![]() Once again if you have trouble with your proprioception and cannot feel when your foot has arrived on the floor you are relying on a lot of visual cues and especially in the dark. ![]() Talking about proprioception leads me to the other gait related to proprioception. Therefore, the moment you ask the patient to stand still and close their eyes the patient begins to sway and that is a positive Romberg test it has very little to do with the cerebellum. ![]() If however you have a problem with proprioception because of your peripheral nerves or posterior columns, then you're relying on your eyes to tell you where you are in space. When you and I are standing like this with our eyes open we are getting signals from our joints to tell us where we are in space. The cerebellum patient is already swinging and it gets a lot worse when you have them proprioception. Now the Romberg test has nothing to do with the cerebellum. One caveat: many people think of the Romberg test as being a test of cerebellar disease. When asked to stand still, their trunk may sway like this and that is called titubation and obviously they would have problems with all the other cerebellar tests. People will tend to fall towards the side of their illness so if the illness is in the cerebellar hemisphere on the left they might fall in that direction. The cerebellar gait is characterized by a broad stand and by a wide staggering quality to it. The patient may have a myriad other abnormalities related to the Parkinson's that we are not going to cover in this session.Īnother gait that's very helpful to recognize and it may be one that you're all familiar with from watching police videos and hopefully not from personal experience is the cerebellar gait. A petit power walk of little steps and there might also be an associated tremor with the gait. Every joint is flexed and the patient typically will take very small steps. It's a posture that's characterized by universal flexion. It's called the hemiplegic gait.Īnother case that we would commonly identify is the gait of Parkinson’s disease. ![]() They can't lift up the leg and step like that so they wind up circumducting so this is the most common gait we will see around here probably. And b) because they have foot drop because their weakness distally. they could just step like this you know they could go like this. The tie is strong but the foot is weak and so they have foot drop and so the circumduction comes about because a) they have extensor hypertonia. Their shoulder is strong and the fingers are very weak. In addition, they develop much more distal weakness than proximity weakness. So you develop flexion hypertonia in the upper limb and extensor hypertonia in the lower limb and that accounts for the leg being like that and the hand being like this. On the left side you have abnormalities of tone that manifests on the right side. It's important to understand why they do what they do when you cut the pyramidal tract. If the condition is mild the hand may not be flexed up like that and the only manifestation might just be a little circumduction and the hand may not be swinging normally the way the other hand swing. The fact that the foot is making a circle like that is what makes this gait so characteristic. They will then have a gait that looks something like this and the characteristic of the gait is the circumduction of the foot. The most common gauge you will see is the hemiplegic gait and this is one that you see in hemiplegia where the arm is typically in this posture and the leg on the affected side is typically somewhat stiff. It would be a great shame for a patient to come to us with an abnormal gait and for us to send the patient for testing or consultation when the diagnosis might be fairly evident in the gait. I'm now going to demonstrate a couple of gaits.
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