History of falls, walking aids
Balance
- Patient to sit in a chair with back straight against the back of the chair
- Keep arms folded while standing
- Sit without leaning or sliding (trunkal instability)
- Arise from chair in single movement without using arms
- Sit down in a smooth motion without falling
Stance
- Patient to place feet together without any support
- Stand for > 30sec
- Stand without loss of balance with eyes closed (Romberg’s Test)
- Turn head to both sides and look up without losing balance
- Maintain balance when nudged gently (nudge 3 times on the sternum)
- Stand on one leg
- Reach up to get an object and down to get an object without loss of balance
Gait
-
- Patient to walk across room, turn and walk back as quickly as possible
- Initiate gait immediately (if no, dopamine deficiency/ substantia nigra lesion)
- Maintain normal step height, clearing the floor with their feet (maximum of 5 cm)
- 5 cm → high stepping
- Maintain a step length between stance toe and swinging heel that is length of foot
- Step symmetry and continuity (raises heel of one foot as other foot touches down)
- Maintain a straight path and normal truncal stability (no swaying back, knee flexion or arm abduction)
- Observed from behind: normal walk stance with feet almost touching
- Stop without difficulty
- Turn without discontinuity of steps
Pathological gaits
- Parkinsonian
- Shuffling gait
- Lack of arm swingin
- Difficulty initiating/stopping.
- Foot drop
- Compensate with high-stepping.
- Spastic hemiparesis
- Leg is extended, foot is plantarflexed
- Sensory ataxia
- Wide, unsteady gait that is worse with eyes closed.
- Cerebellar ataxia
- Unsteady, wide based gai
- Difficulty with turns, veers towards side of lesion
- Antalgic
- Painful, short contralateral step