Gait abnormality

A speed disorder is a movement disorder in which, in particular, the walking is affected. Causes lie on the one hand and orthopedic / surgical field, on the other hand, neurological or psychiatric field.

Clinical Trials

The continuity check is initially clinically, ie without technical aids.

• Examination of normal gait Go: increment, speed, starting and stopping, ground contact and rolling
• Movement in the large joints, rolling on the foot and toes
• 180 ° turn ( required number of steps )

• Acrobat transition (one foot ahead of the other on an imaginary line )
• Toe / Hack transition ( for review of paralysis )

Further studies are possible with the appropriate equipment on a treadmill or videometry, it also analyzes using computer can be performed. However, this plays more in the Sports Medicine Research or a role.

Orthopedic -related gait disorders

• Trendelenburg gait - watschelndes gait in hip joint diseases ( infantile hip dysplasia, dislocation of the joint)
• Duchenne limp - lateral flexion of the trunk to the ( affected ) leg.
• Limping gait with joint stiffness or pain - especially knee or ankle

Neurological gait disorders

• Trendelenburg gait - watschelndes gait in paralysis of the middle gluteal muscle ( usually damage to the nerves supplying )
• Kleinschrittiges ( trippelndes ) gait - in Parkinson syndromes
• Wernicke -man gait in spastic hemiplegia ( hemiparesis ), usually after a stroke
• Cerebelläres gait pattern in disorders of cerebellar function - " how drunk " (see ataxia)
• "Stepper gear" in peroneal paralysis or certain disc herniations

Gait deviations to the side also occur with balance disorders, but usually do not stand in the foreground.

Psychogenic gait disorders

Psychogenic gait disorders are much more common than generally believed. They are subsumed under the dissociative disorder in psychiatry after the ICD -10 - more accurate than dissociative movement disorders. The dissociative movement disorders make 2.6 to 25 % of the movement disorders in neurological departments of. Of this, 32.8% fall on the psychogenic tremor, 25% in psychogenic dystonia, 25% of the psychogenic myoclonus, 6.1% to the psychogenic parkinsonism and 10.9% to the psychogenic gait disorder.

After Feinstein comorbidity with other psychiatric disorders is considerable: 38% anxiety disorder, 19 % major depression, 12 % anxiety & depression. 12 weeks outpatient psychotherapy can significantly improve the symptoms.

Miyasaki criteria

Clinical history on a psychogenic gait disorder are by Miyasaki sudden onset, static course, spontaneous remissions ( not persistent ), psychiatric disorders, multiple somatization, patients in the health sector operates, financial compensation, secondary gain, young and female gender.

The clinical appearance of the movements indicated - after Miyasaki - then on a psychogenic gait disorder out if the following parameters are met: irregularly (frequency, amplitude, distribution, ... ), paroxysmal, propagated at observation decreased in distraction, may by unusual / non-physiological interventions triggered / terminate, contradictory weakness, conflicting sensory disturbances, artificial injuries, deliberate slowness, functional limitation with neurological examination contrary, bizarre, multiple shares, difficult to classify.

Also, the response to therapy, after Miyasaki indicate Psychogenität: do not respond to appropriate medication, but is responsive to placebo, remission of the gait disorder with psychotherapy.

Hayes criteria

Hayes and co-workers developed 20 criteria that can identify a psychogenic gait disorder: female gender, young age, multiple symptoms, contrary to the restriction, sudden onset, beginning with delay after accident, variability of symptoms, sudden healing, primary and secondary gain from illness, psychiatric comorbidity a model ( for gait disturbance ) in the patient's environment, excessive effort / fatigue, slowness, fluctuations, convulsive shaking, uneconomic postures, bizarre gait, neurological examination unremarkable, non-physiological sensitivity losses and the manner of presentation.