Gait

GAIT, a concept defining the totality of all characteristics that characterize the manner of walking of a given individual. The act of walking is directly performed by the motor apparatus of the lower extremities, however, walking, like other movements intended for the displacement of our body as a whole (locomotion), can be effective only with the synergistic participation of all other skeletal musculature. In the implementation of these extensive synergies, both the automatic apparatus regulating kinetic equilibrium (located in the subcortical centers of the brain) and the processes in the cerebral cortex, which can be collectively designated as consciousness of the space surrounding us and the position of our body in it during its locomotor movements, participate. Additionally, it must be kept in mind that the interaction between the environment and the organism during its locomotion is not exhausted only by the aforementioned mechanisms that implement static-dynamic equilibrium; the external environment in various situations stimulates the analytical activity of consciousness, causing corresponding emotional-volitional reactions. As a result of such a complex interaction between the environment and the walking person, the automated act of walking is colored by the characteristic of G., i.e., a symptom complex of motor features characteristic of this personality in general in its goal-setting in accordance with a given external environment. Gait belongs to expressive movements, and its analysis could be used as an objective method, similar to the study of handwriting (see Graphology), in the study of personality in its healthy and various pathological states. Unfortunately, strictly objective methods (graphic) for analyzing Gait are still little available for everyday practice, since the application of devices proposed for this purpose (cine- and chronophotography) requires special technical knowledge and skills; the ichnographic method (see Ichnogram) is convenient to apply due to its simplicity but gives only a partial characterization of Gait. There is no systematic and exhaustive semiotics of Gait; the creation of a classification of types of Gait that would encompass both normal and pathological walking is a task in the correct resolution of which both characterology (psychology of individual differences) and clinical diagnosis are interested. For the full resolution of this task, the possibilities are still very limited at present, because the material we currently have available relates only to the semiotics of pathological forms of Gait, while there is no typological characterization of normal gaits; in this direction, it is necessary to develop the question of typical variants of normal Gait in light of the doctrine of constitution (somatic and psychic) taking into account the age factor. The literature on clinical neurology contains descriptions of typical forms of disorders of Gait in diseases of various parts of the nervous system, representing working material useful in a differential diagnostic respect. Paralytic Gait is distinguished according to one of the main functional features of so-called peripheral paresis-weakening of the strength of affected muscles; this type combines all possible forms of variations, conditioned both by the number of adynamous elements and their location in the musculature participating in the locomotor postures of the body during the act of walking. In clinical semiotics, one of the more common forms of paralytic Gait is distinguished, designated by the term 'cock's gait' or the term of French authors 'steppage'; this form is observed in lesions of the extensors of the feet. Patients are forced to lift the leg with paralyzed muscles high, to separate the drooping foot from the ground, and when lowering the leg to the ground, to make a forward throw of the leg, in order to, taking advantage of the moment of its horizontal position, lower the sole flat; from this adaptive movement, a characteristic slapping of the sole on the floor results, by which, without looking at the patient, one can determine the weakness of the peroneal group of muscles. The high lifting of the leg requires a greater range of motion in the hip and knee joints, as a result of which Gait acquires features that gave French authors occasion to characterize it by the term 'steppage' (from English to step) by similarity with the gait of thoroughbred horses, which is especially _% noticeable in bilateral lesions of the peroneal nerves. German authors denote this form by the term Steppergang (by similarity with the movement of the leg of a sharpener). The described excessive movements of some muscle groups, synergistically working with the affected group to perform a certain phase of the step, are typical for all forms of paralytic Gait - this is the so-called compensatory movements; they impart specific features, for example, to the gait of sufferers from progressive muscular dystrophy, in which atony of the hip joint musculature hinders the lifting of the legs, and this movement is compensated by the intensified work of the muscles of the spine on the side opposite to the leg being lifted, as a result of which the body excessively bends to the side of the leg fixed on the ground at this moment; during walking, a peculiar swaying of the body results, making the Gait resemble that of a duck. It is necessary to point out that this type of Gait can also be observed in deformities of the skeleton of the lower extremities (congenital bilateral dislocation of the hip, rachitic curvatures). Some similarity with these forms is found in the staggering Gait of patients with osteomalacia, in which weakness of the leg muscles appears; patients walk with small steps, moving their legs jerkily, while the body along with the pelvis at each step makes a slight outward turn. Spastic Gait is caused by hypertonia of muscles in lesions of the central motor pyramidal systems: in these cases, there is characteristic stiffness of the legs; patients drag their feet, with difficulty separating the sole from the floor, from which results the sound of shuffling the toe on the floor; sometimes the legs show a tendency to cross (in the spinal form of spastic paralysis), and then when walking, the dragging leg describes an arc convex outward around the other leg - so-called equinovarus. A particular form of spastic gait is hemiplegic, distinguished by the purely external sign of the location of paralysis and caused either by organic lesion of the pyramidal path at any site in the brain area (cortex, internal capsule, peduncle, Varolian bridge) or by so-called functional disorder (hysteria). In the first case, patients when walking move the paralyzed leg along the ground, describing a gentle, convex outward arc; due to the spastic condition of the extensors of the knee joint and flexors of the foot and toes, patients as if 'scissor' with the leg. In the second case, patients drag behind them a leg extended like a stick (Todd's gait). In lesions of the extrapyramidal systems (paralysis agitans, postencephalitic parkinsonism), causing general muscular rigidity, a characteristic Gait is observed, which German authors designated by the term 'old people's gait' (Greisengang), and French - by the term 'marche a petit pas' (gait with small steps). Patients go with sliding small steps, the feet maintain a parallel position, the tempo of Gait gradually accelerates, the size of the step decreases, the impression is created that patients strive to 'overtake themselves'; associated movements of the arms are absent; in the general stiffness of the body, it is inclined forward, thereby moving the center of gravity of the body forward, and patients try to prevent falling by throwing their arms back; if in a patient the bending and woodenness of the body have reached a high degree, a light push in the back can cause the phenomenon of propulsion - running forward to prevent falling, a push from the front can cause retropulsion, which ;after a few steps usually ends with falling. Ataxic Gait is observed in disorders of coordination, depending on the lesion of either central apparatus (cerebellum, pons, quadrigeminal) or pathways conducting sensitivity (peripheral nerves, posterior columns) (see Ataxia). General symptoms: lack of smoothness, elasticity of walking, instability, unsteadiness of Gait, excessiveness, dispersion of movements (see Dysmetria). Depending on the predominant lesion of one or another systems, specific variants of ataxic Gait are obtained. In peripheral and spinal types (polyneuritis, tabes dorsalis) Gait is flaccid, the legs are raised abnormally high, scattering to the sides, and are lowered with the heel striking the floor; the steps are uneven, but the direction of Gait remains correct, and the body hardly participates in the swaying of the body. In the cerebellar type of ataxic Gait, the symptoms of disturbance of equilibrium of the body come to the fore, while the dispersion of movements of the legs is overshadowed; the entire symptom complex resembles the Gait of a drunken person (demarche ebrieuse of French authors). As a special case of cerebellar Gait, asynergic (Babinski) is distinguished, in which a dissociation between the elements of walking sharply manifests: the movement of the leg forward and at the same time the forward bending of the body.

In the asynergistic type of gait, while the leg is lifted and brought forward, the trunk does not follow in that direction but remains behind, thereby creating the possibility of falling (see Asynergia). Tabetic-cerebellar gait is a combination of lesions of the posterior columns and the cerebellolateral pathways (diseases of Friedreich, Pierre Marie). As the name indicates, in this form of gait, features of tabetic and cerebellar forms of locomotor ataxia are mixed, but the swaying movements of the trunk somewhat predominate; a characteristic symptom that facilitates differential diagnosis is static ataxia of the trunk: patients sway when standing, and in this position, the muscle contractions necessary for maintaining balance are clearly evident. - To the semiotics of gait disorders, two more forms are also attributed, in which there is a complete inability to walk; both forms are manifestations of hysteria; the first of these is caused by the occurrence of unbearable pain ('imaginary pains', painful hallucinations) with any attempts at movement in general and walking in particular (akinesia algera), the second form, bearing the name 'astasia-abasia', is characterized by the fact that in bed, patients move their limbs freely, while when attempting to stand and walk, either complete atony or sharply expressed contracture is found in the muscles.