Thursday, December 2, 2010

Walk With Me

What do you think about the following gait assessments in an elderly patient?

1) This patient's toes don't clear the ground; the toes scuff with each step. Thus, the patient uses circumduction of the hip to help toe clearance. When you look at the patient's shoes (because that is part of your regular exam), there is wearing of the soles at the tips.

2) This patient's step is high. There is an audible slap as the foot hits the ground.

3) This patient's gait is described as "stumbling, lurching, staggering, slow, reduced step length, wide-based, reeling, and drunken." Acceleration and braking are impaired, and not only in gait, but with other movements as well.

4) This patient walks as if on ice. He has a cautious gait, slow, with shortened stride length on a normal or slightly wide base. He turns en bloc. There are no other signs of Parkinsonism.


sid said...

1) Post hemiplegia
2) Foot drop due to common peroneal nerve palsy
3) Parkinsonism
4) cerebellar lesion

Craig Chen said...

oh, very close!
Walk With Me

1) In an upper motor neuron lesion, the hip flexor is weak leading to this gait.
2) In a lower motor neuron lesion, the patient compensates for foot drop by raising his feet higher.
3) This is characteristic of cerebellar ataxia.
4) This is the gait of frontal lobe dysfunction or a psychogenic gait.

Source: UpToDate.