APPROACH TO THE PATIENT

WITH DIFFICULT IN WALKING

COMPLIED BY DR ZAR CHI WAI LINN

DIFFICULTY IN WALKING
 WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY

JUNCTION

CNS PNS
(UMNL) (LMNL)

BRAIN SPINAL CORD

CEREBRAL CORTEX EXTRAPYRIMIDAL

CEREBELLUM BASAL GANGLIA

 WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY

JUNCTION

CNS PNS
(UMNL) (LMNL)

BRAIN SPINAL CORD

CEREBRAL CORTEX EXTRAPYRIMIDAL

CEREBELLUM BASALGANGLIA
 WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY

JUNCTION

CNS PNS
(UMNL)
(LMNL)
ANTERIOR HORN CELL
BRAIN SPINAL CORD
REDICULOPATHY

PLEXOPATHY
CEREBRAL CORTEX EXTRAPYRIMIDAL
MONONEUROPATHY

CEREBELLUM BASALGANGLIA MONONEURITIS MULTIPLEX

 DIFFICULT IN WALKING

• Nerve?

• Muscle ?

• Neuro -Mascular Junction?

 NEUROPATHY

• CNS ?
• PNS?
 CNS

• Brain : Hemiplegia?
• Spinal cord : Quadriplegia?
• Cerebeller lesion
• Basal ganglia lesion
 PNS
• Flaccid paraplegia ?

• Peripheral neuropathy? Sensory (Glove and stocking)/Motor/Mixed

• Rediculopathy ?

• Plexopathy?

• Mononeuropathy?

• Mononeuritis Multiplex ?
NEUROPATHY
INSPECTION
INSPECTION
INSPECTION
WHAT DO YOU THINK?
HOW DO YOU START
THE EXAMINATION?
• If the patient can walk, start by Rhombergs Test
 WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY

JUNCTION

CNS PNS MYOPATHIC

(UMNL) (LMNL) GAIT

BRAIN SPINAL CORD

NEUROPATHIC
SPASTIC
GAIT
GAIT
CEREBRAL CORTEX EXTRAPYRIMIDAL

BASALGANGLIA
HEMIPLEGIC CEREBELLUM
GAIT
ATAXIC PARKINSON
GAIT GAIT
HEMIPLEGIC GAIT
ATAXIC GAIT
PARKINSON GAIT
SPASTIC GAIT
NEUROPATHIC GAIT
MYOPATHIC GAIT
GOOD LUCK