Jabir Ibn Hayyan Medical ‫جامعة جابر بن حيان الطبية‬

University Faculty of
‫كلية الطب‬
Medicine Department of
internal medicine ‫ الطب الباطني‬:‫فرع‬

Final Students Report

( GAIT ABNORMALITIES)

( ‫)علي حسين عودة‬

Department of internal medicine Faculty of Medicine, Jabir Ibn Hayyan Medical

University, Najaf city, Iraq

Subject: INTERNAL MEDICINE

Stage: 3RD STAGE

E mail: ALIALALYAWI17@GMAIL.COM

Date of Submission:15-07-2020

Teacher: DR.HAYDER

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 Summary
Gait is the cyclical pattern of musculoskeletal motion that carries the body forwards. Normal
gait is smooth, symmetrical and ergonomically economical. The individual gait pattern is
influenced by age, personality, mood and sociocultural factors. The preferred walking speed
in older adults is a sensitive marker of general health and survival. Safe walking requires
intact cognition and executive control. Acute onset of a gait disorder may indicate a
cerebrovascular or other acute lesion in the nervous system but also systemic diseases or
adverse effects of medication, in particular polypharmacy including sedatives. Sensory ataxia
due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular
encephalopathy or disorders associated with dementia are among the most common
neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait
disorders. With advancing age the proportion of patients with multiple causes or
combinations of neurological and non-neurological gait disorders increases. Thorough
clinical observation of gait, taking a focused patient history and physical, neurological and
orthopedic examinations are basic steps in the categorization of gait disorders and serve as a
guide for ancillary investigations and therapeutic interventions.
Keywords: Aging; Neurological gait disorders; Parkinsonism and Orthopaedic gait disorders.

INTRODUCTION
The normal gait: Each sequence of limb action (called a gait cycle) involves a period of
weight-bearing (stance) and an interval of self-advancement (swing). During the normal gait
cycle approximately 60% of the time is spent in stance and 40% in swing. The exact duration
of these intervals varies with the walking speed. There also are minor differences among
individuals.[1]

GAIT AND POSTURE

The gait may suggest an important neurological or musculoskeletal disorder or provide clues
to the patient’s emotions and overall function. Disorders of gait occur because of pain, fixed
or immobile joints, muscle weakness or abnormal limb control.[2]

TYPES AND CHARACTERS OF GAIT

1. Hemiplegic Gait The patient stands with unilateral weakness on the affected side, arm flexed,
adducted and internally rotated. Leg on same side is in extension with plantar flexion of the
foot and toes. When walking, the patient will hold his or her arm to one side and drags his or
her affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop)
and extensor hypertonia in lower limb.[3]
2. Diplegic Gait Patients have involvement on both sides with spasticity in lower extremities
worse than upper extremities. The patient walks with an abnormally narrow base, dragging

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 both legs and scraping the toes. There is also characteristic extreme tightness of hip adductors
which can cause legs to cross the midline referred to as a scissors gait. In countries with
adequate medical care, patients with cerebral palsy may have hip adductor release surgery to
minimize scissoring.[3]
3. Neuropathic Gait (Steppage Gait, Equine Gait) Seen in patients with foot drop (weakness of
foot dorsiflexion), the cause of this gait is due to an attempt to lift the leg high enough during
walking so that the foot does not drag on the floor. [3]
4. Myopathic gait During walking, alternating transfer of the body’s weight through each leg
requires adequate hip abduction. In proximal muscle weakness, usually caused by muscle
disease, the hips are not properly fixed by these muscles and trunk movements are
exaggerated, producing a rolling or waddling gait. [1]
5. Ataxic gait this gait is described as clumsy, staggering movements with a wide-based gait.
While standing still, the patient's body may swagger back and forth and from side to side,
known as titubation. Patients will not be able to walk from heel to toe or in a straight line. [3]
6. Choreiform Gait (Hyperkinetic Gait) The patient will display irregular, jerky, involuntary
movements in all extremities. Walking may accentuate their baseline movement disorder.[3]
7. Parkinsonian Gait Freezing is defined as a brief, episodic absence of forward progression of
the feet, despite the intention to walk. Freezing may be triggered by approaching a narrow
doorway or crowd, may be overcome by visual cueing, and contributes to fall risk. [4]

DISCUSSION : Investigations
While there is no established diagnostic laboratory workup that is indicated for balance and
gait disorders, consider measuring complete blood count and levels of electrolytes, fasting
glucose, thyroid function, creatinine, blood urea nitrogen, and vitamin B12. If peripheral
neuropathy or a motor neuron disease such as amyotrophic lateral sclerosis is suspected,
nerve conduction studies can be diagnostically useful. Also, cervical and lumbar spinal
stenosis are common causes of myelopathy in neurology cohorts. Bone mineral density
testing with dual-energy x-ray absorptiometry is recommended for all patients older than 65
years of age to identify potential osteoporosis.[4]

DAIGNOSIS
1. Hemiplegic Gait: This is most commonly seen in stroke. With mild hemiparesis, loss of
normal arm swing and slight circumduction may be the only abnormalities.[3]
2. Diplegic Gait: This gait is seen in bilateral periventricular lesions, such as those seen in
cerebral palsy.[3]
3. Neuropathic Gait: If unilateral, causes include peroneal nerve palsy and L5 radiculopathy. If
bilateral, causes include amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease and other
peripheral neuropathies including those associated with uncontrolled diabetes.[3]
4. Myopathic gait: This gait is seen in patient with myopathies, such as muscular dystrophy.[3]
5. Ataxic gait: Most commonly seen in cerebellar disease. The gait of acute alcohol intoxication
will resemble the gait of cerebellar disease. Patients with more truncal instability are more
likely to have midline cerebellar disease at the vermis.[3]

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 6. Choreiform Gait: This gait is seen with certain basal ganglia disorders including Sydenham's
chorea, Huntington's Disease and other forms of chorea, athetosis or dystonia.[3]
7. Parkinsonian Gait: This gait is seen in Parkinson's disease or any other condition causing
parkinsonism, such as side effects from drugs.[3]

TREATMENT
Prevention and treatment of iatrogenic, especially medication-induced, gait disorders are
important measures to reduce the burden of falls in the geriatric population. Several gait
disorders are amenable to specific treatment. Levodopa is the drug of choice for the treatment
of the gait disorder of PD and in some other parkinsonian syndromes. Rare conditions, such
as myoclonus and orthostatic tremor also may respond well to medication. In normal pressure
hydrocephalus, cervical spondylotic myelopathy, lumbar spinal stenosis and hip or knee
osteoarthritis, surgical treatment should be considered.[4]

CONCLUSION
Any gait disorder should be thoroughly investigated in order to improve patient mobility and
independence, to prevent falls and to detect the underlying causes as early as possible.

REFERENCES

1. 13. davidson s. Davidson's principles and practice of medicine. 23rd ed. [Place of publication
not identified]: Elsevier; 2018..
2. Macleod J, Douglas G, Nicol E, Robertson C. Macleod's clinical examination ed. 13th ed.
Edinburgh: Elsevier Churchill Livingstone; 2013.
3. Gait Abnormalities [Internet]. Stanford Medicine 25. 2020 [cited 14 July 2020].
4. Jameson J, Kasper D, Longo D, Fauci A, Hauser S, Loscalzo J. Harrison's principles of
internal medicine. 20th ed. 2018..