TRANSCRIBED BY:

Page 1 of 3

Alfredo Guzman, M.D.

Sana umulan ng common sense Rustum Casia, Rain Song Paulo Coelho

GAIT and STATION

2.7 08 Sept

2014

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.

PROCEDURE

Ask the patient to:

1. Walk across the room 2. Turn and come back 3. Walk heel-to-toe in a straight line (TANDEM WALKING) 4. Walk on their toes in a straight line 5. 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 6. Hop in place on each foot 7. Do a shallow knee bend

Difficulty doing a shallow-knee bend PROXIMAL muscular weakness(quadriceps and hip extensors)

8. Rise from a sitting position

Difficulty in rising from a sitting position PROXIMAL muscular weakness (pelvic girdle and legs)

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.

ROMBERG TEST

i. Have the patient stand still with heels and toes together.

ii. Ask the patient to close her eyes and balance herself o Closing the eyes removes

visual input

(+) 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.

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

o 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)

o 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.

TOPIC OUTLINE

I. Gait Testing II. Cerebellar Testing III. Abnormalities of Gait and Posture This trans came from upper batch trans + transcibers notes + Master

Bates :D

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

Page 2 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.

Doc Guzman

Kapag nanginginig, pero nakaka-point pa rin INTENTION TREMOR, a form of DYSMETRIA

Kapag lumalampas siya PAST POINTING

RAPID ALTERNATING FINGER MOVEMENTS

1. 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.

Interpretation: The movement should be performed with speed and accuracy. Inability to do this, known as dysdiadokinesia, may be indicative of cerebellar disease.

HEEL TO SHIN TEST

1. 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

Normal posture, step size, and arm swing

Tandem walking

Hemiplegic Gait

Retropulsion

ABNORMALITIES OF GAIT AND POSTURE

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

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

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

Page 3 of 3

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

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

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

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. At ipagbawal ang sumilong at ang pagdadala ng payong. I-require sa mga nagdududa, walang opinyon at tatanga-tanga na kahit ilang minuto, magpa-ambon. Sana umulan ng common sense. Maligo tayong lahat.

QUIZ TIME!!!

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?

Answ

ers

: 1) A

2) C

3) D

4) B

5) P

roprio

ceptio

n 6

)

Heel-to

-Toe T

est

7)

Rom

berg

s T

est

8)

Dysdia

dochokin

esia

9) T

ande

m W

alk

ing

10) P

roxim

al M

uscle

We

akness