Hello my name is Dr. Amanda Witt. I'm a physical medicine and rehabilitation physician. I also do have a specialty and a specialization in neuromuscular medicine. So I'm going to go through a few videos about gait analysis for neuromuscular. So my approach to gait analysis is number one just remember the few basics about gait. And so your stance phase, so that's when you're actually bearing weight through your leg, starts with a heel strike, foot flat, push off, and then the swing is a lot easier to think about. It's early swing, mid swing, and late swing. Some of the things that we see in neuromuscular medicine really have to do with the weight-bearing leg where they don't have the tibialis anterior strength. They don't have the dorsiflexion to manage a heel strike or maybe they can do a heel strike, but it quickly turns into a flat foot position because the eccentric contraction of the tibialis anterior fatigues very quickly. The other thing you'll see early in a foot drop situation would be a little bit of the big toe helping extending the extensor helicis longus extending to help the tibialis anterior with the dorsiflexion. The swing leg, basically you will see some problems. Maybe they hip hike, maybe they have some other compensation to really get that foot drop to swing through without dragging. You should have very minimal hip movement. The whole idea behind gait is that it is simple and energy-efficient. Any muscle weakness, any little alteration to that gait can have a big impact on how much energy it takes to walk and really keep that center of gravity in a straight line. What I do is I look at each joint. I start with the hips and I go down to see what they're doing. Does the hip have minimal movement? Does it have just enough to advance the leg and keep the pelvis stable side to side? It's a gluteus medius job, of course. Does it drop? If it does, what side is it dropping on? Does that correlate with other weakness on that side? Then I look at the knee. The knee really tells you a lot about not only the quad strength, but also what the ankle is doing. If the ankle is dropped, like in a foot drop plantar flexion situation, the knee is going to hyperextend. You can do this yourself, kind of stand. What happens to your knee when you put all your pressure on your toe? It forces it back. If there's plantar flexion weakness or they're hypermobile at the ankle, then you might have excessive dorsiflexion and that can cause the knee to buckle. So the knee tells you a lot about the ankle strength. And then of course you look at the foot. Is it dropping? Are they able to get that heel strike? Are they able to get a decent push off? So if you're noticing abnormalities, kind of look at the pattern. Who's at one side, both side? And if the joint is not looking stable, it's the knee is hyperextending, hyperflexing, the hips dropping. What do you think that could be compensating for? In neuromuscular medicine, also the lumbar spine will become hyper lordotic to compensate for hip extensor weakness. And so you can see that movement up into the low spine, that compensation. So the first thing you notice is that yes, he does have an arm swing, but it's not a very good one. The arms really aren't moving back and forth very well. His trunk is flexed forward, so he has a forward momentum that is unusual. Alright, let's watch his hips. The right one does tend to drop a bit, but that's not too dramatic. That left hip girdle is probably a little weak. Other thing is look at his feet. He doesn't ever have a heel strike. He has a toe strike all the way through, and he shuffles. He doesn't really pick up his feet very much. They drag. So he's got a lot going on from the back. Now let's look at the front. Here we go. The other thing that is more noticeable from the front position is that he scissors. His feet are crossing over one another, so his hip adductors have some spasticity to them. That's something we see commonly in cerebral palsy children, but he's got this scissoring gait. I think this also goes with kind of this flexed posture. The knees stay flexed through the whole gait cycle, and he never has a heel strike. He stays forward on his toes, and so I think an interesting combination of gait abnormalities in a patient. This gentleman actually has Parkinson's disease that he has had for several years, and that is known. The characteristics he has in his gait from Parkinson's are a decreased arm swing and forward flexion of the trunk as well as a shuffle to his gait, but he also has spasticity. He scissors. He is up on his toes. He has that forward momentum, that knee flexion that really is very classic for a crouch gait in a cerebral palsy patient. So we don't typically see a spastic gait in neuromuscular patients, especially not with a Parkinson's overlay, but he has ALS. It was a relatively new diagnosis of ALS. Even though he had an altered gait and some poor balance from his Parkinson's, the three to six months prior to this video, he had had a marked increase in his balls and loss of balance. So if you have spasticity and you're up on your toes with this forward momentum and you have Parkinson's, which alters your ability to start and stop and control your movement, he was just a fall waiting to happen. He was very impulsive with his movements. He was also very impulsive in the exam room, even just with manual muscle testing, and that is part with his dementia from the Parkinson's and probably a little frontal release from the ALS as well, but this combination of a gait caused him to lose emulation very quickly because he was just not safe with that impulsivity and forward momentum.

gait analysis

neuromuscular patients

muscle function

abnormalities

neurological conditions