Stumbling gait

Introduction The gait is a typical abnormal gait. When walking, the body swayed from side to side, showing a duck step. Common in neurological disorders, rickets, Kashin-Beck disease, progressive muscular dystrophy or bilateral congenital dislocation of the hip. Gait is the external manifestation of human body structure and function, exercise regulation system, behavior and psychological activities while walking, but one of the system or some aspects of dysfunction can cause gait abnormalities. If the muscle strength cannot be restored, only the stent is used instead of the muscle function to improve the gait.

Cause

May be caused by cerebral palsy, pediatric spinal muscular atrophy, auditory nerve sheath tumor, developmental hip dislocation, Kashin-Beck disease and other diseases.

Gait is the external manifestation of human body structure and function, exercise regulation system, behavior and psychological activities while walking, but one of the system or some aspects of dysfunction can cause gait abnormalities. Common pathological gait performance can be divided into the following categories: short leg gait (both legs length), joint tough gait, short step, muscle weakness gait, drunken gait, panic gait (pre-shooting) State), tendon gait, gluteus maximus gait (body posture of the waist and bulge), gluteal muscle gait (duck step) and so on. The principle of correction is to identify as much as possible the cause of gait abnormalities and targeted gait training. However, it is necessary to pay attention to the abnormal gait caused by some muscle spasms, such as gluteus maximus gait, gluteus musculature, etc. It is a functional compensatory phenomenon that cannot be corrected by gait training. If the muscle strength cannot be recovered, only the stent is used. Instead of muscle function exercises, the gait is improved.

an examination

Related inspection

Urine routine blood routine lead test bone and joint soft tissue CT examination blood biochemistry six tests

Awkward and often falling, walking when the torso is unstable with a slightly rhythmic movement of the head ( gait). Muscle strength is normal, tendon reflex exists, tendon reflex or extensibility, no muscle atrophy. In some cases, ataxia with tendon and no reduction in muscle tone, called spastic-ataxic diplegia, may improve with the growth and development of the patient. Older children can be seen with cerebellar gait, limb ataxia, nystagmus and incoherent pronunciation. They need to be differentiated from myoclonus, chorea, hand and foot, dystonia and tremor. Cerebellar atrophy can be seen by CT and MRI.

Spinal muscular atrophy in children

Juvenile spinal muscular atrophy, also known as SMA-III, is also known as Kugelberg-Welander disease, Wohlfart-Kugelberg-Welander syndrome or mild SMA. It is the lightest type of SMA. The disease develops symptoms in late childhood or adolescence, beginning with abnormal gait and weakness of the proximal muscles of the lower extremities. Slow progress. Gradually with the lower extremities and upper limbs. Can survive to adulthood. It is characterized by neuronal proximal muscle atrophy, which is easily confused with limb-type muscular dystrophy. Children often have elevated phosphocreatine kinase. Children with SMA-III who can walk can have squat gait, lumbar protrusion, abdomen bulge, and tendon reflex. The time to maintain independent walking is closely related to the age of onset of muscle weakness. Before the age of 2 years, the person who is ill will not be able to walk around 15 years old. After 2 years of age, the person who has the disease can keep walking ability until 50 years old. A large number of prospective clinical studies have shown that SMA-II and III have slow or no progression of myasthenia symptoms within a few years.

Auditory nerve sheath

Abnormal gait: Unsteady walking, showing a gait, is the result of balance damage and dysfunctional movement. When the patient walks, the two legs are separated, and the straight line cannot be taken. The body swings forward and left in a curve, or advances in a "Z" shape. There is a tendency to dump to the affected side and sometimes fall. Developmental dislocation of the hip - congenital dislocation of the hip in infants and children.

Clinical symptoms: walking late, abnormal gait: gait instability when starting to walk, swaying or swaying (one side); both sides are duck gait, limbs are not equal, and the trunk is compensatory Side bends.

Kashin-Beck disease

If it occurs in adolescence, due to the early ossification of the epiphyseal plate, the developmental disorder appears as a dwarf type. It has short stature, large joints, and limited pain and activity. It has the earliest incidence of ankle joints, followed by finger joints, knees, elbows, wrists, toe joints and hips. Because of the inconsistent speed of the tarsal plate, the lower extremities often have knee varus, knee valgus or hip varus deformity. The fingers are short and small, and the feet are flat. The younger the age, the heavier the deformity.

If it occurs in the later stages of adolescence, the deformity is not obvious. Mainly manifested as symptoms of osteoarthritis, joint swelling, a small amount of fluid, a sense of friction during exercise, and sometimes with interlocking symptoms, and sometimes can be detected in the joints with free body. There are many cases of lower extremity in adults, and it is very inconvenient to walk because of swelling of the knees and knees.

Differential diagnosis

Swing gait: duck step or swing step, is a common sign of congenital pulp dislocation, unilateral dislocation appears claudication, bilateral dislocation, standing pelvis forward, hips back, waist lordosis, abdomen bulge, walking Swinging left and right, it is called duck step or swing step, and walking slightly faster, that is, easy to fall.

Rooster gait: cock gait; when standing, the two thighs are close, the calves are slightly separated, the feet stand like toes, and when walking, like a ballet, it is a sharp walk;

Sensory ataxia gait: sensory ataxia gait, this refers to the deep sensory dysfunction is characterized by a large stride when walking, the legs are wider, the foot is higher, the foot is strong, the ground eyes are both eyes It can be partially relieved when blinking, unstable or even unable to walk when closed eyes, often accompanied by sensory disturbance Romberg sign positive in subacute combined degenerative spinal cord.

Drunk gait: Because the center of gravity is not easy to control, the distance between the legs is widened when walking. The body swings to the sides after the leg is lifted. The upper limb often swings to the horizontal direction or before or after, sometimes it cannot stand, and the instability is more obvious when changing the position. This gait cannot be taken straight and is also called " gait".

Eight-character foot gait: The eight-character foot gait is the eight-character foot. The "eight-character foot" means that the two feet are separated like "eight characters" when you are on the road. When the "eight-footed" walks, the gait is ugly, the posture is not correct, the gait is unstable, the steps are not open, which brings inconvenience to physical labor and sports, and it is easy to make the shoes go shape-shaped and burn fast. Usually, the "eight-character" is divided into "inner eight characters" and "outer eight characters". When the "eight-character" person walks, the toes are opposite, and the soles are facing outwards; when the "outer eight-character" walks, the opposite is true. It is difficult for children to form a "eight-footed" from an early age.

Dance-like gait: Dance-like gait is a clinical manifestation of chorea-like movements.

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