Gait disturbance (dysbasia)
- Causes of infringement of gait (dysbasia)
Abasia (Greek ἀ-a prefix with value of absence, not - without - + — circulation, gait) – also a dysbasia – disturbance of gait (walking) or impossibility to go because of gross violations of gait.
1. In a broad sense the term the abasia means disturbances of gait at the defeats involving various levels of system of the organization of the motive act and includes such types of disturbances of gait as an ataxic gate, gemiparetichesky, paraspastic, spastiko-atactic, hypokinetic gate (at parkinsonism, the progressing nadjyaderny paralysis and other diseases), walking apraxia (a frontal dysbasia), an idiopathic senile dysbasia, peroneal gait, duck gait, walking with the expressed lordosis in lumbar area, hyperkinetic gait, gait at musculoskeletal system diseases, a dysbasia at mental retardation, dementia, psychogenic disturbances, an iatrogenic and medicinal dysbasia, disturbances of gait at epilepsy and paroxysmal dyskinesia.
2. In neurology quite often use the term an astasia abasia, at integrative sensomotor disturbances, more often at the elderly, connected with disturbance postural or locomotory synergies or postural reflexes, and quite often the option of disturbance of balance (astasia) is combined with walking disturbance (abasia). In particular allocate a frontal dysbasia (walking apraxia) at damage of frontal lobes of a brain (as a result of a stroke, distsirkulyatorny encephalopathy, normotensive hydrocephaly), a dysbasia at neurodegenerative diseases, a senile dysbasia, and also the gait disturbances observed at hysteria (a psychogenic dysbasia).
Causes of infringement of gait (dysbasia):
A certain role in emergence disturbance of gait of frustration belongs to an eye and an inner ear.
Elderly people with deterioration in sight have disorders of gait.
The person with an infectious disease of an inner ear can find disorders of balance that leads to disturbances of his gait.
One of frequent sources of disturbances of gait are functional disorders of the central nervous system. It can be the states connected with reception of sedative drugs, alcohol and abuse of drugs. Apparently, a part in emergence of disturbances of gait is played by bad food, especially at elderly people. Deficit of B12 vitamin often causes a feeling of numbness of extremities and disturbance of balance that leads to gait changes. At last, any disease or a state at which there is a damage of nerves or muscles can cause gait disturbances.
One of such states is infringement of an intervertebral disk in lower parts of a back. This state will respond to treatment.
The side amyotrophic sclerosis (Lu Gehrig's disease), multiple sclerosis, muscular dystrophy and Parkinson's disease belong to number of more serious defeats which are followed by gait changes.
Diabetes often causes an anesthesia in both legs. Many people having diabetes lose ability to define position of legs in relation to a floor. Therefore they observe instability of situation and disturbance of gait.
Some diseases are followed by gait disturbance. If there is no neurologic symptomatology, it is even difficult for experienced doctor to find out a cause of infringement of gait.
The hemiplegic gate is observed at a spastic hemiparesis. In hard cases the changed position of extremities is characteristic: the shoulder is brought and developed inside, the elbow, a wrist and fingers of a hand are bent, the leg is unbent in coxofemoral, knee and talocrural joints. The step begins the affected leg with assignment of a hip and its movement around, the trunk at the same time deviates to the opposite side ("the hand asks, the leg mows").
At moderate spasticity position of a hand is normal, but its movements in a step to walking are limited. The affected leg badly is bent and is developed outside.
Hemiplegic gate - frequent residual disturbance after a stroke.
At paraparetic gait of the patient rearranges both legs slowly and tensely, around - the same as at a hemiparesis. At many patients of a leg when walking cross as if scissors.
Paraparetic gait is observed at damage of a spinal cord and cerebral palsy.
Cock gait is caused by an insufficient dorsiflexion of foot. At a stop step forward partially or completely hangs down therefore the patient is forced to raise a leg above - so that fingers did not touch about a floor.
Unilateral disturbance happens at a lumbosacral radiculopathy, neuropathy of a sciatic nerve or a fibular nerve; bilateral - at polyneuropathy and a lumbosacral radiculopathy.
Duck gait is explained by weakness of proximal muscles of legs and is observed usually at myopathies, is more rare at defeats of a neuromuscular synapse or spinal amyotrophy.
Because of weakness of sgibatel of a hip the leg comes off a floor at the expense of a trunk inclination, the turn of a basin promotes the movement of a leg forward. Weakness of proximal muscles of legs usually happens bilateral therefore the patient goes rolling over.
At parkinsonichesky (akinetiko-rigid) gait of the patient it is hunched, legs of his polusognuta, a hand are bent in elbows and pressed to a trunk, the pronatsionno-supinatsionny tremor of rest is swept often up (with a frequency of 4-6 Hz). Walking begins with an inclination forward. Then the tripping, shuffling short steps follow - their speed steadily increases as the trunk "overtakes" legs. It is observed at the movement both forward (propulsion), and back (retropulsion). Having lost balance, the patient can fall (see. "Extrapyramidal frustration").
Apraksichesky gait is observed at bilateral damage of a frontal lobe because of disturbance of ability to planning and performance of the sequence of actions.
Apraksichesky gait reminds parkinsonichesky - the same "a pose of the applicant" and the tripping short steps, - however at a detailed research essential distinctions come to light. The patient easily carries out the separate movements necessary for walking, - both lying, and standing. But when to it suggest to go, it cannot long move a little. Having taken, at last, several steps, the patient stops. In several seconds the attempt to go repeats.
Apraksichesky gait is often combined with dementia.
At horeoatetozny gait the rhythm of walking is broken by the sharp, violent movements. Due to the chaotic movements in a hip joint gait looks "stirred up".
At cerebellar gait of the patient widely places legs, the speed and length of steps change all the time.
At defeat of a medial zone of a cerebellum "drunk" gait and an ataxy of legs are observed. The patient keeps balance as with open, and blindly, but loses it at change of a pose. Gait can be bystry, but it is spasmodic. Often when walking the patient tests uncertainty, but it passes if at least slightly to support him.
At defeat of hemispheres of a cerebellum of disturbance of gait are combined with a locomotory ataxy and a nystagmus.
Gait at a touch ataxy reminds cerebellar gait - widely placed legs, loss of balance at change of a pose.
Difference is that at the closed patient's eyes at once loses balance and if not to support him, can fall (instability in Romberg's pose).
Gait of a vestibular ataxy. At a vestibular ataxy of the patient it is filled up on one party all the time - irrespective of, there is it or goes. There is an explicit asymmetric nystagmus. Force of muscles and proprioceptive sensitivity are normal - unlike a unilateral touch ataxy and a hemiparesis.
Gait at hysteria. An astasia - an abasia - typical disturbance of gait at hysteria. The patient has sokhranna the coordinated movements of legs - both lying, and sitting, but he cannot stand and move without assistance. If to distract the patient, he keeps balance and takes several normal steps, but then defiantly falls - in hands of the doctor or on a bed.