Gait

4.5.06

Gait control
• Cortex, pyramidal.
• Cortex, extra-pyramidal.
• Cerebellum.
• Reflex arc - can be tested.

Development of walking
• Milestones.
• Development of all structures required.
• Characteristic patterns when impaired.

Milestones
• Sits at 6 months.
• Crawls at 9 months.
• Stands and walks aided at 15 months.
• Walks unaided at 15 months.
• Runs at 18 months.
• Adult pattern by 3 years.
• Fully mature pattern only by 6 years.

Infant gait pattern
• Jerky, unsteady, wide-based.
• Arms abducted and extended.
• Foot-strike flat and knee flexed.
• Longer double stance phase.
• Rapid steps, but low velocity.

What can go wrong?
• Brain.
• Spinal cord.
• Nerves.
• Muscles.
• Joints.
• Bones.

Brain
• Cortex and internal capsule.
-Stroke - usually one-sided.
• Extrapyramidal system.
-Parkinson's.
• Cerebellum - important in coordination of gait.
-Ataxias.

Spinal cord
• Injuries.
• Tumours.
• Degeneration.

Upper and lower motor neurones
• Upper motor neurone lesion.
-Increased tone and reflexes.
-Spastic paralysis.
• Lower motor neurone lesion (anterior grey horn).
-Decreased tone and reflexes.
-Flaccid paralysis.

Nerves and muscles
• Injuries.
-Laceration, traction.
• Pressure.
-Carpal tunnel syndrome.
• Degeneration.
-Polio, motor neurone disease, myopathies.

Bones and joints
• Injuries.
-Fractures, ligament ruptures.
• Degenerations.
-Osteoarthritis.

Gait analysis
Normal gait
• Gait cycle.
• Stance phase.
• Swing phase.
• Double stance.
• Double swing.

Some abnormal gaits:
• Painful gait (antalgic) - short stance phase.
• Drop foot gait - rupture of tibialis anterior, L5 root problem.
• Parkinsonian.
• Cerebellar.
• Stiff leg gait - joint abnormalities.
• Athetoid - wild, abnormal movements.
• Back-knee gait.
• Tabetic - heavy walk - no sensory input from feet - syphilitic loss of proprioception.
• Spastic diplagic - scissor gait.
• Stroke (paraplagic).
• Lurching (rolling) gait - hip pathology.
• Trendellenburg.
• Slapping gait - less pronounced version