The Sound of Footsteps!!!
“it's possible to learn more about neurologic status from watching a patient walk than from any other single procedure”
Russell Nelson DeJong (1907-1990)
#MedTwitter #neurotwitter #EndNeurophobia
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“it's possible to learn more about neurologic status from watching a patient walk than from any other single procedure”
Russell Nelson DeJong (1907-1990)
#MedTwitter #neurotwitter #EndNeurophobia
1/
Phases of gait
Critical incidents!
Stance (60%): (1) heel strike (2) foot flat (3) heel off
(4) toe-off
Swing (40%): (5) toe clearance (6) heel strike
via: Morgan E
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Critical incidents!
Stance (60%): (1) heel strike (2) foot flat (3) heel off
(4) toe-off
Swing (40%): (5) toe clearance (6) heel strike
via: Morgan E
2/
Cerebellar ataxic gait
“Wide based, reeling, careening (drunken sailor)”
- inability to walk tandem
- step length varies unpredictably
- turning may bring out a stagger
- acute alcohol intoxication
via: Matthewhr1
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“Wide based, reeling, careening (drunken sailor)”
- inability to walk tandem
- step length varies unpredictably
- turning may bring out a stagger
- acute alcohol intoxication
via: Matthewhr1
3/
Hemiparetic (spastic hemiparesis) gait
“Involved leg spastic, circumduction, often with foot drop”
- pyramidal lesion
- sound by toe scraping, & wear of shoe at toe
- freq: stroke; arm flex, adduct, intern rotated; leg extend
via: onlinemedicalvideo
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“Involved leg spastic, circumduction, often with foot drop”
- pyramidal lesion
- sound by toe scraping, & wear of shoe at toe
- freq: stroke; arm flex, adduct, intern rotated; leg extend
via: onlinemedicalvideo
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Hemiparetic (spastic hemiparesis) gait
“Involved leg spastic, circumduction, often with foot drop”
via: Dr. Rishikesh A. Bhakare
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“Involved leg spastic, circumduction, often with foot drop”
via: Dr. Rishikesh A. Bhakare
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Scissoring gait
“Stiff legged, scissoring (wooden soldier)”
- congenital spastic diplegia and myelopathies
- narrow base
- steps are short and slow, feet seem to stick to the floor
- swaying without true loss of coordination
via: Alhadapediatrics
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“Stiff legged, scissoring (wooden soldier)”
- congenital spastic diplegia and myelopathies
- narrow base
- steps are short and slow, feet seem to stick to the floor
- swaying without true loss of coordination
via: Alhadapediatrics
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Scissoring gait
“Stiff legged, scissoring (wooden soldier)”
youtube.com/shorts/d0LmaJn… via: Neurologia BP
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“Stiff legged, scissoring (wooden soldier)”
youtube.com/shorts/d0LmaJn… via: Neurologia BP
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Parkinsonian gait
“Small steps, flexed posture, shuffling, festination”
- upper extremities are flexed, except fingers extended
- decreased arm swing
- en-bloc turning
- start hesitation
via: Dr. Prodigious
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“Small steps, flexed posture, shuffling, festination”
- upper extremities are flexed, except fingers extended
- decreased arm swing
- en-bloc turning
- start hesitation
via: Dr. Prodigious
8/
Apraxic gait
“loss of the ability to use the legs properly in walking”
- frontal lobe disease
- disorganized walking skills
- shuffling small steps
- normal motor and sensory function on couch examination
via: Jenwit Thippawan
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“loss of the ability to use the legs properly in walking”
- frontal lobe disease
- disorganized walking skills
- shuffling small steps
- normal motor and sensory function on couch examination
via: Jenwit Thippawan
9/
Steppage (equine) gait
“high steppage pattern to clear the toes from the floor, double tap”
- foot drop and sensory ataxia
- double tap # sound: toe first (foot drop) heel first (sensory)
via: emrcpian
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“high steppage pattern to clear the toes from the floor, double tap”
- foot drop and sensory ataxia
- double tap # sound: toe first (foot drop) heel first (sensory)
via: emrcpian
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Steppage (equine) gait
“high steppage pattern to clear the toes from the floor, double tap”
via: Alain Wambe
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“high steppage pattern to clear the toes from the floor, double tap”
via: Alain Wambe
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Myopathic (waddling) gait
“Exaggerated ‘sexy’ hip motion, waddling, lumbar hyperlordosis”
- muscular dystrophy
- broad base
via: onlinemedicalvideo
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“Exaggerated ‘sexy’ hip motion, waddling, lumbar hyperlordosis”
- muscular dystrophy
- broad base
via: onlinemedicalvideo
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Myopathic (waddling) gait
“Exaggerated ‘sexy’ hip motion, waddling, lumbar hyperlordosis”
via: Dr. Yemin Ahmed
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“Exaggerated ‘sexy’ hip motion, waddling, lumbar hyperlordosis”
via: Dr. Yemin Ahmed
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Trendelenburg’s sign
“abnormal drop of the pelvis on the side of the swing leg due to hip abductor weakness”
“pelvic ptosis”
via: openmichigan
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“abnormal drop of the pelvis on the side of the swing leg due to hip abductor weakness”
“pelvic ptosis”
via: openmichigan
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Trendelenburg’s gait
“abnormal drop of the pelvis on the side of the swing leg due to hip abductor weakness”
youtube.com/shorts/ZUPQp5o… via: kenzothiazepine
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“abnormal drop of the pelvis on the side of the swing leg due to hip abductor weakness”
youtube.com/shorts/ZUPQp5o… via: kenzothiazepine
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Antalgic gait
“an abnormal pattern of walking secondary to pain that ultimately causes a limp, whereby the stance phase is shortened relative to the swing phase”
via: Dr. Prodigious
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“an abnormal pattern of walking secondary to pain that ultimately causes a limp, whereby the stance phase is shortened relative to the swing phase”
via: Dr. Prodigious
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Sensory ataxic gait
“Wide-based, steppage”
- post columns or peripheral nerves
- “spinal ataxia”
- pt is extremely dependent on visual input for coordination (# cerebellar ataxia)
- “steppage gait” heel first
- ‘Frankenstein’ gait
youtube.com/shorts/hq4buUL… via: Tony scaria
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“Wide-based, steppage”
- post columns or peripheral nerves
- “spinal ataxia”
- pt is extremely dependent on visual input for coordination (# cerebellar ataxia)
- “steppage gait” heel first
- ‘Frankenstein’ gait
youtube.com/shorts/hq4buUL… via: Tony scaria
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Spastic-ataxic gait
“proportion of each abnormality depends on the particulars of the case”
- Ataxic component: cerebellar or sensory
via: Dr. Sourya Acharya
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“proportion of each abnormality depends on the particulars of the case”
- Ataxic component: cerebellar or sensory
via: Dr. Sourya Acharya
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Marche à petits pas
“Small steps, slow shuffling”
- resembles parkinsonian, but lacks rigidity and bradykinesia
- length of steps less than foot’s length
- frontal lobes, NPH, multi-infarct dementia
via: Osama SM Amin
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“Small steps, slow shuffling”
- resembles parkinsonian, but lacks rigidity and bradykinesia
- length of steps less than foot’s length
- frontal lobes, NPH, multi-infarct dementia
via: Osama SM Amin
19/
Cautious (senile) gait
“velocity slows, steps shorten, and the base widens”
- 'healthy person walks on an icy surface'
- aging vestibular system, impaired proprioceptive by distal neuropathy in the elderly, and impaired vision
via: Global news
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“velocity slows, steps shorten, and the base widens”
- 'healthy person walks on an icy surface'
- aging vestibular system, impaired proprioceptive by distal neuropathy in the elderly, and impaired vision
via: Global news
20/
Magnetic gait
“inability to lift the feet off the floor”
- NPH
via: Hydrocephalus association
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“inability to lift the feet off the floor”
- NPH
via: Hydrocephalus association
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Magnetic gait
“inability to lift the feet off the floor”
youtube.com/shorts/Enp5map… via: Dr.Pawan Soni
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“inability to lift the feet off the floor”
youtube.com/shorts/Enp5map… via: Dr.Pawan Soni
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Functional gait
“recognizing positive clinical features of functional gait disorders”
- complex
- inconsistency
- incongruity
youtube.com/shorts/zJIZtob… via: Pogakula Udaykiran
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“recognizing positive clinical features of functional gait disorders”
- complex
- inconsistency
- incongruity
youtube.com/shorts/zJIZtob… via: Pogakula Udaykiran
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Astasia
“inability to stand”
- functional?
- everything normal, except for the inability to stand
- freq assoc to abasia
doi.org/10.1002%2Fmdc3… via: Mov Disord Clin Pract
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“inability to stand”
- functional?
- everything normal, except for the inability to stand
- freq assoc to abasia
doi.org/10.1002%2Fmdc3… via: Mov Disord Clin Pract
25/
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