Gait disorder

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Classification according to ICD-10
R26 Disturbances in gait and mobility
ICD-10 online (WHO version 2019)

A gait disorder is a disorder of the musculoskeletal system. The causes are either orthopedic , neurological or psychiatric . Synonyms: abasia , dysbasia, pathological gait, gait disorder, gait disorder.

Clinical trial

The gait test is initially carried out clinically, i.e. without any technical aids:

  • Examination of the normal gait pattern
    • Walking: step size, speed, start and stop, ground contact and rolling
    • Movement in the large joints, rolling of the foot and toes
    • 180 ° turn (required number of steps)
  • Testing under difficult conditions
    • Tightrope walk (one foot in front of the other on an imaginary line)
    • Toe or heel gait (to check for paralysis)

Further tests are possible with the appropriate equipment on a treadmill or under videometry ; analyzes can also be carried out using a computer. This plays a role in rehabilitation , but even more so in research or sports medicine .

Orthopedically related gait disorders

  • Hip limb resp. Duchenne limp / Trendelenburg limp, myopathic gait (English: myopathic gait / waddling gait )
    Causes: Duchenne muscular dystrophy or other muscular dystrophies
    Description: lateral inclination of the trunk to the affected supporting leg, with inclination of the pelvis to the healthy side: Trendelenburg limp, at Inclination of the pelvis to the sick side: Duschenne limp
  • Stiffening limps
    Causes: Coxarthrosis , Perthes disease , for joint stiffness or pain in the area of ​​the hip, knee or ankle
    Description: The pelvis is rotated to the affected side while walking.

Deviations in the rolling of the foot can also lead to a gait disorder. Rolling requires mobility in the dorsiflexion of the ankle joint as well as the toes. If rolling is hindered - for example due to restricted mobility or a misalignment of the foot - the gait pattern changes , and pain and increased wear and tear can occur in other parts of the body. Deviations from the expected gait line (the path of the center of gravity of the pressure distribution when the foot rolls off) can be an indication of possible overload damage, possible premature aging of cartilage surfaces or a physiological muscle imbalance. In hallux rigidus (also called “stiff toe”), a stiffening of the metatarsophalangeal joint of the big toe hinders rolling and leads to a relieving posture in which the weight is shifted to the outer edge. Also in the internal gear , which is usually due to a Senkfußes or Knicksenkfußes occurs, the foot does not roll as intended on the big toe, but on the outer side. Due to the incorrect loads it can u. a. a metatarsal pain ( metatarsalgia arrive) and a reinforced joint wear.

Neurological gait disorders

  • Parkinson's gait resp. akinetic -rigide gait disturbance / small-step gait (ger .: parkinsonian gait / festinating gait / shuffling gait)
    causes: Parkinson's syndrome , a side effect of haloperidol or other agents
    Description: Generalized Rigor & bradykinesia / hypokinesia (the arms when walking), kleinschrittiges, trippelndes Gait pattern (marche a petits pas / magnetic gait), tendency to tilt the head forward and propulsion / retropulsion (tendency to fall forwards or backwards) and thereby festination (faster and faster walking so as not to fall forwards), difficulty initiating the Gait and turn while standing
  • Hydrocephalus-related gait disorder
    Causes: Hydrocephalus , normal pressure hydrocephalus , (same symptoms: Binswanger's disease )
    Description: Similar to Parkinson’s gait in terms of the small-step, tripping gait, but without rigor or tremor. Variable symptoms depending on the degree of severity: mild (careful walking and difficulties with tightrope walking), pronounced (difficulties with normal walking, magnetic walk and unstable gait pattern) & difficult (walking impossible without support). See Hakim Triassic .
  • Wernicke-man gait (ger .: hemiparesis / hemiplegic gait )
    causes: Most stroke, spastic hemiplegia ( hemiparesis )
    Description: Unilateral weakness in the affected side, foot circular pushed forward.
  • Spastic gait resp. Scissor gait ( diplegic gait / spastic gait / scissor gait )
    Causes: bilateral, periventricular lesion, as in infantile cerebral palsy
    Description: Bilateral weakness, feet are pushed forward in a circle when walking.
  • Atactic gait resp. Gait ataxia / staggering gait / cerebellar gait disorder (English: ataxic gait )
    Causes: with disorders of the cerebellar function (see ataxia ) or alcohol intoxication
    Description: when standing & standing still; body tumbling back and forth (titubation), clumsy due to lack of balance
  • " Stepper gear " resp. Houndstooth / stork gait / (paralysis limp ) (English: neuropathic gait / steppage gait / equine gait )
    Causes: HSN, polyneuropathies, ALS, certain types of herniated discs
    Description: lack of dorso-extension of the foot when walking and, as a result, characteristic, more pronounced lifting and sagging of the foot as a gait pattern
  • Tabetic walk resp. Foot stomping or caused by sensitive ataxia gait disturbance (ger .: tabetic gait )
    causes: among other things, tabes dorsalis , funicular myelosis , Primary orthostatic tremor
    Description: Lack of proprioception; this results in the feet striking harder when walking in order to compensate for the lack of sensory input.

Sideways gait deviations also occur with balance disorders , but are usually not in the foreground.

Psychogenic gait disorders

Psychogenic gait disorders are more common than commonly assumed. In psychiatry according to the ICD-10 they are subsumed under dissociative movement disorders under dissociative disorders . Dissociative movement disorders make, according to Myasaki et al. 2.6 to 25% of movement disorders in neurological departments. Of this, in turn, 32.8% were attributable to psychogenic tremor, 25% to psychogenic dystonia , 25% to psychogenic myoclonus, 6.1% to psychogenic parkinsonism and 10.9% to psychogenic gait disorder.

According to Feinstein, the comorbidity with other mental illnesses is considerable: 38% for anxiety disorders, 19% for severe depression, 12% for anxiety disorders and depression. Outpatient psychotherapy can significantly improve the symptoms.

Miyasaki

Anamnestic indications of a psychogenic gait disorder are, according to Miyasaki, sudden onset, static course, spontaneous remissions (not lasting), psychiatric abnormalities, multiple somatizations, patients working in the health sector, financial compensation, secondary gain from illness, young and female gender.

The clinical appearance of the movements suggests a psychogenic gait disorder if the following parameters are met: irregular (frequency, amplitude, distribution, etc.), paroxysmal , increased when observed, decreased when distracted, can be triggered or terminated by unusual or non-physiological interventions , contradicting weakness, contradicting sensory disturbances, artificial injuries, deliberate slowness, functional impairment contradicting neurological examination, bizarre, multiple components, difficult to classify.

Hayes

Hayes and his co-workers put together 20 criteria that they believe could indicate a psychogenic gait disorder if several of them coincide, including multiple symptoms, inconsistencies in restricted mobility, sudden onset and sudden healing, onset with delay after an accident, variability in symptoms, primary and secondary disease gain, psychiatric comorbidity, a model for the presence of a gait disorder in the patient's environment, fluctuations, convulsive shaking, "bizarre" gait, normal neurological examination, unphysiological loss of sensitivity and the type of presentation.

Changes in the context of syndromes

Gait disorders can occur with the following diseases:

In old age

In the age dizziness and unsteadiness often occur. They are easily treatable if specific deficits can be identified.

Individual evidence

  1. ^ A b Christian Larsen: Feet in good hands: Spiraldynamik - programmed therapy for concrete results , Thieme Verlag, 2014, ISBN 978-3-13-176993-0 . Pp. 57-58 .
  2. ↑ Christopher Constantin Komma: An anthropometric, training-specific and biomechanical comparison between healthy runners. Inaugural dissertation to obtain the doctoral degree in medicine from the medical faculty of the Eberhard-Karls-Universität zu Tübingen . 2008 ( d-nb.info ). P. 19.
  3. ↑ Orphanet; Primary Orthostatic Tremor [1]
  4. ^ A. Feinstein, V. Stergiopoulos, J. Fine, AE Lang: Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. In: Neuropsychiatry Neuropsychol Behav Neurol. 2001; 14 (3), pp. 169-176.
  5. ↑ JM Miyasaki, DS Sa, N. Galvez-Jimenez, AE Lang: Psychogenic movement disorders. In: Can J Neurol Sci. 2003; 30 Suppl 1, pp. S94-S100.
  6. ^ A. Feinstein, V. Stergiopoulos, J. Fine, AE Lang: Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. In: Neuropsychiatry Neuropsychol Behav Neurol. 2001; 14 (3), pp. 169-176.
  7. ^ VK Hinson, S. Weinstein, CG Goetz, B. Bernard, S. Leurgans: Single-blind clinical trial for treatment of psychogenic movement disorders with psychotherapy. In: American Academy of Neurology. San Francisco April 25-30, 2004. S65.004, A539
  8. ↑ JM Miyasaki, DS Sa, N. Galvez-Jimenez, AE Lang: Psychogenic movement disorders. In: Can J Neurol Sci. 2003; 30 Suppl 1, pp. S94-S100.
  9. ↑ Hayes et al: A video review of the diagnosis of psychogenic gait. In: Movement Disorders. 1999; 14, pp. 914-921.
  10. ↑ F. Hefti: Pediatric Orthopedics in Practice. Springer 1998, p. 646, ISBN 3-540-61480-X .
  11. ↑ Jahn, Klaus; Kressig, Reto W .; Bridenbaugh, Stephanie A .; Brandt, Thomas; Schniepp, Roman. Dizziness and unsteady gait in old age. Causes, diagnosis and therapy . Deutsches Ärzteblatt (2015), Volume 112, No. 23, pp. 387-93, DOI: 10.3238 / arztebl.2015.0387 .

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