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Gait disorder in candidate wishing to pilot or airhostess

 ·        Definition:  Series of  rhythmical,  alternating  movements  of  the  trunk  &  limbs  which  result  in  the  forward  progression  of  the  center  of  gravity,  &  thereby  forward  movement  of  body.

·   INTRODUCTION     Human  walking  follows  a  repetitive  pattern  called  the  gait  cycle. The  gait  cycle  can  be  divided  into  two phases, (1)  the  stance  phase  when  the  lower  limb  is  in  contact  with  the  ground  and  (2)  the  swing  phase  when  the  limb  is  lifted  off  in  order  to  advance  the  body forwards. Stance  phase  accounts  for  60%  of  the gait  cycle  & the  swing  phase  contributes  about  40%.

·        Phases  of  Gait  Cycle (8  phase  model):    See the figure as an attachment

Stance  Phase (60%)

1.      Initial  contact

2.      Loading  response

3.      Mid stance

4.      Terminal  stance

5.      pre swing

 

Swing  Phase (40%)

4.      Initial  swing

5.      Mid  swing

6.      Terminal  swing

 
 


    

 ·        Gait  examination  is  very important  in  assessment of  neurological  &  musculoskeletal  disorders.  It  reveals  involvement  of  various  parts  of  he  nervous  system  like  cerebral  cortex,  extrapyramidal  system, cerebellum,  Lower  motor  neuron  lesions  like  GBS,  myopathies,  muscular  dystrophy  &  neuropathy.  It  also  helps for  analysis  of  various  musculoskeletal  disorders.

·        It  is  important  to observe  the  child  walking  &  sometimes  running  for  a  distance  of  a  few  feet. Also,  watch how  he  is  getting  up  from  floor  &  climbing  the stairs.

·        Thorough  clinical  observations  of gait,    careful  history  taking  focused  on  gait  &  physical,  neurological  &  orthopedic  examinations  are  basic steps  in  categorization  of  gait  disorders  &  serve  as  a  guide  for  necessary  investigations &  therapeutic  interventions.

·        Abnormality  in  gait  may  be  caused by

×          Pain

×          Joint &  muscle  range  of  motion  limitation

×          Muscular  weakness/paralysis

×          Neurological involvement (UMN,  LMN).

×          Leg  length  discrepancy.

·        Antalgic  gait  (limping  gait)

×          Painful  limb  &  therefore  limp  is  adopted  as  to  avoid  pain  on  weight  bearing  structures.

×          Stance  phase is  shortened.

×          Common  causes:  Fractures,  Tendinitis,  Arthritis.

·        Ataxic  gait  (Reeling  gait)  (Tandem  gait)

×          Most  common  manifestation  of  cerebellar  damage.

×          Often  the  first clinical  sign  of  cerebellar  disease.

×          Wide  base.

×          Can  not  follow  walking  path  in  a  straight  line,  but  instead  veers  in  different  directions, giving  the  appearance  of  stumbling  or  drunkenness.

×          Falls  to  the  side  of  lesion.

×          Frequent  falling.

×          Sometimes  high  -  steppage gait  pattern is  also  seen.

·        Hemiplegic  gait  (Circumduction  gait)

×          With  spastic  type  of  hemiplegic  leg.

-        Hip  into extension,  adduction  &  medial  rotation.

-        Knee  in  extension  &  unstable.

-        Ankle  in  a  drop  foot  with  ankle  planter  flexion  &  inversion  (in  both  stance  &  swing  phases).

×          In  order  to  clear  the  foot  from  the  ground  the hip  & knee  should  flex.

×          But  the  spastic  muscles  would  not allow the  hip  &  knee  to  flex  for  the  floor  clearance.

×          So the  patient  hikes  hip  &  bring  the  affected  leg  by  making  a  half  circle,  circumducting  the  leg.  Hence,  the  gait  is  known  as  ‘Circumductory  gait’.

×          No  reciprocal  arm  swing.

×          Step length  tends  to  be  lengthened  on  the affected  side  &  shortened  on  the  normal  side.

·        Scissoring  Gait

×          Results  from  spasticity  of  bilateral  adductor  muscles  of  hip.

×          One  leg crosses  directly  over  the  other  with  each  step like  crossing  the  blades  of  the  scissor.

×          Commonly seen  in  children  with  cerebral  palsy of  spastic  diplegia  type,  arthrogryposis  etc.

·        High  stepping  gait  (stamping  gait)

×          It is  seen  in  patients  with  foot  drop, weakness  of  foot  dorsiflexion.

×          There  is  an  attempt  to  lift  the  leg  high  enough  during  walking  so  that  foot  does  not  drag  on  the  floor.

×          On  bringing  the  foot  to  the  ground,  toes  touch  first   &  then  heel.  It  results  in  high  stepping  gait  when  sudden  sound, also  called  as  stamping  gait.

×          It  is  due  to  paralysis  of  common  peroneal  nerve.

×          It  is  seen  in  peripheral  neuropathies,  lesions  of  cauda equine  etc.

·        Trendelenburg  gait

×          It  results  due  to  weakness  of  gluteus  medius  muscle.  It  is  called  as  ‘Trendelenburg  gait’  or  ‘lurching  gait’  when  one  side  is  affected.

×          The  person  sifts  the  trunk  over  the  affected  side  during  stance  phase.

×          When  right  gluteus  medius  or  hip  abductor  is  weak,  it  causes  two  things:

-        The  body  leans  over  the  left  leg  during  stance  phase  of  the  left  leg  and

-        Right  side  of  the  pelvis  will drop when  the  right leg  leaves  the  ground  &  begins  swing  phase.

×          Shifting  the  trunk  over  the  affected  side  is  an  attempt  to  reduce  the  amount  of  strength  required  of  the  gluteus medius  to  stabilize  the  pelvis.

×          Causes

-        Weak  abductors  (Poliomyelitis,  DMD).

-        Congenital  dislocation  of  hip  joint.

-        Perthes  disease.

·        Waddling  gait  (Duck  gait)

×          Bilateral  paralysis  of  gluteus  medius  muscle  causes  waddling  or  duck  gait.

×          The  patient  lurch  to  both  sides  while  walking.

×          The  body sways  from  side  to  side  on  a  wide  base  with excessive  shoulder  swing.

×          It  is  seen  in  muscular  dystrophies  like  Duchenne  Muscular  Dystrophy  (DMD),  Spinomuscular  atrophy  (SMA)  etc.

·        Short  limb  gait

×          Shortening  <  1.5  cm  compensated by  pelvic  tilt  &  shortening  upto  5  cm  compensated  by  equines.

×          Shortening  >  5  cm, the  patient  dips  his  body  on  that  side.

·        Toe  walking  (Equinus  Gait)

×          May  be  normal  in  children  upto  age  of  2  years.

×          It  is  seen  in  children with  spastic  cerebral  palsy  &  Duchenne  muscular  dystrophy.

·        Festinate  Gait  (Short  shuffling  Gait):  (Parkinson’s  Gait)

×          Seen  in  Parkinson’s  disease.

×          Because  of  rigidity,  all  the  joints  will  go  for  a  flexion  position  with  spine  stooping  forward.

×          This  posture  displaces  the  centre  of  gravity  anteriorly.

×          So  in  order  to  keep  centre  of  gravity  within  limits,  patient  will  walk  with  small,  shuffling  steps.

×          Due  to  loss  of  voluntary  control  over  the  movement,  the  patient  loses  balance  &  walks  faster  as  if  he  is  chasing the  centre  of  gravity.  Therefore,  it  is  called as  ‘Festinate  gait’.  It  is  also  called  as  ‘Shuffling  gait’  due  to  his  shuffling  steps.


Comments

  1. Excellent.! Gait describe in very simple language so anyone can understood. Otherwise it's very difficult.

    ReplyDelete

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