Do you know what the gait depends? It turns out, with various diseases, not only the appearance, the expression of the person, but also a person's gait. An experienced doctor will often be diagnosed only by looking at the patient. Many inner malaise are reflected on our appearance, and the assessment of how a person looks, moving, what his gait, posture, the manner of sitting and standing, largely helps a specialist to raise the correct diagnosis, and then support it with various studies.
Doctors are very often asked the patient to walk along the office, rating a walk.
What no ghosts can tell your gait?
If when walking shoulders bent forward, as if protecting the chest and belly, the head is a bit drawn, there is a manner of clutching his hands in the castle on the stomach - a sign of the gastrointestinal tract: chronic gastritis, stomach ulcers, duodenal.
If a person goes like on prosthesis, trying to flex his legs as little as possible, makes small tags, it has to make efforts to sit down and especially get up, - problems with joints: Arthrosis, arthritis.
The man goes, holding his head as a crystal vase, turns not the neck, but the entire body is a cervical osteochondrosis. Combined with a common paleness - strong headaches, migraine. If, at the same time, the head is inclined slightly side, we can talk about the mositis - inflammation of the cervical muscles.
The person who keeps overly straight, leans all the torso, without bending the back, is a sign of Bekhtereva's disease.
Uncertain gait, as it were, as if a constant support of support, is peculiar to those who suffer from dizziness in problems with pressure or vegetative dystonia.
"The gait can tell not only about the illnesses, but also about the psychological problems of a person. Watch your movements and determine what your problem is."
A screaming gait with the depressed shrug and head - a symptom of deep depression.
Nervous, like on hinges, gait, excessive gesticulation, even with a calm conversation - a sign of neurosis, psychopathy.
The inhibition of movements, small mobility, stiffness of the hands - a sign of a serious mental disorder, right up to schizophrenia.
Even barely noticeable head shaking speaks about atherosclerosis of the brain vessels or neurological problems, young people are often post-tramamic Parkinsonism. Hand controversy says rather about vascular pathology.
If a person suffered a microinsult, then during walking it falls on one side and makes a characteristic movement: the hand is pressed against the body, the leg is assigned to the side.
Careful gait, fear of touching anything, hands pressed to the body - any chronic pain syndrome.
Flowing gait, as if man steps on hot coals, - a sign of gout or polyarthritis.
If a person walks, arranging his legs, as in the stilts, sits predominantly sideways, then we can talk about hemorrhoids.
The gait can tell not only about the illnesses, but also about the psychological problems of a person, since when problems occurs, the brain receives a signal and transmits it with muscles, and this is reflected, including on the gait. Watch for your movements and determine what your problem is.
Gait General - marches, check a step. Thus, a person demonstrates strength and superiority, but it is often unnecessary self-confident, cruel.
Spyware - walks, as if it fell, it becomes not on the heel, but on the whole stop, strongly straining the icy muscle. Such a person is careful, afraid to take himself responsibility. This gait develops in those who do not have anyone in life.
Jumping - It goes, almost without touching the heel of the Earth, springs on tiptoe, trying to swell. Such a person hovers in the clouds, something dreams about something, he considers himself an unrecognized genius.
Street - Shares, walks slowly, dragging legs. Such a gait usually happens in the elderly, as well as in people who are devoid of ambitions, belligerent, lazy, slow.
Star - Theatrical movements, chin raised very high, the steps are measured and verified. The narrative opens if it accelerates the pace of walking: with a majestic posture, a fussy step looks unfulstly and ridiculous. So gait speak high self-esteem, arrogance, snobsm.
Marine - walks the goat, spreading his legs wide. Such a person has no confidence in tomorrow. Official position Sharating, family relationships crack on the seam. No wonder so walk sailors, which most of their lives are spent away from home.
Elephant - Tops loudly, shaking surrounding items. And on the weight of the human weight, the gait depends at all. Such a man of timid and shy, trying to compensate for insufficient will and severity.
Dysbasia walking or breach of gait - causes of chance in the elderly
Disorders of equilibrium and gait - relatively common phenomena, they also call the gaitty precariousness.
More often there is a dysbasia walk in older people with, worsening vision.
Different diseases, alcoholic beverages, drugs, sedatives cause this condition.
The appearance of gait violations in some cases is associated with infections of the inner ear.
Symptoms of the Dysbasia Walking
The name of the ailment contains the Greek prefix DYS, meaning "violation". Typical manifestation of the disease - asymmetry gait.
For example, a person makes the key to the foot normal step, and then slowly pulls the second. Difficulties may arise at the very beginning of the movement.
The patient fails to tear the legs from the floor, he trample in one place, performs small tags.
Common symptoms of the imbasia:
- the inability to be able to bend the foot joints normally;
- constant collisions with objects around;
- difficulty performing reversal;
- difficulties when walking down the steps;
- feeling of the obsessive muscles;
- stubbing, falling;
- muscle weakness;
- shivering in the legs.
Such symptoms may occur with the damage to the vessels and violation of the bonds between the structures of the brain (GM). More bizarre gait changes are associated with hysteria.
It is a walking zigzag, sliding movements, semitted legs. Diseases of the joints are more often manifested by a slow, unsure gait, shortening the step.
Causes of disease
Two main groups of factors that lead to a walk of walk - anatomical and neurological.
Cause violations of the gait of the disease of the musculoskeletal system, the head and spinal cord.
So, on the basis of the innervation disorder of vessels, angiooremical disease occurs.
The lesions of the intervertebral disk at the bottom of the back also violates the gate.
Anatomical reasons
Anatomical causes of walking area:
- overly rotated femoral bone;
- lower limbs of unequal length;
- congenital leg dislocations.
Most often, the affusion appears in various CNS diseases.
Crazy paralysis, muscle dystrophy, sclerosis - serious lesions, in which walking is often disturbed.
The same effect occurs in the abuse of alcohol, soothing means, drug use.
Neurological causes of the infusion
Neurological reasons for the imbasia:
- damage to the shells of nerve fibers GM and CM (sclerosis);
- paralysis of the small-terrestrial nerve of the lower limb;
- shaking paralysis or;
- circulatory disorders in brain vessels;
- functional disorders in the cerebellum;
- pathology of the frontal share of GM;
- cerebral paralysis.
The deficiency in the body of vitamin B12 leads to the appearance of a feeling of numbness in the limbs.
As a result, a person cannot determine the position of the feet relative to the floor surface.
Sugar diabetes exacerbates problems with equilibrium due to lower sensitivity in the lower limbs.
Dog types
Careful, screaming gait, difficulties in preservation of equilibrium is the most common symptoms of a walk.
There are other manifestations, on the basis of which experts allocate several types of violations.
Ataxia is a violation of the coherence of muscle movements. The sick person shakes when walking, can not move without assistance.
There are several reasons for ataxia, one of the main - the shock of the cerebellum. The coherence of muscular movements is broken during vestibular disorders.
Frontal dysbasia
The sick person partially or completely loses the ability to walk.
Such violations appear in extensive damage to the frontal fractions of the GM. This type of dysbasia often accompanies.
Hemipartic gait ("kosy")
The victim hardly tears the patient from the surface and transfers it forward, performing the limb circular movement outward.
A man tilts the body in the opposite direction. The hemipartic gait occurs during injuries, GM tumors and cm ,.
Hykoknetic gait ("screaming")
The patient will turn on the spot for a long time, then performs slow, composed legs.
Body Pose Stressful, Short Steps, turns are difficult. Reasons may be many diseases and syndromes.
"Duck" gait
Muscle weakness, paresis, congenital dislocations of the hips are the main causes of difficulties when picked up legs and move forward.
Such actions of the patient tries to carry out, turning the pelvis and tilting the case.
Pathology usually occurs in both limbs, so the human gait resembles the movement of the duck - the bodies of the body is left, then to the right.
The fact is that the dysbasia walk is characterized by a variety of symptoms and reasons.
This makes it difficult to choose a doctor, to which the patient should be referred to first.
The assistance of a neurologist, traumatologist, surgeon will be required. Sometimes consultations of the endocrinologist, otolaryngologist or oculist are needed.
A neurologist at the disease in the patient uses various diagnostic techniques.
The patient prescribe a study of liquor, X-ray, CT, MRI, ultrasound. It is necessary to hand over common and biochemical blood tests.
Treatment of walking violations
Medical facilities will help to remove pain.
Complex treatment, long-term and demanding persistence on the part of the patient will be required.
Piracetam - remedy for the imbasya
The course of therapy often includes massages, medicinal gymnastics, physiotherapy.
Dysbasia medication treatment:
- Piracetam - nootropic agent. Improves microcirculation and metabolism in neurons. Analogue according to the active substance - the drug membropyl;
- Tolperison - Miorosant. Reduces pain in the field of peripheral nerve endings, eliminates increased muscle tone;
- Middokalm - Tolperison in combination with lidocaine (by the local peculiar means);
- Twekkain - Muscular relaxant and topless tool;
- Gincoom is an angioprotector of plant origin. Reduces permeability and normalizes metabolic processes in the vascular wall.
Conclusion
Dysbasia walk occurs with many dangerous diseases.
It is necessary to have a survey as soon as possible so that the specialists establish the causes, the type of walking and prescribed adequate treatment.
The course of therapy is long, includes the use of nootropic drugs, muscle relaxants and angioprotectors.
Video: how to fix duck gait
If the child walks on the socks, the causes of the phenomenon are different. One child has this trend about diseases, and another is the usual desire to become higher than the growth. Is it an innumerable symptom, what to do in a matter of one case? Let's deal with together!
The main causes of walking on socks
When a child walks on the socks, the reasons can be concluded both in pathology and behavior. It is considered within the limits of the norm when the child moves to a year, swaying from side to side, turning his feet or towering from fingers.
If the child walks on the socks, the reasons can be a game, fear and fear. In order not to issue your location with loud steps, it moves on tiptoe.
Causes of walking on the socks can be:
- Cold floor in the house.
- Having a non-poison or memories of it.
- Attracting the attention of parents.
- Copying women walking on heels.
Parents have reasons for concern, we are talking about five diseases:
Palsy.
The disease that develops in young children. The reason for its appearance is an incorrect course of pregnancy or generic process. Walking on tiptoe is the main symptom.
Generic injury or birth ahead of time
About such a rejection can learn long before the parents see the first tags of their children.
Pyramid insufficiency
It manifests itself with disorders of the nervous system. According to doctors, this is a common diagnosis.
Incorrect formulation of two stops or foot
This phenomenon appears in children, which from early age began to be seen in walkers.
Muscular dystonia
With muscular dystonia there is a violation of the activity of the child and the increased muscle tone.
Causes of incorrect walk at different ages
Causes of two-year-old kid
Little child can just like to go on socks If a child is 2 years old, and he walks on the socks, the reasons are often harmless. For the prevention and calmness of the child, you can record on the foot massage.
Speaking about the development of diseases, they are detected by the end of the first year of life and manifest themselves more terrible symptoms.
When a child walks on her socks, Komarovsky sees the reason that the calf muscles are developed. Nothing a terrible doctor in such regularity does not discover.
For reasons of socks the doctor refers the habit that is produced after a long stay in the walkers. In incorrectly chosen walkers, the baby does not turn out to rely on the surface of the whole stop.
Causes of a five-year-old baby
If a child is 5 years old, and he walks on the socks whether there are insane reasons? First, with any concerns, it is recommended to consult a doctor - pediatrician, orthopedic, neurologist.
How many doctors say if the child walks on the socks in 3-4 years, the reasons for non-serious, subject to the absence of other symptoms. A similar phenomenon passes with time without special treatment. By the five-year-old age, it disappears and children begin to step on a complete foot.
Parents should be concerned if you notice:
- Disruption of appetite.
- Sleep disturbance.
- Incorrect coordination.
- Complaints on headaches.
- Reduced activity.
In the presence of these symptoms, it is necessary to turn to a neurologist, which after the inspection will appoint an additional examination.
Causes of older children
Clawed leg - the possible cause of a child's walk on socks. On the development of deformation may affect injuries, pathology of the neuromuscular apparatus If a child is 8 years old, he walks on the socks, the reasons are broken in violation of the development of the musculoskeletal system and neurology.
It's one thing, if he rises on socks by mood or need. And completely different if it regularly moves so.
Parents must follow the behavior of their child to notice other symptoms.
Especially if the child has been diagnosed or.
It rarely come across the fact that the child begins to rise unexpectedly on tiptoe. More often deviation manifests itself from the moment the baby will begin to make the first steps.
When a child of 10 years walks on her socks, the reasons may be the same as in young children. Perhaps the child thus wants to reset the emotional tension. To meet with such a symptom can have a child both with hyperactivity, increased excitability and in the shy, prone to anxiety.
Medical treatment of walking on socks
Medicase treatment can be in the reception of certain drugs. The choice of them largely depends on the cause of the child's walk on the socks. It can be both vitamin complexes and serious preparations affecting the nervous system.
The doctor may prescribe:
- Course of physiotherapy, UHF or electrophoresis.
- Taking baths with herbs.
- Massage.
- Daily gymnastics.
- Swimming.
These treatments are effective, efficient and proven. Thanks to their execution, you can get rid of the ailment less than a month. Subject to the timely appeal to the doctor.
Do not stay indifferent to the fact that the child often walks on the socks! It is better to consult a doctor and find out the true reason as early as possible. The health of the child and his happy life depend only on you.
Making a child massage
With regular walking of a child on her socks, a massage may be required. It is desirable that the massage will conduct an experienced specialist.
Effective massage techniques can be performed at home:
Flexion and straightening of the foot
The movement is performed reflexively. To do this, it is necessary to gently press the area that is under the fingers, moving from the little finger towards the heel.
Stroke
Massage movements must be clear and painless To perform, it should be put on the rise of the foot index and middle finger of one hand, the second is to hold the child's leg. Large finger draw in the foot of the eight.
Hanging
A small child should be put on a solid smooth surface, causing to walk along it. The child must be kept on weight, at hand, watching him completely resting on all the feet.
Squats
To restore normal walking, 15 lessons will be required. In order to prevent the course, the course is recommended to repeat in a month.
If the child goes on the socks, and parents do not know what to do, it is recommended to listen to the following 5 tips:
- It is thoroughly approaching the choice of shoes, preferring orthopedic models. The most important thing is that the foot rise is fixed with the lacing or velcro fasteners. It is recommended to buy shoes in size from high-quality material. Ideally, genuine leather.
- Try to go at home by barefoot. Well, if the child will walk barefoot on the street in the summer - in the sand, shells, stones and grass. Walking through such surfaces will be a kind of massage that contributes to the proper formation of the foot.
- For a schoolboy, the doctor recommends active exercises: jumping, walking along the inclined surface, a bearish gait, walking on the heels, goose step.
- Do medicinal gymnastics and perform simple exercises at home. Every morning the baby should begin with charging. For the purpose of treatment and prevention, it is recommended to engage in.
Taking advantage of these tips, it will be possible to teach a child to walk on the full foot and avoid further deviations.
What will happen if not treated?
The constant walking of the child on the socks can negatively affect his posture If a child walks on her socks over 7 years old, clarification of the reasons should be entrusted to the competent doctor. Most often they are associated with pathological processes.
The sad consequences to which tiptoe circulation leads:
- Kosolapie.
- Flatfoot.
- Wrong posture.
- Beach curvature.
- Pain feelings of the back and legs.
- Delay in development.
- Torticollis.
If a child is constantly standing on one socks, his heel will stop developing, its growth slows down. That part of the foot, on which he will walk, will grow, from which it becomes disproportionate.
No matter how harmless does not seem like a symptom of tiptoe beating, the child needs to show the doctor to inspect and identify the causes of such deviation.
The gait is body physiognomy, according to Balzak. By walking a person, you can define not only its gender and age, but also his mood, character, social affiliation. How to determine the value of the gait?
Let's start with the simplest - with a gait of a confident person. If a person goes smoothly, straight, rapidly, the tempo of his steps is rapidly, this indicates the confidence of the owner of such a gait.
If a person screames his feet, his hands are dangling not in the beat, and the head is omitted, the feeling that he goes to the execution or carries heavy wear, it speaks about the disorder of feelings, deep depression. Perhaps a person is in a state of crisis or he has a not very pleasant meeting. Therefore, if you notice that a person goes to a meeting with you, it can talk about his reluctance to see you, he does it as needed.
The bouncing gait (a person sighs on his feet) can have a dual meaning. First. The direct meaning of such a gait is happy, unmarried mood, joyful events occur in a person's life, he is satisfied and cheerful, cheerful, is configured to positive. The second meaning, more hidden: a person deliberately tries to be fun and carefree, although in fact something oppressed. Calculate imaginary joy is very easy, it is enough to pay attention to facial expressions and gestures.
If a person does not dissemble his knees, it goes on semi-bent legs, it can be evidenced by his respective age and pain in the joints, if the owner of such a gait is young, then this feature says that he is insecrated in himself, is closed, Mnight.
If a person throws his legs badly to the sides, his hands can rest in his pockets, or to sign Boca, his pose resembles the letter "f". This is either a sign of excessive self-confidence or carelessness, lack of employment, constant idleness. He squises thus, because he just has no place to rush, he is not burdened with any duties.
Careful person Very often, when walking first, comes on the heels and lightly rolling on the sock, you will never see it resting on the entire foot. He cautious in everything, including in the gait.
If a person takes a lot of legs while walking, it means that he wants to attract as much attention to others. He feels like a very significant person, wanting to loudly declare his appearance.
About the female gait should be told separately. By how a woman moves, you can determine its goal, a vital installation. If the woman goes slowly, making small steps, smoothly shakes his hips, then she is currently configured to search for a satellite, its goal is to attract surrounding men.
If a woman is confident, picking up the heels, her thighs go from side to side very sharply, it says about her setting on business communication. This is a solid, business woman who is unlikely to easily refuse to their principles.
The woman rolls away from one foot to another, which means, did not learn how to use the most important female gun - gait. Such a woman used to do household. Her ship is home, life, family. Perhaps she is a large mother.
- Atthantic gait:
- cerebellum;
- stamping ("Tabetic");
- with a vestibular symptom complex.
- "Hemipartic" ("kosy" either by type "Triple shortening").
- Paraspastic.
- Sports-Atactic.
- Hykokinetic.
- Apraquess walking.
- Idiopathic shenyl dysbasia.
- Idiopathic progressive "freasing-dibash".
- Gait in the "Skating Pose" with idiopathic orthostatic hypotension.
- "Peroneal" gait is one-sided or bilateral steward.
- Walking with re-installing in the knee joint.
- "Duck" gait.
- Walking with pronounced lordosis in the lumbar region.
- Gait for diseases of the musculoskeletal system (ankylose, arthrosis, tendon retractions, etc.).
- Hyperkinetic gait.
- Dysbasia at mental retardation.
- Gait (and other psychomotoric) with pronounced dementia.
- Psycho violations gait different types.
- Dysbazya Mixed Origin: Integrated Dysbasia in the form of gait disorders Against the background of certain combinations of neurological syndromes: Ataxia, pyramid syndrome, aprage, dementia, etc.
- Dysbasia Yatrogenic (unstable or "drunk" gait) during drug intoxication.
- Dysbasia caused by pain (antalgic).
- Paroxysmal disorders in epilepsy and paroxysmal dyskinesia.
Atthantic gait
Movements with cerebelcochkova ataxia are poorly commensurate with the features of the surface on which the patient is coming. Equilibrium is violated to a greater or lesser extent, which leads to corrective movements that make a random chaotic character. Characteristic, especially for the defeat of the cerebellum worm, walking on a wide base as the result of instability and step-down.
The patient is often shaken not only when walking, but also in the standing position or sitting. Sometimes a titback is revealed - the characteristic cerebeller tremor of the upper half of the body and the head. Distribution, adiadocynez, intente tremor, postural instability are revealed as accompanying signs. Other characteristic signs (chandented speech, nystagm, muscular hypotension, etc.) can be detected.
Main reasons:the cerebelchik ataxia accompanies a large number of hereditary and acquired diseases occurring with the brains and its bonds (spin-cerebellar degeneration, malabsorption syndrome, alcohol degeneration of cerebellum, multiple systemic atrophy, late atrophy of cerebellum, hereditary ataxia, wholesale, tumors, paranoplastic degeneration of cerebellum and many Other diseases).
With the defeat of the conductors of a deep muscular feeling (most often at the level of the rear pillar), a sensitive ataxia is developing. It is expressed particularly strongly when walking and manifests itself with characteristic movements of legs, which are often defined as a "stamping" gait (the foot with force is lowered with all soles on the floor); In extreme cases, walking is generally impossible due to the loss of deep sensitivity, which is easily detected in the study of the muscular-articular feeling. A characteristic feature of sensitive ataxia is its vision correction. The sample of Romberg was founded: when the eye is closed, the sensitive attaxia is sharply enhanced. Sometimes with closed eyes, pseudoaththies in the elongated hands are revealed.
Main reasons:sensitive ataxia is characteristic not only for the defeat of the rear poles, but also for other levels of deep sensitivity (peripheral nerve, rear root, brain barrel, etc.). Therefore, sensitive ataxia is observed in the picture of diseases such as polyneuropathy ("peripheral pseudotabes"), funicular myelosis, spinal dry tok, complications of vincristine treatment; paraproteinemia; Paranesplastic syndrome, etc.)
With vestibular disorders, ataxia is less pronounced and more manifested in the legs (stepling when walking and standing), especially at dusk. The coarse lesion of the vestibular system is accompanied by an unfolded pattern of the vestibular symptom complex (a systemic dullness, spontaneous nystagm, vestibular ataxia, vegetative disorders). Light vestibular disorders (vestibulopathy) manifests itself only by the intolerance to vestibular loads, which often accompanies neurotic disorders. With vestibular ataxia there is no cerebellar signs and impaired muscular-articular feeling.
Main reasons:the vestibular symptom complex is characteristic of the lesion of vestibular conductors at any level (sulfur tubes in the outer hearing aisle, the maze, the disease of the Meniere, the neuromance of the auditory nerve, dispelled sclerosis, degenerative lesions of the brain brain, Siringobulbia, vascular diseases, intoxication, including medicinal, Brain injury, epilepsy, etc.). A peculiar vestibulopathy usually accompanies psychogenic chronic neurotic states. An analysis of dizziness complaints and related neurological manifestations is important for the diagnosis.
"Hemipartic" gait
The hemipartic gait is manifested by extension and feet cyrchumduction (the hand is bent in the elbow joint) in the form of "kosy" gait. Paretical foot when walking is exposed to the body weight of a shorter period than a healthy leg. There is a circumduction (circular movement of the leg): the foot is inflicted in the knee joint with a slight fitted flexion of the foot and performs a circular movement to the outside, while the body is somewhat deflected in the opposite direction; Homolateral hand loses some of its functions: bent in all joints and pressed to the body. If the wand is used when walking, it is used on a healthy side of the body (for which the patient leans and transfers its weight to it). At each step, the patient raises the pelvis to tear the straightened foot from the floor and with difficulty tolerates it forward. Less frequently, the walking is upset by the type of "triple shortening" (flexion in three foot joints) with a characteristic approach and lowering the pelvis on the side of the paralysis at every step. Related symptoms: weakness in the amazed limbs, hyperreflexia, pathological stop signs.
Legs are usually dispersed in the knee and ankle joints. The walking slowdown, the legs "scream" on the floor (appropriately wearing the shoes sole), sometimes move on the type of scissors with their crossbar (due to the increase in the tone of the thigh muscles), on socks and with a light peeling of the fingers ("pigeon" fingers). This type of violation of the gait is usually due to a more or less symmetric bilateral lesion of the pyramid tract at any level.
Main reasons:paraspastic gait is most often observed under the following circumstances:
- Scarmized sclerosis (characteristic spastic and attactic gait)
- Lacunar state (in elderly patients with arterial hypertension or other risk factors of vascular diseases; often the episodes of small ischemic vascular strokes are often preceded, accompanied by pseudobulbar symptoms with speech impairments and bright reflexes of oral automatism, gait with small steps, pyramid signs).
- After the injury of the spinal cord (history instructions, the level of sensitive disorders, urination disorders). Little's diseases (a special form of cerebral paralysis; symptoms of the disease are available from birth, there is a delay in motor development, but normal intellectual development; often only the selective involvement of the limbs, especially the lower, with the movement of scissors with crossing legs during walking). Family spastic spinal paralysis (hereditary slowly progressive disease, symptoms more often appear on the third decade of life). With cervical myelopathy in the elderly, mechanical compression and vascular insufficiency of the cervical spinal cord often cause paraspastic (or spastic-attactic) gait.
As a result of rare, partially reversible states, such as hyperthyroidism, portional anastomosis, latyrism, lesion of the rear poles (with a deficiency of vitamin B12 or as parenoplastic syndrome), adrenoleteicodistrophy.
The intermittent paraspastic gait is rarely observed in the painting of the "intersterating chromium of the spinal cord."
Paraspastic gait sometimes imitates the dystonia of the lower extremities (especially with the so-called dope-response dystonia), which requires a syndromal differential diagnosis.
Spasticoantic gait
With this violation of the gait to the characteristic paraspastic gait, an obvious attactiv component is joined: unbalanced body movements, easy refiglation in the knee joint, instability. This picture is characteristic, almost pathognomonic for multiple sclerosis.
Main reasons:it can also be observed in the subacute combined degeneration of the spinal cord (the funicular myelosis), freiderium diseases and other diseases with the involvement of cerebellar and pyramidal pathways.
Hykokinetic gait
This type of gait is characterized by slow, clad leg movements with a decrease or absence of friendly movements of hands and intense pose; Mattering the initiation of walking, shortening the step, "scarcany", difficult by turning, trample on the spot before starting the movement, sometimes - "pulsing" phenomena.
Most frequent etiological factorsthis type of gait includes:
- Hykokinetic-hypertonic extrapyramidal syndromes, especially Parkinsonism syndrome (in which there is a light flexor posture; during walking, there are no friendly movements of the hands; there is also a rigidity, a masculine person, quiet monotonous speech and other manifestations of hypocinezia, a rattle of rest, the phenomenon of the gear; gait slow, "Scarcating", rigid, with a shortened step; Possible "Pencing" phenomena when walking).
- Other hypokinetic extrapyramidal and mixed syndromes, including progressive suprankleary paralysis, olivo-ponly-cerebellar atrophy, shee-drajer syndrome, stream-nigital degeneration (Parkinsonism syndromes-plus), Binswanger's disease, vascular "Parkinsonism of the lower half of the body." With a lacquer state, there may also be a gait for the type "Marche A Petits PAS" (small short irregular shocking steps) against the background of pseudobulbar paralysis with swallowing impairment, speech disorders and parkinginson-like motility. MARCHE A PETITS PAS can also be observed in the picture of the normotensive hydrocephalus.
- Akinotic-rigid syndrome and the corresponding gait is possible in peak disease, cortico-basal degeneration, Cratetzfeldt-Jacob disease, hydrocephalius, headquarters tumors, gentonal disease, Wilson-Konovalov, postgoxic encephalopathy, neurosimifilis, and some other rare diseases.
In young patients, torsion dystonia can sometimes debut an unusual strained gait due to the dystonic hypertonus in the legs.
Muscular fiber permanent activity syndrome (Isaac Syndrome) is most often observed in young patients. The unusual voltage of all muscles (predominantly distal), including antagonists, blocks a gait, like all other movements (gait "Barny")
Depression and catatonia may be accompanied by a hypokinetic gait.
Apraquess walking
Apraquess walking is characterized by a loss or reduced ability to properly use legs in the act of walking in the absence of sensory, cerebellar and paretic manifestations. This type of gait is found in patients with extensive cerebral injuries, especially frontal fractions. The patient cannot imitate some movements of the legs, although certain automatic movements are saved. Reduced the ability to a consistent composition of movements with "bipide" walking. This type of gait is often accompanied by travelery, hypocinezia, rigidity and, sometimes, hegenhalten, as well as dementia or urinary incontinence.
An option for Apraquess walking is the so-called axial apraxia in Parkinson's disease and Vascular Parkinsonism; Dysbasia for nylotensive hydrocephalus and other diseases with the involvement of logo-subcortical bonds. The syndrome of an isolated aprage walk is also described.
Idiopathic sedening dysbasia
This form of the infusion ("gait of the elderly", "Shenyl gait") manifests itself a slightly shortened slowed down, easy postural instability, a decrease in friendly movements in the absence of any other neurological disorders in the elderly and old people. The basis of such a disease is the complex of factors: multiple sensory deficit, age-related changes in the joints and spine, deterioration of vestibular and postural functions, etc.
Idiopathic progressive "Frising-Dibaz"
"Friesing Dibaz" is usually observed in the painting of Parkinson's disease; It is less common in multi-infarction (lacunar) state, multisystem atrophy and normotensive hydrocephalus. But the elderly patients who have "freasing-dibazya" are the only neurological manifestation. The degree of "frozen" is varying from sudden motor blocks when walking to a total inability to start walking. Biochemical blood tests, liquor, as well as CT and MRI show a normal picture, with the exception of weakly pronounced cortical atrophy in terms of cases.
Gait in the "Skating Pose" in idiopathic orthostatic hypotension
This gait is also observed in the coverage syndrome, in which peripheral vegetative failure (mainly orthostatic hypotension) becomes one of the leading clinical manifestations. The combination of symptoms of Parkinsonism, pyramid and cerebellar signs has an impact on the features of the gait of these patients. In the absence of cerebulic ataxia and pronounced Parkinsonism, patients are trying to adapt the gait and pose of the body to orthostatic changes in hemodynamics. They move wide, aimed at the side by rapid steps to the legs slightly bent, lowly tilting the body forward and lowering their heads ("Skizzobz Pose").
"Peroneal" gait
Peroneal gait is one-sided (more often) or double-sided steps. The gait in the type of steplex develops with the so-called hanging foot and causes the weakness or paralysis of the feet of the feet and (or) fingers. The patient either "drags" the foot when walking, or, trying to compensate for the hanging of the foot, raises it if possible above to tear it from the floor. Thus, enhanced flexion in the hip and knee joints; The stop is thrown forward and lowers down on the heel or the entire foot with a characteristic slave sound. Phase support when walking shortened. The patient is not capable of standing on the heels, but it can stand and walk on socks.
The most common causethe unilateral pack of the extensors of the foot is the violation of the function of a small-terrestrial nerve (compression neuropathy), lumbar plexopathy, rarely damage to the roots L4 and, especially, L5, as with the hernia of the intervertebral disc ("Vertebrian Puloberes Paralysis"). Bilateral pares of foot extensors with bilateral "steps" is often observed in polyneuropathy (marked by paresthesia, sensitive disorders by type of stocking, lack or reduction of agchyllated reflexes), with perontal muscular atrophy of the Character-Mari-Tuta - the hereditary disease of the three types (there is a high arch of the foot, Atrophy of the muscles of the lower leg (the legs "stork"), the absence of achillov reflexes, sensitive disorders are minor or absent), with spinal muscle atrophy - (in which paresis is accompanied by atrophy of other muscles, slow progression, firecakes, lack of sensitive disorders) and in some distal myopathies ( Perontal Syndromes), especially with the dystrophic Motonia Steinert-Strong Atten-Gibb (STEINERT-STRONG ATTEN-GIBB).
The close picture of the violation of the gait develops with the defeat of both distal branches of the sciatic nerve ("hanging stop").
Walking with corporate joint
Walking with single or bilateral reservoir in the knee joint is observed during the paralysis of the knee extensors. The paralysis of the knee extensors (quadrupping the thigh muscle) leads to re-installing in the support of the leg. When bilateral weakness, both legs are reworked in the knee joints during walking; Otherwise, weight transfer from foot to the leg can cause changes in the knee joints. The descent on the stairs begins with a parethic leg.
The reasonsthe one-sided car includes the damage to the femoral nerve (the loss of the knee reflex, the impaired sensitivity in the innervation area N. SAPHENOUS]) and the lesion of the lumbar plexus (symptoms similar to those with damage to the femoral nerve, but the discharge and iliac-lumbar muscles are also involved). Most often, the cause of the bilateral pan is myopathy, especially the progressive muscular dystrophy of Duzhenna in boys, as well as polyimize.
"Duck" gait
Pares (or mechanical failure) of the thrown muscles, that is, hip abductors (MM. Gluteus Medius, Gluteus Minimus, Tensor Fasciae Latae) leads to the inability to hold the pelvis horizontally relative to the leg carrier. If the insufficiency is only partial, then the rejection of the body towards the supporting leg can be sufficient to transfer the center of gravity and prevent the pelvic skew. This is the so-called dung chromoty, when there are bilateral disorders, it leads to an unusual gait "in the march" (patient, as it were, it turns out from foot to foot, "duck" gait). With the full paralysis of the hip abductors, the transfer of the center of gravity, described above, is already insufficient, which leads to a silence of the pelvis at every step towards the movement of the foot - the so-called chromoty of Trendelenburg.
One-sided paresis or the insufficiency of the hip abductors can be caused by the lesion of the upper berry nerve, sometimes as a result of intramuscular injection. Even in the inclined position, the lack of force is detected for the outdoor leads of the affected leg, but there are no sensitive disorders. Such insufficiency is detected with a unilateral congenital or post-traumatic dislocation of the thigh or postoperative (prosthetics) damage to the thigh abductor. Bilateral paresis (or insufficiency) is usually a consequence myopathy,especially progressive muscular dystrophy, or bilateral congenital dislocation of hips.
Walking with pronounced lordosis in the lumbar region
If hip extensors are involved, especially m. Gluteus Maximus, the rise in the stairs becomes possible only at the beginning of the movement with a healthy leg, but on the descent on the ladder there is an affected foot. Walking on a flat surface is violated, as a rule, only with bilateral weakness m. Gluteus Maximus; Such patients go with a ventral tilted pelvis and with increased lumbar lordosis. With one-sided paresa M. Gluteus Maximus is impossible to drive the damaged foot by the post, even in the position of the Pronation.
Causeit is always (rare) damage to the lower berry nerve, for example, due to intramuscular injection. Bilateral paresis M. Gluteus Maximus is detected most often with the progressive form of a pelvic belt muscular dystrophy and a dunene form.
Occasionally in the literature is mentioned so-called hip-lumbar extension syndrome, which is manifested by reflex disorders of the muscle tone in the extensors of the back and legs. In a vertical position, the patient notes a fixed non-timber expressed lordosis, sometimes with side curvature. The main one is the symptom of "boards" or "shield": in the position of the lying on the back with a passive lifting for both feet of the elongated legs, there is no bending in the hip joints. Walking, bearing the pushing character, is accompanied by compensatory chest kyphosis and head slope forward in the presence of rigidity of the cervical muscle extensors. The pain syndrome is not leading in a clinical picture and often wears a lubricated, abortive character. Frequent cause of syndrome: fixation of a fool bag and an end thread by a rubric-jammed process in combination with osteochondrosis against the background of the dysplasia of the lumbar spine or with a spinal tumor on the cervical, breast or lumbar level. The regression of symptoms occurs after surgical mobilization of the fool bag.
Hyperkinetic gait
Hyperkinetic gait is observed with different types of hyperkinases. These include diseases such as Korea Sidengama, Hantington, generalized torsion dystonia (gait "camel"), axial dystonic syndromes, pseudo -expressive dystonia and dystonia feet. More rare causes of walking of walking are myoclonus, torso tremor, orthostatic tremor, turret syndrome, late dyskinesia. With these states of the movement required for normal walking, unexpectedly interrupted by involuntary, disorderly movements. A strange or "dancing" gait is developing. (Such a gait with Hantington's Horretton sometimes looks so strange that it can resemble a psychogenic imbazio). Patients must constantly fight these violations to move purposefully.
Gait violations when mental retardation
This type of the infusion is still not enough problem. The clumsy standing with the too bent or dismissed head, the pursuit of hands or legs, awkward or strange movements - all this is often detected in children with mental delay. In this case, there are no proprium inspection disorders, as well as cerebellar, pyramidal and extrapyramidal symptoms. Many motor skills formed in childhood are age-dependent. Apparently, unusual motility, including a gait from mentally retarded children, is associated with the delay in maturation of the psychomotor sphere. It is necessary to exclude the comorbide with the mental retardation of the state: children's cerebral paralysis, autism, epilepsy, etc.
Gait (and other psychomotoric) with severe dementia
Dysbasia during dementia reflects the total decay of the ability to organized targeted and adequate action. Such patients begin to pay attention to their disorganized motility: the patient stands in an awkward posture, trample on the spot, spinning, being unable to go to walk, sit down and adequately gesticulate (the decay of the "body language"). The fussy, chaotic movements come to the fore; The patient looks helpless and confused.
The gait can vary significantly in psychosis, in particular with schizophrenia ("shuttle" motoric, movement in a circle, podding and other stereotypes in the legs and hands during walking) and obsessive-compulsive disorders (rituals during walking).
Psychogenic violations of the gait of different types
There are violations of gait, often reminiscent of those described above, but developing (most often) in the absence of the current organic damage to the nervous system. Psychogenic violations of gait often begin sharply and provoked by an emotional situation. They are variable in their manifestations. They can accompany agoraphobia. Characterized by the predominance of women.
Such a gait often looks strange and poorly described. However, attentive analysis does not allow it to attribute it to the known samples of the aforementioned types of the infusion. Often the gait is very picturesque, expressive or extremely unusual. Sometimes the image of the fall (astolya-abazion) dominates it. The whole body of the patient reflects the dramatic call for help. During these groteskone, non-coordinated movements, it seems that patients periodically lose their equilibrium. Nevertheless, they are always able to keep themselves and avoid falling from any inconvenient position. When the patient in the public, then his gait may even acquire acrobatic traits. There are also enough characteristic elements of a psychogenic imbasia. The patient, for example, demonstrating ataxia, often walks, "swing braid" by the legs, or, presenting paresis, "drags" the leg, "dragging" it on the floor (sometimes touching the floor of the thumb and foot). But a psychogenic gait may sometimes resemble a gait for hemipareva, paraparemic, cerebellum diseases and even with Parkinsonism.
As a rule, there are other conversion manifestations, which is extremely important for diagnosis, and false neurological signs (hyperreflexia, pseudosimpta of Babinsky, pseudo-attack, etc.). Clinical symptoms should be assessed comprehensively, it is very important in each such case to discuss the likelihood of true dystonic, cerebellar or vestibular walking disorders in detail. All of them can sometimes cause indiscriminate changes to the gait without sufficiently clear signs of organic disease. Dystonic breaches more often than others can resemble psychogenic disorders. Many types of psychogenic imbasia are known and even their classifications are proposed. The diagnosis of psychogenic motor disorders should always be subject to the rule of their positive diagnosis and the exclusion of organic disease. It is useful to attract special tests (Huvel test, the weakness of the municipal muscles and others). The diagnosis is confirmed by the placebo effect or psychotherapy. The clinical diagnosis of this type of the infusion often requires special clinical experience.
Psycho breaches are rarely observed in children and the elderly
Dysbasia mixed origin
There are often cases of an integrated dysbassia against the background of certain combinations of neurological syndromes (ataxia, pyramid syndrome, aprage, dementia, etc.). Such diseases include children's cerebral paralysis, multiple systemic atrophy, Wilson-Konovalov disease, progressive suprankleary paralysis, toxic encephalopathy, some spin-sechebellar degenerations and others. In such patients, the gait carries in itself the features of several neurological syndromes at the same time and its careful clinical analysis is needed in each individual case to assess the contribution of each of them in the imbasy manifestation.
Dysbasia Yatrogenic
Non-hydrogen dysbasia is observed during drug intoxication and is often attacked ("drunk") predominantly due to vestibular or (less often) cerebellar disorders.
Sometimes such a damage is accompanied by dizziness and nystagm. Most often (but not exclusively) the dysbazia cause psychotropic and anticonvulsant (especially diphenin) drugs.
Dysbasia caused by pain (antalgic)
When there is a pain while walking, the patient is trying to avoid it, changing or shortening the most painful phase of walking. When the pain is one-sided, the affected leg tolerates the weight of a shorter period. Pain may occur at a certain moment of each step, but it can be observed during the entire act of walking or gradually decrease with continuous walking. The gait violations caused by pain in the legs most often appear outwardly as "chromota".
Intermittent chromoty is a term that is used to designate pain, which appears only during walking at a certain distance. In this case, pain is due to arterial failure. This pain appears regularly when walking after a certain distance, gradually increases intensity, and over time it occurs on shorter distances; It will appear rather if the patient rises up or goes fast. The pain causes the patient to stop, but disappears after a short rest period, if the patient stands. The pain is most often localized in the field of shin. A typical reason is the stenosis or occlusion of blood vessels in the top of the hip (typical history, vascular risk factors, the absence of pulsation on the foot, noise over the proximal blood vessels, the absence of other reasons for pain, sometimes sensitive disorders in stocking type). Under similar circumstances, there may be pain in the crotch or hip pain, caused by occlusion of pelvic arteries, such pain should be differentiated from Ishiagia or a process affecting a horse tail.
Intermittent chromotypes with a horse-tail lesion (caudogenic) is a term that is used to designate pain in the compression of the roots, is observed after walking at different distances, especially when descenting down. The pain is a consequence of the compression of a horse-tail root in the narrow spinal channel at the lumbar level, when the connection of spinal changes causes an even greater narrowing of the channel (canal stenosis). Therefore, this type of pain is most often found in older patients, especially men, but may also meet at young age. Based on the pathogenesis of this type of pain, the noted violations are usually bilateral, root nature, mainly in the rear area of \u200b\u200bthe perineum, the upper part of the hip and lower leg. Patients also complain about back pain and sneezing pain (symptom of niffera). Pain during walking causes the patient to stop, but usually does not completely disappear if the patient is worth it. The relief occurs when the position of the spine is changed, for example, when sitting, a sharp slope forward or even squatting. The root nature of violations becomes especially obvious if there is a firing character of pain. In this case, there are no vascular diseases; Radiography reveals a decrease in the sagittal size of the spine in the lumbar region; Myelography shows a contrast passage violation at several levels. Differential diagnosis is usually possible, given the characteristic localization of pain and other features.
Pain in the lumbar region when walking can be a manifestation of spondyleze or lesion of intervertebral discs (a history of spicy back painted with irradiation on a sedanish nerve, sometimes the absence of achilla reflexes and muscle paresis innervated by this nerve). The pain may be a consequence of spondylolisthesis (partial dislocation and "slipping" of lumbar-sacral segments). It can be called ankylosing spondylitis (Bekhtereva's disease), etc. Radiographic study of the lumbar spine or MRI often clarify the diagnosis. Pain due to spondyleze and pathology of intervertebral discs is often enhanced with a long seat or an uncomfortable posture, but it can decrease or even disappear when walking.
The pain in the hip and the groove region is usually the result of the hip-hip arrangement. The few first steps cause a sharp increase in pain, which gradually decreases while continuing to walk. It is rarely observed pseudo-creative irradiation of pain on the leg, a violation of the internal rotation of the thigh, causing pain, a feeling of deep pressure in the field of the femoral triangle. When the cane is used when walking, it is located on the side of the opposite pain for the weight of the body weight on a healthy side.
Sometimes during walking or after a long standing, there may be pain in the groin area associated with the damage to the iliac-inguinal nerve. The latter is rarely spontaneous and more often associated with surgical interventions (lumbotomy, appendectomy), at which the nerve barrel is damaged or annoyed by compression. This cause is confirmed by the history of surgical manipulations, improving the thigh, the maximum pronounced pain in the region for two fingers medially anterior anterior outer ileum, sensitive disorders in the ileum and scrotum area or large sexual lips.
The burning pain along the outer surface of the thigh is characteristic of a passing of Merallia, which rarely leads to a change in the gait.
Local pain in the area of \u200b\u200blong tubular bones arising when walking should cause suspicion of the presence of a local tumor, osteoporosis, peonge disease, pathological fractures, etc. For most of these states that can be detected with palpation (palpation pain) or radiography, back pain characteristic. The pain on the front surface of the lower leg may appear during or after a long walk, or other excessive tension of the leg muscles, as well as after the acute occlusion of the foot vessels, after surgery on the lower limb. The pain is manifestation of the arterial insufficiency of the muscles of the front area of \u200b\u200bthe leg, known as the front tibial arteriopathic syndrome (expressed increasing painful swelling; pain from the compression of the front departments of the leg, the disappearance of the pulsation on the back of the foot; no sensitivity on the back of the foot in the innervation zone of the deep branch of a small nerve; Pares of the muscles of the extensor of the fingers and the short extensor of the thumb), which is an option for muscular bed syndrome.
Pain in the foot and fingers is especially frequent. The cause of most cases is in the deformity of the foot, such as a flatfoot or a wide foot. Such pain usually appears after walking, after standing in the shoes on a rigid sole, or after wearing severity. Even after a short walk, the heel spur can cause pain in the heel area and increased sensitivity to the pressure of the plantar heel. Chronic tendinite Achilles tendons manifests itself, not counting the local pain, palpable tendon thickening. Pain in the front sections of the foot is observed when Morton methtarzalgia. The reason is the pseudonevrom of an interpalic nerve. At the beginning, the pain appears only after a long walk, but later it may appear after short episodes of walking and even at rest (pain is localized between the heads of III-IV or IV-V hanging bones; it also occurs when squeezed or displacement relative to each other of tall bones; No sensitivity on the contacting surfaces of the foot; the disappearance of pain after local anesthesia into the proximal interbranch space).
There is enough intense pain along the plantar surface of the foot, which forces to stop walking, can be observed in a tarzal tunnel syndrome (usually when dislocations or a fracture of ankle, pain occurs behind the medial ankle, paresthesia or loss of sensitivity on the plantar surface of the foot, dryness and thinning of the skin, the lack of sweating on The sole, the impossibility of leading the fingers compared to the other stop). Suddenly occurring visceral pains (angina, pain during urolithiasis, etc.) are able to reflect on the gait, significantly change it and even cause a stop of walking.
Paroxysmal breakdowns
Periodic Dysbasia may be observed in epilepsy, paroxysmal dyskinesia, periodic ataxia, as well as with pseudo-producing, hyper exclusion, psychogenic hyperventilation.
Some epileptic automatons include not only gestures and certain actions, but also walking. Moreover, such forms of epileptic seizures that are provoked only walking are known. These seizures sometimes resemble paroxymismal dyskinesia or apraction of walking.
Paroxysmal dyskinesia, which started during walking, can cause dysbazia, stop, falling patient or additional (violent and compensatory) movements against the background of continuing walking.
Periodic ataxia causes periodically cerebulichkum dysbazia.
Psychogenic hyperventilation often not only causes lipotic states and fainting, but also provokes tetani convulsions or demonstrative motor disorders, including periodic psychogenic imbazia.
Hyperexcission is capable of causeing breaches and, in pronounced cases - drops.
Miasthenia is sometimes the cause of periodic weakness in the legs and the imbasia.