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Cerebellar Exam
 
 

Assessment of Gait

 
 
 
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Overview

Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.
Gait involves many different systems - vision, proprioception, upper motor neurons, lower motor neurons, basal ganglia, cerebellum and higher planning centres. Full neurological assessment is required to correlate gait disturbances.
  • How to Assess

  • Ask the patient to walk ~5m and return to their starting point.
  • Look For

  • Posture - position of the head, shoulders and spine.
  • Symmetry - symmetrical rise and fall of the shoulders, hips, knees and feet.
  • Rhythm - natural movement through the stance and swing phases.
  • Coordination - steadiness of the gait and amount of sway. Dyscoordination may indicate an ataxic or spastic gait.
  • Foot separation - wide-based or narrow-based. A wide base  is used to compensate for poor coordination.
  • Stride length - the distance between heel placements of one foot over one gait cycle.
  • Cadence - the number of steps per minute.
  • Causes of Abnormal Gait

  • Pain - inflammation, infection, malignancy, trauma
  • Weakness - muscular, neuromuscular or neurological
  • Deformity - arthritis, surgery, shortening post fracture, congenital malformations
  • Instability - peripheral neuropathy, cerebellar or brainstem pathology

Antalgic Gait

The presence of an antalgic gait indicates injury or other pathology causing pain on weightbearing.
  • Look For

  • A painful gait, with quick stance on the affected lower limb.

Ataxic Gait

An ataxic gait occurs with cerebellar lesions or with loss of proprioception.
  • Look For

  • An unsteady, staggering, wide-based gait.

Apraxic Gait

An apraxic gait is common with frontal lobe pathology.
  • Look For

  • A wide-based gait with short, shuffling steps.

Trendelenburg Gait

The Trendelenburg gait is indicative of proximal myopathy.
  • Look For

  • Dropping of the affected side during the stance phase and the unaffected side during the swing phase.

Spastic Gait

Spastic gait may occur with cerebral palsy or hemiplegia.
  • Look For

  • A poorly coordinated gait with short steps and jerky movement.

Festinating Gait

Festinating gait may be caused by Parkinson's disease or other causes of parkinsonism.
  • Look For

  • Quick, shuffling steps with the torso held rigid.

Short Leg Gait

A short leg gait may occur in the context of any condition in which one leg is shorter than the other.
  • Look For

  • Dipping of the affected leg.
  • Causes of Short Leg Gait

  • Congenital short leg
  • Fracture
  • Joint disease
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