Abnormalities of Gait

 

Spastic Hemiparesis

  • associated with unilateral upper motor neuron disease

 

Manifestations:

  • one arm is flexed, close to the side and immobile
  • the leg is circled stiffly outward and forward, circumducted
  • often the toe is dragged when walking

 

Scissors gait:

  • associated with bilateral spastic paresis of the legs

 

Manifestations:

  • Each leg is advanced slowly
  • Thighs tend to cross forward on each other at each step
  • The steps are short
  • The patient looks as if he were walking through water.

 

Stepping Gait:

  • Associated with foot drop, usually secondary to lower motor neuron disease

 

Manifestations

  • The feet are lifted high, with knees flexed and then brought down with a slap on the floor.
  • The patient looks as if he were walking upstairs.

 

Sensory Ataxia

  • Associated with loss of position sense in the legs

 

Manifestations:

  • The gait is unsteady and wide-based, the feet are far apart.
  • The feet are lifted high and brought down with a slap
  • The patient watches the ground to guide his steps
  • He cannot stand steadily with feet together when his eyes are closed, Romberg test is positive.

 

Cerebellar Ataxia

  • Associated with disease of the cerebellum or associated tracts

 

Manifestations

  • The gait is staggering, unsteady and wide-based with exaggerated difficulty on the turns
  • The patient cannot stand steadily with feet together, whether eyes closed or open.

 

Parkinsonian Gait

  • Associated with the basal ganglia defects of Parkinson’s disease

 

Manifestations:

  • The posture is stooped
  • The hips and knees are slightly flexed
  • Steps are short and often shuffling
  • Arm swings are decreased and the patient turns around stiffly – “all in one piece”.

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.

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