Professional Documents
Culture Documents
7
08 Sept
2014
GAIT TESTING
The ability to stand and walk normally is dependent on input from
several systems, including:
o Visual
o Vestibular
o Cerebellar
o Motor
o Sensory
The precise cause of the dysfunction can be determined by
identifying which aspect of gait is abnormal and incorporating this
information with that obtained during the rest of the exam
o E.g. Difficulty getting out a chair and initiating movement =
Parkinsons Disease
o Lack of balance and a wide based gait would suggest a
cerebellar disorder
Ataxia
A gait that lacks coordination, with reeling (to move from side
to side as if youre going to fall) and instability
(+) Romberg = The patient loses balance, when eyes are closed
(hindi na alam ng tao kung nasan siya, kasi sarado na ang mata)
Loss of balance suggests impaired proprioception.
In disease of the cerebellum:
o Lateral lobe, falling is toward the affected side
o Frontal lobe, falling is to the opposite side
o Midline or vermis, falling indiscriminately
Doc Guzman:
PROCEDURE
Ask the patient to:
1.
2.
3.
4.
5.
6.
7.
8.
Doc Guzman:
i.
ii.
ROMBERG TEST
Have the patient stand still with
heels and toes together.
Ask the patient to close her eyes
and balance herself
o Closing the eyes removes
visual input
TRANSCRIBED BY:
Bates
TEST FOR PRONATOR DRIFT
Pronator drift
This is the pronation of one forearm.
It is both sensitive and specific for a corticospinal tract lesion
originating in the contralateral hemisphere
Downward drift of the arm with flexion of fingers and elbow
may also occur
CEREBELLAR TESTING
Functions of the cerebellum
o Fine tunes motor activity
o Assists with balance
Dysfunction results in a loss of coordination and problems with gait.
Ipsilateral control:
o The left cerebellar hemisphere controls the left side of the body
and vice versa.
Specifics of Testing
There are several ways of testing cerebellar function.
For the screening exam, using one modality will suffice.
Page 1 of 3
Hemiplegic Gait
Retropulsion
Doc Guzman
1.
1.
Direct the patient to touch first the palm and then the dorsal side of
one hand repeatedly against their thigh. Then test the other hand.
Spastic Hemiparesis
Caused corticospinal lesions (e.g. stroke)
Poor control of flezor muscles during swing phase
Affected arm is flexed, immobile and held close to the side, with
elbow, wrists, joints flexed
Affected leg extensors spastic
Patient may drag toe, circle leg stiffly outward and forward
(circumduction, yung dinemo ni sir)
May lean toward unaffected
1.
Interpretation: The movement should trace a straight line along the top
of the shin and be done with reasonable speed
Scissors Gait
Seen in spinal cord disease causing bilateral lower extremity
spasticity
Adductor spasm, abnormal proprioception
Gait is stiff, steps are short
Patients advance each leg slowly, and the thighs tend to cross
forward on each other at each step
They appear to be walking on water
Normal
posture, step size, and arm
swing
Tandem walking
Page 2 of 3
Steppage Gait
Seen in foot drop
Patients either drag the feet or lift them high, with knees flexed,
and bring them down with a slap onto the floor
They cannot walk on their heels
Tibialis anterior and extensors are weak
Sensory Ataxia
Caused by loss of position sense in the legs
Unsteady and wide-based gait
They watch the ground for guidance when walking
They can stand steadily with feet together when eyes are open,
but not when closed (+) Romberg
QUIZ TIME!!!
Answers:
1) A 2) C 3) D 4) B 5) Proprioception 6)
Heel-to-Toe Test 7) Rombergs Test 8)
Dysdiadochokinesia 9) Tandem Walking
10) Proximal Muscle Weakness
Matching Type:
A. Parkinsons Disease
B. Cerebellar Ataxia
C. Foot Drop
D. Spinal Cord Disease/ Lesion
_____1) Shuffling Gait
_____2) Steppage Gait
_____3) Scissors Gait
_____4) Wide-Based Gait
5) Rombergs Test is a test for?
6-7) Give two tests for GAIT
8) Inability to do rapid, alternating movements
9) The Heel-to-Toe test is also known as?
10) Difficulty doing a SHALLOW KNEE BEND suggests what
pathology?
Cerebellar Ataxia
Gait is staggering, unsteady,, wide-based, with exaggerated
difficulty on turns
Patients cannot stand steadily with feet together, whether eyes
are open or closed
Page 3 of 3