abnormalities of gait & posture.pptx
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NEUROLOGIC EXAMINATIONAbnormalities of Gait & Posture
ABNORMALITIES OF GAIT & POSTURE Spastic Hemiparesis Scissors Gait Steppage Gait Parkinsonian Gait Cerebellar ataxia Sensory ataxia
SPASTIC HEMIPARESIS Observed in
corticospinal tract lesion in stroke
Cause poor control of flexor muscles during swing phase
Affected arm: Flexed immobile held close to the
side elbow, wrists and
interphalangeal joints flexed
SPASTIC HEMIPARESIS CONT. Affected leg:
Extension spastic Ankle plantar flexed
and inverted Patients may drag
toe, circle leg stiffly outward and forward ( circumduction)
Lean trunk to contralateral side to clear affected leg during walking
SCISSORS GAIT Observed in spinal cord
disease Cause bilateral lower
extremity spasticity, adductor spasm & abnormal proprioception
Gait is stiff Patients advance leg slowly
& thighs tend cross forward on each other at each step
Steps are short Appear as walking on water
STEPPAGE GAIT Seen in foot drop Usually secondary to
peripheral motor unit disease
Patients either drag the feet or lift them high with knees flexed and bring the feet down with a slap on the floor
Appear as waling up stairs Cannot walk on their heels May involve in both legs or
one Tibialis anterior and toe
extensors are weak
PARKINSONIAN GAIT Seen in Basal
Ganglia defects of Parkinson disease
Posture is stooped with flexion of head, arms, hips and knees
Steps are short and shuffling with involuntary hastening (festination)
Arm swings are decreased
Postural control is poor (retropulsion)
CEREBELLAR ATAXIA Observed in disease of cerebellum or tracts Gait is staggering, unsteady, wide based with
exaggerated difficulty on turns Patients cannot stand steadily with feet
together whether eyes are open or closed Cerebellar signs are present:
Nystagmus Dysmetria Intension tremor
SENSORY ATAXIA Observed in loss of position sense in the legs
( polyneuropathy or posterior column damage) Gait is unsteady ad wide based ( feet wide apart) Patients throw their feet forward and outward and
bring them down, first on the heels and then on the toes, with a double tapping sound
Watch ground for guidance when walking With eyes closed they cannot stand steadily with
feet together and the staggering gait gets worsen
DISORDERS OF MUSCLE TONE Rigidity:
Lesion at the Basal Ganglia system Flaccidity:
Lesion at the lower motor neuron system at any point from anterior horn cell to peripheral nerves
Paratonia: Lesion in both cerebral hemispheres.
Spasticity: lesion of the upper motor neuron of corticospinal
tract at any point from cortex to spinal tract
ASSESSING MOTOR SYSTEM Focus on:
Body position Involuntary movements Characteristics of muscles ( bulk, tone and
strength) coordination
Body position Observe the patients
body movement during movement and at rest
Involuntary movements watch for tremors, tics,
fasciculations Note their;
location, quality, rate, rhythm, amplitude
Relation to posture, activity, fatigue, emotion and other factors
Muscle Bulk Inspect the size and
contours of muscles Do muscles look flat or
concave Do muscles suggest
atrophy Is the process unilateral
or bilateral Is it distal or proximal Attend particularly to
hands, shoulders and thighs
Muscle Tone Assessed best by
feeling the muscle’s resistance to passive stretch Persuade the patient to
relax Take one hand of the
patient while supporting the elbow
Flex and extend the patient’s fingers, wrist and elbow
Put the shoulder through moderate range motion
Tense patients show increased resistance
Muscle strength Assess for paresis,
paralysis, plegia, hemiparesis, hemiplegia & quadriplegia Ask patient to move
actively against the examiners resistance
If muscles are weak to overcome the resistance test against the gravity along with gravity eliminated
SCALE FOR GRADING MUSCLE STRENGTH
METHODS FOR TESTING MAJOR MUSCLE GROUPS Test flexion ( C5, C6 - biceps) and extension
(C6, C7, C8 - triceps) at the elbow: Ask patient to pull and push against your hand
Test extension at the wrist (C6, C7, C8, radial nerve – extensor carpi radialis longus & brevis) Ask the patient to make a fist and resist when
the examiner pulls down
Test the grip (C7, C8, T1) Ask the patient to squeeze two of the examiners
fingers as hard as possible and not to let them go
Test opposition of the thumb (C8, T1, median nerve ) The patient should try to touch the tip of the
little finger with the thumb, against the examiner’s resistance
test flexion at the hip (L2, L3, L4 - iliopsoas) Examiner should place the hand on the patient’s
thigh and asking the patient to raise the leg against the examiner’s hand
Test adduction at the hips (L2, L3, L4 - adductors) The examiner places his hands firmly on the be
between the patient’s knees and asks the patient to bring both legs together
Abduction of the hips ( L4, L5, S1 – gluteus medius & minimus) Examiner places hands firmly on the bed outside the
patient’s knees and ask the patient to spread both legs against the hands
Test extension at the hips ( S1 – gluteus maximus) Have the patient push the posterior thigh down
against the examiner’s hand
Test extension at the knee (L2, L3, L4 – quadriceps) Support the knee in flexion and ask the patient to
straighten the leg against examiner’s hand Test flexion at the knee ( L4, L5, S1, S2 -
hamstrings) Place the patient’s leg so that the knee is flexed with
the foot resting on the bed. Ask the patient to keep the foot down as the examiner try to straighten the leg
Test dorsiflexion ( L4, L5 – tibialis anterior) Test plantar flexion ( S1 – gastrocnemius &
sloeus)
COORDINATION Observe the patient’s performance in;
Rapid alternating movements Point to point movements Gait and other related body movements Standing in specific ways
Rapid alternating movement Observe the speed, rhythm and smoothness of
movements
Point to point movement Finger to nose test Heel to shin test
Gait Walk across the
room Balance, swinging of
the arms & posture Tandem walking
( walk heel to toe) Walk on toes and
heels Hop Do a swallow knee
bend
Stance The Romberg test
Observe the patient’s ability to maintain the upright position
Test for pronator drift Observe for the
position of the arm Tap the arms briskly
downward