TAILIEUCHUNG - Chapter 024. Gait and Balance Disorders (Part 3)

Parkinsonism and Freezing Gait Parkinson's disease (Chap. 366) is common, affecting 1% of the population 55. The stooped posture and shuffling gait are characteristic and distinctive features. Patients sometimes accelerate (festinate) with walking or display retropulsion. There may be difficulty with gait initiation (freezing) and a tendency to turn en bloc. Imbalance and falls may develop as the disease progresses over years. Other progressive neurodegenerative disorders may also involve a freezing gait; these include progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, and primary pallidal degeneration. . | Chapter 024. Gait and Balance Disorders Part 3 Parkinsonism and Freezing Gait Parkinson s disease Chap. 366 is common affecting 1 of the population 55. The stooped posture and shuffling gait are characteristic and distinctive features. Patients sometimes accelerate festinate with walking or display retropulsion. There may be difficulty with gait initiation freezing and a tendency to turn en bloc. Imbalance and falls may develop as the disease progresses over years. Other progressive neurodegenerative disorders may also involve a freezing gait these include progressive supranuclear palsy multiple system atrophy corticobasal degeneration and primary pallidal degeneration. Such patients with atypical parkinsonian syndromes frequently present with axial stiffness postural instability and a shuffling gait but tend to lack the characteristic pill-rolling tremor of Parkinson s disease. Falls within the first year suggest the possibility of progressive supranuclear palsy. Hyperkinetic movement disorders also produce characteristic and recognizable disturbances in gait. In Huntington s disease Chap. 367 the unpredictable occurrence of choreic movements gives the gait a dancing quality. Tardive dyskinesia is the cause of many odd stereotypic gait disorders seen in chronic psychiatric patients. Frontal Gait Disorder Frontal gait disorder sometimes known as gait apraxia is common in the elderly and has a variety of causes. Typical features include a wide base of support short stride shuffling along the floor and difficulty with starts and turns. Many patients exhibit difficulty with gait initiation descriptively characterized as the slipping clutch syndrome or gait ignition failure. The term lower body parkinsonism is also used to describe such patients. Strength is generally preserved and patients are able to make stepping movements when not standing and maintaining balance at the same time. This disorder is a higher level motor control disorder as opposed to an apraxia. The

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