Look at this patient while he walks.

Test this patient's gait.


1. Cerebellar gait

The patient has a broad-based gait, reeling and lurching to one side.

Proceed as follows:

Tell the examiner that you would like to examine the patient for other cerebellar signs (see p. 144).

2. Parkinsonian gait

The steps are small and shuffling, and the patient walks in haste (festinates). The entire body stoops forwards, knees bent, head

hunched forward, and the feet must hurry to keep up with it as if trying to catch up with the centre of gravity. There is associated loss

of arm swing and mask-like facies.

Proceed as follows:

Tell the examiner that you would like to look for other signs of Parkinson's disease (see pp 136-7).

3. Hemiplegic gait

The gait is slow. spastic and shuffling. With each step the pelvis is tilted upwards on the involved side to aid in lifting the foot off the

ground, and the entire affected limb is circumducted, rotated in a semicircle at the pelvis. The upper limb is flexed, adducted and

does not swing, and the lower limb is extended.

4. Sensory ataxia

The feet stamp, the movement of the legs bearing no relation to the position of the legs in space since proprioception is impaired or

absent. The patient has to look down at the ground to compensate for the loss of proprioception. The patient walks on a wide base;

the feet are lifted too high off the ground and are brought down too vigorously.

Proceed as follows:

· Check for Romberg's sign, vibration and position sense.

· Sensory ataxic gait may be due to the following:

-Tabes dorsalis.

- Subacute combined degeneration of the cord.

· Tell the examiner that you would like to look for Argyll Robertson pupils and anaemia.

5. High-stepping gait

This is usually unilateral and results from foot-drop. The patient has to lift the foot high in order to avoid dragging the forefoot.

It may be due to the following:

* Lateral popliteal nerve palsy.

· Poliomyelitis.

· Charcot-Marie-Tooth disease.

· Lead or arsenic poisoning.

6. Scissor gait

This is seen in spastic paraplegia. The adductor spasm may be so severe as to lead to the legs crossing in front of one another.

Short steps with the front of the feet clinging to the ground result in a wearing out of the toes of shoes.

Proceed as follows:

Tell the examiner that the underlying aetiology would probably be cord com-pression, multiple sclerosis or cerebral palsy.

7. Waddling gait

The legs are held wide apart and the patient shifts weight from one side to the other as he walks. Comment on the lumbar lordosis. It

is seen in advanced pregnancy and proximal weakness (Cushing's syndrome, osteomalacia, thyrotoxicosis, poly-myositis, diabetes,

hereditary muscular dystrophies).


What do you understand by the term 'astasia abasia'?

This is seen in psychogenic disturbances in which the patient is unable to walk or cannot stand. The patient falls far to the side on

walking but usually regains balance before hitting the ground. The legs may be thrown out wildly or the patient may kneel with each


What do you understand by the term 'marche a petits pas'?

This describes a gait in which the movement is slow and the patient walks with very short, shuffling and irregular steps with loss of

associated movements. It is seen in normal-pressure hydrocephalus. This gait bears some resemblance to that seen in Parkinson's