parkinsonian gait | pathological gait defination | pathological gait types | pathological gait analysis | Parkinson Gait

Introduction to gait : -

It is a term used to describe the style ,manner or pattern of walking.

Gait Cycle

It is defined as all the activities that occur from heel contact of one foot to the next heel contact of the same foot.

Two gait terminologies are described:

(A) traditional terms 

 1. Stance phase  - Heel strike 

•                     Foot flat
•                     Mid stance
•                     Heel off
•                     Toe off

2. Swing phase    - Initial swing 

•                     Mid swing
•                    Terminal swing

B. RLA (Rancho Los Amigos) - 

  1.  Stance phase  - Initial contact 

•                       Loading response
•                       Mid stance
•                      Terminal stance
•                      Pre swing

  2. Swing Phase   - Acceleration 

•                        Mid swing 
•                        Deceleration

                             PATHOLOGICAL GAIT

It is an altered gait pattern due to deformities or muscle weakness

This alteration is broadly divided into : Neurological cause and musculoskeletal cause

Neurological gai t: - Parkinson gait

                                 Hemiplegic gait

                                 Ataxic gait

                                 Scissoring gait

                                 Hyperkinetic gait

Musculoskeletal :-   Tredelenburg's gait

                                Waddling gait

                                Gluteus maximus gait

                                 High stepping gait

Painful gait        :     Antalgic gait

PARKINSON GAIT :  
 Introduction : - The gait patterns is said to be shuffling gait or festinating gait The patient adopt the flexed posture of neck, trunk, hip, and knee  due to rigidity of the muscles. Because of the flexed postures the COG anteriorly and the patient try to chase the COG and to keep it in same position and regain balance, the patient tends to have the rapid shuffling gait.

causes:
The disorder is mainly due to deficiency of the dopamine in the basal ganglia circuit leading to a motor deficits. Gait is the most affected characteristic of this disorder.

This type of gait is mostly seen in:

•        Parkinson's disease
•       Wilson's disease
•       Cereberal atherosclerosis

clinical features

1. Tremors: resting tremors, postural tremors, pin rolling tremors in the thumbs and the fingers.

2. Rigidity: decreases the ROM, easily fatigue, alteration in the gait pattern.

3. Bradykinesia: slowness in the movement.

4. Postural instability : Stooped posture, head protruted forward, flexion of the neck, trunk, elbow, hip and knee.

PARKINSONIAN GAIT PATTERN

•       Festinating gait
•       Shuffling gait
•       Toe-heel gait
•       Have difficulty in initiating gait
•       Patient takes a small step on walking
•      There is loss of heel-toe gait, as the toe strike first
•       Loss of arm swing during walking
•       Turning and changing direction is difficult
•       Patient is only able to stop when he comes to contact with wall or object
•       FOG(Freezing of gait): is typically a transient episode lasting less than a minute, in which the gait is halted and the patient complaint that his/her feet is glued to the ground.

 PT management

    Physical therapy has shown to have positive effect on gait parameters.

Improve musculoskeletal flexibility

•       gental stretching of elbow, hip, knee and ankle flexors
•       active ROM of the extrimities
•       active assisted exercise of neck, trunk rotation

Balance training 

•       it can be started from low COG position(sitting) to high COG position(standing)
•     by pushing the patient and ask him to maintain the postures

Physiotherapists may help to improve gait by creating training programs to:

•       lengthen a patients stride length
•       broaden the base of support
•       improve the heel-toe gait pattern
•       straight out a patients posture
•       increase arm swing patterns
•       improving trunk flexibility, along with the strengthening of the core muscles and lower extremities has associated with the increased balanced and an improvement in gait pattern
•       aerobic exercise such as tandem bicycling and water aerobics are also crucial in improving strength and overall balance 

Due to the progressive nature of PD's , it is important to sustain an exercise routine

•       side walking
•       tandem walking
•       stair case walking
•       reaching activities
•      Walking in pre- marked foot print in front of the postural mirrors: to improve foot placement and widen the patient's base of support
•       obstracle waking: to improve turning and changing direction