NEUROLOGY-GAIT DISORDERS LEARNING OBJECTIVES 1) UNDERSTAND THE ELEMENTS OF A NORMAL GAIT and DISCUSSION AND ILLUSTRATION OF GAIT ABNORMALITIES

Elements of Normal Ga t! A" #ost$re! s t%e &erson 'al( n) *ert +all, or %$n+%ed o*erB" Arm S' n) C" Len)t% of Str de! s t%e &at ent ta( n) small ste&s *s" lon) ste&sD" Base! %o' +lose are t%e feet to ea+% ot%erE" R%,t%m and #ro&$ls on F" Asso+ ated Mo*ements! are t%e a++om&an, n) tr$n+al mo*ements- .%at else s )o n) on ' t% t%e /od, as t% s &erson s 'al( n)G" M$s+le Coord nat on and Ma ntenan+e of E0$ l /r $m Normal Ere+t Bod,1 Head Stra )%t Arms Han) /, t%e S de1 Ea+% Mo* n) Nat$rall, ' t% O&&os te Le) Sl )%t E*erted Foot E0$al Ste&s Heel Str (e F rst Med al malleol$s almost &asses ea+% ot%er Narro' /ase Fle2 on at t%e H & and 3nee Dors fle2 on of t%e foot Ma ntenan+e of Balan+e at r )%t an)les to d re+t on of /od, mo*ement Lean n) For'ard6 allo' n) /od, to fall some'%at /efore +%e+(ed /, t%e s$&&ort of t%e le) Abnormal H$n+%ed O*er and Head Gl$ed To t%e Floor F 2ed and Fle2ed Rotated O$t'ard S%$ffl n)1 Small Ste&s1 or Irre)$lar ste&s Foot Dro&s or S+ra&es t%e Floor . de /ase E2+ess *e fle2 on 4+om&ensat on) Foot Stam& n) 4not a/le to dors fle2) Totter n)1 Reel n) Ina/ l t, to sta/ l 5e 'e )%t Ina/ l t, to sta/ l 5e 'e )%t Hasten n) or In*ol$ntar, a++elerat on of Ga t

7) RE8IE. OF SUBS9STEMS RES#ONSIBLE FOR ALTERATION OF GAIT

S$/s,stems res&ons /le for Normal : A/normal Ga t! .%at ma(es ,o$r )a t )o-

n$+le$s

Cort +os& nal tra+ts ; F ne motor +ontrol

<sla&& n) Ste&&a)e

8ol$ntar,1 D s+rete1 S( lled Mo*ements

<E2tra&,ram dal= /asal )an)l a ; s$/+ort +al motor s,stems! Smoot%ness of )a t>f ne t$ne motor mo*ements Ca$date1 #$tamen1 #all d$m1 s$/t%alam + n$+le$s1 s$/stant a n )ra1 red

Cere/ellar &at%'a,s ; /alan+e : +oord nat on: M$s+le tone Sensor, s,stems ; Feed/a+(" .%en 'e &$t o$r foot on t%e )ro$nd1 'e (no' '%ere o$r foot s /e+a$se 'e )et feed/a+( from &ress$re re+e&tors and ?o nt &os t on re+e&tors n o$r foot" If ,o$ see a &at ent t%at s t%e )ro$nd= ' t% t%e r foot1 t%ere s a &oster or +ol$mn defe+t" )a t"

8est /$lar s,stem ; ma?or n&$t from nner ear ) * n) nformat on to t%e /ra n tell n) '%ere ,o$ are n @>D s&a+e so t%at ,o$ +an +om&ensate ' t% eno$)% tone n ,o$r m$s+les" Intr ns + /alan+e"

&ro)rams so A&ra2 as

#refrontal +orte2 A asso+ at *e 5ones ; <HO. TO=6 a$tomat + t%at 'e donBt %a*e to t% n( a/o$t t%e ste&s of 'al( n)"

sensat on

#er &%eral ner*es ; 'ea(ness *ers$s stren)t% 4t ed n ' t% m$s+les)" Also

8 s on> To see '%ere ,o$ are )o n) M$s+le ; m$s+le d seases %a*e t%e r o'n )a t &ro/lems" #ro&r o+e&t on> Co nt #os t on n S&a+e Ant >)ra* t,1 #ost$ral1 and R )%t n) Refle2es

@) NEUROANATOMICAL LOCALIDATION OF S#ECIFIC GAIT DISORDERS

A" #art of Lo+al 5at on of a d sorder s to el + t and &erform an e2+ellent H and #" E2am nat on of t%e #at ent ' t% an a/normal Ga t n+l$des t%e follo' n)! " .al( n) Nat$rall, " Stand n) ' t% Feet To)et%er " E,es O&en and Closed *" .al( n) ' t% e,es o&en and +losed *" .al( n) n a stra )%t l ne %eel to toe * " .al(1 Sto& and T$rn Br s(l, B" Ne$roanatom +al Lo+al 5at on n+l$des t%e follo' n)! " Cere/ellar Ga t 1" DDE! MS and Certa n T$mors 4Med$llo/lastoma) 7" . de Based @" Unstead ness and Irre)$lar t, of Ste&s F" Lateral 8eer n) " Ga t of Sensor, Ata2 a 1" DDE! Ta/es Dorsal s1 F>Ata2 a1 B17 Def + en+,1 and Sensor, #ol,ne$ro&at%, 7" . de Based Ga t @" Le)s are fl$n) a/r$&tl, for'ard and feet stam& for+ /l, F" Irre)$lar ste&s of *ar a/le len)t% and %e )%t 4 m&a rment of ?o nt &os t on) " S&ast + Ga t 1" DDE! Stro(e1 Tra$ma1 MS 7" Hem &le) a or Hem &ares s @" Le) s Held st ffl, and rotates o$t'ard F" Foot S+ra&es t%e Floor G" Arms Held F 2ed and Fle2ed

*" Fest nat n) Ga t 1" DDE! #ar( nsonBs D sease 7" <Bod, Tr, n) to +at+% U& ' t% t%e Head= @" Hasten n) or n*ol$ntar, a++elerat on of Ga t F" R ) d t, and S%$ffl n)1 ' t% s%ort ste&s G" Tr$n( s /ent for'ard *" Ste&&a)e:E0$ ne Ga t 1" DDE! #ol o1 Com&ress on of #eroneal Ner*e1 and C>M>T D sease 7" Foot Dro& and Sla&& n) No se as t%e foot % ts t%e floor @" E2+ess *e Fle2 on at t%e H & D$e to t%e .ea( Foot * " .addl n) Ga t 1" DDE! MD and Con)en tal d slo+at on of H &s 7" .ea(ness of #ro2 mal M$s+les @" Ina/ l t, to sta/ l 5e t%e 'e )%t>/ear n) H & F" Cl n +al # +t$re> B$l)es o$t and o&&os te s de of &el* s dro&s * " Sta))er n):Dr$n(en Ga t 1" DDE! ETOH or Bar/ t$rate Into2 +at on 7" Totter n)1 Reel n) @" Im&a rment of Control of Tr$n( and Le)s F" Irre)$lar Ste&s * " Ga t D sorder n Normal 1" E2am&le! #ress$re H,dro+e&%al$s 7" S m lar To! #ar( nsonBs DE )a t and Frontal Lo/e Ga ts @" . de Based Ga t F" S%ort Ste&s:S%$ffl n) and Slo' Arm S' n) 2" Frontal Lo/e D sorder of Ga t 1" Fle2ed #ost$re 7" . de Based1 S%$ffl n)1 and Hes tant Ste&s @" Feet are )l$ed to t%e floor F" Hes tant to n t ate 'al( n) and somet mes %alt 2" Elderl, Ga t 1" Slo'er Ga t 7" Smaller Ste&s @" Sl )%tl, Stoo&ed #ost$re F" Broader Base G" 8a)$e Bo$ndar, /et'een normal and a/normal 2 " H,ster +al Ga t 1" DE of E2+l$s on6 t%ere are no ot%er asso+ ated ne$rolo) +al s )ns

F) DDE OF GAIT DISORDERS

A" T%ere 'ere t%e aforement oned ne$rolo) +al +a$ses of )a t d sorders n+l$d n) t%e follo' n) )eneral +ate)or es! " Cort +os& nal Tra+t #ro/lems " S$/+ort +al Motor S,stem #ro/lems " Cere/ellar #at%'a,s *" Sensor, S,stems *" 8est /$lar S,stem * " A&ra2 as

* " #er &%eral Ner*es * " M$s+le B" T%ere are also non>ne$rolo) +al +a$ses of )a t d sorders as 'ell1 n+l$d n) t%e follo' n)! " Net Im&a+t of A) n) Alone 1" Slo'er Ga t 7" Smaller Ste&s @" Sl )%tl, Stoo&ed #ost$re F" Broader Base G" 8a)$e Bo$ndar, /et'een normal and a/normal " " *" *" *" H & D sease Co nt D sease Ba+( #a n De&ress on Bar/ t$rate and:or ETOH Into2 +at on 4ot%er s$/stan+es as 'ell-)