By closely evaluating (from front, back, and side):
-How the patient gets up from a chair (useful in Parkinson’s or limb girdle dystrophy)
-How the patient initiates walking (also useful in Parkinson’s)
-How the patient walks at a slow pace
-How the patient walks at a fast pace
-How the patient turns
-How the patient walks on toes (this cannot be mustered by patients with Parkinson’s disease,
sensory ataxia, spastic hemiplegia, or paresis of the soleus/gastrocnemius)
-How the patient walks on heels (diagnostic in motor ataxia, spastic paraplegia, or foot drop)
-How the patient walks a straight line in tandem (i.e., heel to toe) (useful in all gait disorders)
-How the patient walks with eyes first opened and then closed (a patient with sensory ataxia does much
worse with closed eyes, whereas a patient with motor ataxia or cerebellar ataxia does poorly either way)
-How the patient stands erect with eyes first open and then closed (Romberg’s)
-How the patient copes with sudden postural challenges, such as a modest pull from behind after adequate warning; inadequate postural reflexes (as often seen in nursing home residents) will cause a
few steps of retropulsion, and even a tendency to fall backward.
Most gaits share nonspecific characteristics, such as a widened base while standing, short steps while
walking, and greater proportion of the gait cycle spent in double-limb support (in some cases as much as
50%). A few gaits (cerebellar ataxia, coxarthritis, and Parkinson’s) have unique features. Still, observation
alone is limited and never as informative as a thorough physical exam.
-How the patient gets up from a chair (useful in Parkinson’s or limb girdle dystrophy)
-How the patient initiates walking (also useful in Parkinson’s)
-How the patient walks at a slow pace
-How the patient walks at a fast pace
-How the patient turns
-How the patient walks on toes (this cannot be mustered by patients with Parkinson’s disease,
sensory ataxia, spastic hemiplegia, or paresis of the soleus/gastrocnemius)
-How the patient walks on heels (diagnostic in motor ataxia, spastic paraplegia, or foot drop)
-How the patient walks a straight line in tandem (i.e., heel to toe) (useful in all gait disorders)
-How the patient walks with eyes first opened and then closed (a patient with sensory ataxia does much
worse with closed eyes, whereas a patient with motor ataxia or cerebellar ataxia does poorly either way)
-How the patient stands erect with eyes first open and then closed (Romberg’s)
-How the patient copes with sudden postural challenges, such as a modest pull from behind after adequate warning; inadequate postural reflexes (as often seen in nursing home residents) will cause a
few steps of retropulsion, and even a tendency to fall backward.
Most gaits share nonspecific characteristics, such as a widened base while standing, short steps while
walking, and greater proportion of the gait cycle spent in double-limb support (in some cases as much as
50%). A few gaits (cerebellar ataxia, coxarthritis, and Parkinson’s) have unique features. Still, observation
alone is limited and never as informative as a thorough physical exam.