TAILIEUCHUNG - Chapter 024. Gait and Balance Disorders (Part 4)

Neuromuscular Disease Patients with neuromuscular disease often have an abnormal gait, occasionally as a presenting feature. With distal weakness (peripheral neuropathy) the step height is increased to compensate for foot drop, and the sole of the foot may slap on the floor during weight acceptance. Neuropathy may be associated with a degree of sensory imbalance, as described above. Patients with myopathy or muscular dystrophy more typically exhibit proximal weakness. Weakness of the hip girdle may result in a degree of excess pelvic sway during locomotion. Toxic and Metabolic Disorders Alcohol intoxication is the most common cause of acute walking difficulty. Chronic toxicity. | Chapter 024. Gait and Balance Disorders Part 4 Neuromuscular Disease Patients with neuromuscular disease often have an abnormal gait occasionally as a presenting feature. With distal weakness peripheral neuropathy the step height is increased to compensate for foot drop and the sole of the foot may slap on the floor during weight acceptance. Neuropathy may be associated with a degree of sensory imbalance as described above. Patients with myopathy or muscular dystrophy more typically exhibit proximal weakness. Weakness of the hip girdle may result in a degree of excess pelvic sway during locomotion. Toxic and Metabolic Disorders Alcohol intoxication is the most common cause of acute walking difficulty. Chronic toxicity from medications and metabolic disturbances can impair motor function and gait. Mental status changes may be present and examination may reveal asterixis or myoclonus. Static equilibrium is disturbed and such patients are easily thrown off balance. Disequilibrium is particularly evident in patients with chronic renal disease and those with hepatic failure in whom asterixis may impair postural support. Sedative drugs especially neuroleptics and long-acting benzodiazepines affect postural control and increase the risk for falls. These disorders are important to recognize because they are often treatable. Psychogenic Gait Disorder Psychogenic disorders are common in outpatient practice and the presentation often involves gait. Some patients with extreme anxiety or phobia walk with exaggerated caution with abduction of the arms as if walking on ice. This inappropriately overcautious gait differs in degree from the gait of the patient who is insecure and making adjustments for imbalance. Depressed patients exhibit primarily slowness a manifestation of psychomotor retardation and lack of purpose in their stride. Hysterical gait disorders are among the most spectacular encountered. Odd gyrations of posture with wastage of muscular energy astasiaabasia .

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