Examination of Gait
PURPOSE
The main purpose of the examination of gait is to localize neurologic dysfunction by looking for characteristic patterns of gait abnormalities.
WHEN TO PERFORM THE GAIT EXAMINATION
Gait should be assessed in all patients in whom ambulation can be attempted as part of a standard neurologic examination. In patients who can attempt it safely, tandem gait should also be examined in most patients as part of a standard neurologic examination. Testing the patient’s ability to walk on the heels or the toes needs only to be performed when weakness of foot dorsiflexion or plantar flexion is suspected.
NEUROANATOMY OF GAIT
Walking requires the coordinated effort of several neurologic structures and functions:
The frontal lobes to generate the motor pathways to initiate gait
Cerebellar (and vestibular) function for coordination and balance
The basal ganglia for appropriate speed of movement
Muscle strength to move the legs and to overcome gravity to remain upright
Sensation, particularly proprioception, to know where the feet and legs are in space
EQUIPMENT NEEDED TO EXAMINE GAIT
None.
HOW TO EXAMINE GAIT
Gait
The gait can be tested with the patient’s shoes on or off. If gait is tested outside the patient’s room, it is best to have the patient wear shoes. In a patient without a suspicion for a significant gait problem, testing the patient’s gait inside the examination room (or simply observing the patient when he or she walks into or out of the room) may suffice to prove that gait is normal. When an abnormality of gait is suspected, watching the gait for a longer distance, such as in a hallway, may be necessary.
Ask the patient to walk, and observe the patient’s base (how far the legs are apart), stride, and balance. In some cases, you may only need to see
the patient walk a few steps to confirm that the gait is normal, and, in other cases, you may want to watch the patient walk a longer distance.
Ask the patient to turn around and walk back to the starting point. Watch how the patient turns (this is particularly important in the assessment of parkinsonism; see Chapter 46, Examination of the Patient with a Movement Disorder), and then observe the gait again as the patient walks back.
Tandem Gait
Ask the patient to walk a straight line, “like walking a tightrope.” It is often helpful to show the patient a line on the floor on which to walk.
Observe the patient’s ability to walk a few (e.g., four or five) steps in this way.Related posts:
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