Pathological Gait Patterns in Parkinson’s disease and Cerebral Palsy
Normal vs Pathological Gait Analysis
In very simple terms, pathological means something which falls out of normal patterns like human body suffering from disease and as a result displaying abnormal behaviors marked by signs and symptoms of the disease. Gait in simple words means a way of walking at various speeds utilizing different types of footfalls and rhythms, so pathological gait means an abnormal way of walking due to some malfunction or disease. So below are a few pathological gait patterns in patients suffering from Parkinson’s disease and cerebral palsy:
Gait Patterns in Parkinson's Disease
- Hypokinetic disorder with reduced speed and amplitude of walking characterized by small shuffling steps with forward bent posture (semiflexed trunk)
- Slowness in initiating gait or freezing (inability to take first step)
- Hip movement - 25% normal (little extension)
- Knee movement - 25% normal (little extension) consisting of single flexion extension
- (2 phases) rather than normal four phases.
- Ground contact occurs with knee flexed and foot flat
- Ankle movements reversed during stance and swing phase compared to normal. Reduced toe clearance during swing
Ground reaction forces:
- Single peak in vertical force at middle rather than beginning and end of stance
- No horizontal propulsive force for push-off
- Greater lateral movement of center of pressure than normal
- Forward progression is achieved by letting the trunk fall forward, lifting the foot and placing it further forward
Abnormalities in patterns of muscle activation
- EMG of leg extensors lower than normal and poorly modulated
- Increased TA activity in swing (for floor clearance)
- Antagonistic leg muscle coactivation during support phase greater in patients compared to healthy individuals (rigidity)
Gait Patterns in Cerebral Palsy
- Characteristically a childhood movement disorder due to perinatal brain damage (high incidence in prematurely born infants)
- Cerebral palsy is characterized by spastic diplegia (marked by spasticity and hypertonia) and inappropriate muscle activation
- Muscle contractures produce excessive rotation at some joints leading to skeletal deformities that contribute to movement disorder, e.g., talipes equinovalgus deformity of legs with strongly pronated feet during gait
- Gait impairments in cerebral palsy are quite variable, varying from mild to incapacitating, depending on the extensiveness and location of brain damage
Common impairments among ambulatory individuals include:
- Drop foot gait where toe contacts ground before heel (most common impairment)
- Knee remains flexed throughout stance with hip excessively flexed at mid-stance
- Both hip and knee remain flexed throughout stance
- Failure to dorsiflex ankle during stance resulting in knee hyperextension
- Failure to plantarflex ankle in late stance, resulting in knee hyperextension
- Muscle activity is generally less well modulated than normal subjects with periods of abnormal antagonistic muscle coactivation.
- Abnormal patterns of activation may sometimes be coping strategies rather than impairments, i.e., impaired ability to activate a muscle at one joint may require compensation at another joint which requires an abnormal pattern activation
So above were a few pathological gait patterns as seen in parkinsonisms and cerebral palsy patients. Sometimes, pathological gait patterns are also seen in patients who are under stress but abnormal gait patterns without the presence of any bodily injury and only due to muscle weakness and/or numbness need to be treated accordingly.
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