Gait Assessment and Application

LSU Physician Champion - Dr. Gary Glynn

Gait is an important part of the neurologic exam

Dependent upon inputs from multiple systems

Visual, Vestibular, Cerebellar, Motor, Sensory

Examination consists of having the patient stand from a seated position, walk across the room, and return to the examiner. In particular, note:

Ease of standing from a seated position, Balance, Walking speed, Stride and step length, How the patient holds his arms and legs

Hemiplegic gait: A result of upper motor neuron spastic hemiplegia. The hypertonic extremity swings (circumduction) with ambulation and exaggerated hip elevation. The arm is hypomobile usually with elbow flexion and shoulder internal rotation secondary to spastic hemiplegia.

Scissoring gait: A result of bilateral upper motor neuron spastic diplegia. Hypertonic hip adductors and flexors causes the knees and thighs to touch or cross in a “scissor-like” movement. Seen most commonly in cerebral palsy.

Ataxic gait: Cerebellar or proprioceptive dysfunction causes wide based gait and over correction of movements causing an erratic, wobbly gait. Proprioception etiology exacerbated by closing eyes; cerebellar etiology exacerbated by tandem walking.

Antalgic gait: Described by “anti” (without) and “algic” (pain), an antalgic gait is usually a shortened stance phase of gait to avoid pain with weight-bearing on the ipsilateral leg.

Trendelenburg gait: Due to weakened abductor muscles of the thigh, gluteus medius and minimus mm. You will see a “hip drop” on the contralateral side secondary to weak abductors. The patient will then lean to ipsilateral side to level out the hips to clear the opposite leg when walking. Pathology is of neuromuscular origin, including but not limited to superior gluteal nerve palsy or L4 root pathology.

Parkinsonian gait: Caused by a disorder of the basal ganglia. It is a narrow based gait with stooped posture and feet shuffling; slow, small steps. The patient may lean forward in an attempt to move faster causing feet shuffling, termed festination; or the patient may lose balance and begin doing this in reverse, termed retropulsion.

Steppage gait: Weak dorsiflexors of the foot cause an ipsilateral foot drop. The patient will lift the affected leg higher as to not drag foot on the ground. Classically secondary to a peroneal nerve palsy. An ankle-foot-orthosis can be very helpful.

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