failure • Multiple sclerosis • Spinal cord trauma • Spinal cord tumor • Syphilitic meningomyelitis • Syringomyelia • Cerebral palsy

  6. Neuropathic gait disorders • distal muscle weakness • unilateral or bilateral • if sensory alterations accompany weakness, the diagnosis of peripheral neuropathy is more assured • produced by loss of proprioceptive input from the legs

  7. Steppage gait • weakness of foot dorsiflexors • foot drop • excessive flexion of hips and knees when walking • unilateral or bilateral atrophy of distal leg muscles • decreased ankle reflex

  8. 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 gait • Polio • Multiple sclerosis • Guillain-Barré • Spinal disc herniation • Peroneal Muscle Atropy • Peroneal nerve Injury • Polyneuropathy

  9. Steppage gait • CADENCE --------------------Normal • STEP LENGTH---------------Normal • BASE ------------ ------------Normal • OTHER ASSOCIATED SIGNS------- Overlifting and slapping of feet

  10. 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 gait 1.Pregnancy 2.Congenital hip dysplasia 3.Muscular dystrophy 4.Spinal muscle atrophy 5.myasthenia gravis

  11. Waddling-myopathic • CADENCE ---------------------Normal • STEP LENGTH----------------Normal • BASE --------------------------Slightly wide • OTHER ASSOCIATED SIGNS-------Overlifting of hip(s)

  12. Gluteal lurch • Caused by hip extensor weakness • In stance phase trunk will bend backwards to try and keep CoG behind hip joint

  13. 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 • festination • hypokinesia • muscular rigidity • postural instability

  14. ProConditions associated with a propulsive gait • Carbon monoxide poisoning • Parkinson's disease • Manganese Toxicity • Carbon monoxide poisoning • Drug:metoclopramide;haloperidol;phenothiazine

  15. Parkinsonian festinating • CADENCE -------------------Slow until festination • STEP LENGTH---------------Short • BASE -------------------------Normal • OTHER ASSOCIATED SIGNS-------Quickening step, forward leaning, shuffling,may have trouble with gait initiation

  16. Choreic gait • Irregular, dancelike gait • slow and wide-based • spontaneous knee flexion and leg raising • Athetotic and choreic movements of the upper extremities

  17. Stomping gait (sensory ataxia gait) Conditions associated • Friedreich's ataxia • Pernicious anemia • Tabesdorsalis • Peripheral neuropathy • Spinal cord disease • Multiple sclerosis

  18. Cerebellar ataxic • CADENCE ---------- ---------------Irregular • STEP LENGTH------- -------------Slightly short • BASE ------------ ------------------Wide • OTHER ASSOCIATED SIGNS------- Erratic shifting of weight

  19. Sensory ataxic • CADENCE ----------------------Normal • STEP LENGTH-----------------Short • BASE ---------------------------Slightly wide • OTHER ASSOCIATED SIGNS-------Excessive force in step resulting in stamping

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