EXAMINATION OF GAIT
Objectives:
At the end of this session each student will be able to:
1. Define gait.
2. Classify abnormal gaits.
3. Examine the gait properly.
4. Describe abnormal gaits.
5. Interpret the abnormal gaits.
J.J. Kambona (M.B.Ch.B;
M.Med)
Definition: Gait is to the way of walking.
1
Classification abnormal gaits:
Neurological gait.
o Apraxic gait. o Waddling gait.
o Functional gait. o Hemiplegic gait.
o Marche é petit pas. o High-stepping gait.
o Shuffling or festinating gait.
o Scissoring gait (paraplegic gait)
o Broad-based gait (Cerebellar and sensory ataxia)
Non-neurological gait.
o Orthopaedic gait. o Antalgic gait.
How to do it, what you find and what it means:
Ask the patient to walk. Ensure that you are able to see the upper and
lower limbs adequately.
Assess the symmetry of the gait:
o Symmetrical gaits:
Normal gait. Apraxic gait.
Waddling gait. Scissoring gait.
Wide-based gait. Marche é petit pas.
Bilateral high stepping gait.
Shuffling or festinating gait.
o Asymmetrical gaits:
Antalgic gait.
Orthopaedic gait. Hemiplegic gait.
Unilateral high stepping gait.
Symmetrical gaits:
Assess the pace size:
o Small:
Stooped posture and reduced arm swing: Parkinson’s disease.
Stooped posture with marked or normal arm swing: Marche é
petit pas.
o Normal: Look at the lateral distance between the feet.
Normal feet separation: Normal.
Widely separated: Broad-based gait.
Legs uncoordinated: Cerebellar disease.
Crossing over, toes dragged: Scissoring gait.
Assess lifting of the knees:
o Normal lifting: Normal.
o Knees lifted high: Bilateral high-stepping gait (sensory
ataxia).
Assess the movements of the pelvis and shoulders:
o Normal movements: Normal.
o Marked rotation of pelvis and shoulders: Waddling gait.
Assess the whole movement:
o Normal movements: Normal.
o Disorganized as if forgotten how to walk, patient frequently
appears rooted on the spot: Apraxic gait.
o Bizarre, complicated and inconsistent: Functional (hysterical)
gait.
2
Asymmetrical gaits:
The patient on pain: Antalgic gait.
Knees lifted up normally while walking: Normal.
One knees lifted higher while walking: Foot drop.
The patient is not on pain but has bone deformity: Orthopaedic gait.
One lower limb swing out to the side while walking: Hemiplegic gait.
SUMMARY:
Neurological gaits:
Hemiplegic gait:
The upper limb is held in flexion and lower limb in relative extension.
During walking the affected lower limb is swung out at the hip
(circumduction) and dragged stiffly on the ground in extension.
It indicates unilateral upper motor neuron lesion with the lesion
on the pyramidal tract (corticospinal tract).
Commonest causes:
o Stroke. o Multiple sclerosis.
Shuffling or festinating gait:
o A person walks in stooped posture, small steps, reduced arm swing
and may be difficult to start and stop walking (dyskinesia).
o The lesion is on the extra-pyramidal tract (basal ganglia).
Commonest causes:
o Head injury. o Parkinson’s disease.
o Major tranquilizers e.g. chlorpromazine.
Marche é petit pas:
A person walks in upright or stooped posture, in small steps, marked
or normal arm swing.
Commonest causes: Multiple small vessel cerebrovascular disease.
Waddling gait:
A person walks with marked rotation of the hips and shoulders (like a
duck or a pregnant woman).
Commonest causes:
o Proximal myopathies.
o Limb girdle muscular dystrophy.
o Bilateral congenital dislocation of the hips.
Broad-based gait:
o Cerebellar ataxia:
A person walks at normal paces, with feet widely separated and
uncoordinated leg movements (like a drunkard person).
Commonest causes:
Alcohol. Cerebrovascular
Phenytoin. disease.
Multiple sclerosis.
o Sensory ataxia:
A person walks in normal paces with legs widely separated and the
knees are lifted high bilaterally and placed on the ground with
greater care. Romberg’s test is also positive.
Commonest causes: 0
Posterior column loss.
Severe peripheral neuropathy.
3
Scissoring gait (spastic paraplegic gait):
A person displays marked stiffness of both legs with the feet
remaining on the ground and legs crossing over and toes dragging.
Commonest causes:
o Cerebral palsy. o Multiple sclerosis.
High-stepping gait:
A person walks in normal paces with normal feet separation and the
affected foot being lifted higher at the knee to allow room for the
inadequate dorsiflexed foot to swing through and on reaching the
ground the foot slaps the ground.
Commonest cause:
Foot drop (weakness of dorsiflexion [tibialis anterior muscle] due to
lateral popliteal nerve palsy).
Apraxic gait:
Despite the normal power in the lower limbs, the patient cannot
formulate the motor act of walking. The feet appear stuck to the floor
and patient cannot walk.
Commonest causes:
Bilateral hemisphere disease e.g. normal pressure hydrocephalus and
diffuse frontal lobe disease.
Functional gait:
It is variable and inconsistent. It is worse when watched and may be
mistaken for the gait in chorea, especially Huntington’s chorea, which
is shuffling, twitching and spasmodic.
Commonest cause: Hysteria.
Non-neurological gaits:
Orthopedic gait:
The commonest causes are shortened limb, previous hip surgery and
trauma.
Antalgic gait:
The painful limb spends less time on the ground. The commonest
causes are arthritis and trauma.
References:
1. Geraint fuller. Gait; Neurological examination made easy. 3 rd edition,
page: 41-46.
2. Hutchison R. Examination of the central nervous system. Hutchison’s
clinical methods. 21st edition, chapter 11, page 219-281.
3. Essential of clinical medicine, page: 89-129.
4. Neurological disorders. The Merck manual of diagnosis and therapy. 17 th
edition, page 1341-1502.
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