Motor System Examination Part-12 | Gait & Station | CNS Examination | Pediatrics — Transcript

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1. 0:01hello everyone
2. 0:02this is my 12th video on motor system
3. 0:04examination in first 11 videos i have
4. 0:07already covered the bulk posture tone
5. 0:10power deep tendon reflex and superficial
6. 0:12reflexes
7. 0:13today i am going to tell you the details
8. 0:15of gate
9. 0:17whenever we are observing the gate and
10. 0:19station of the patient we are basically
11. 0:24looking at the cns so gate and station
12. 0:27both are the mirror of cns so we have to
13. 0:30observe each and every patient how the
14. 0:33patient is working how the patient is
15. 0:36standing from the sitting and the lying
16. 0:38down position
17. 0:39gate is the way patient walks and
18. 0:41station is the way patient stands and
19. 0:44maintain the posture
20. 0:46for the normal gait and the estration
21. 0:48there should be normal motor function
22. 0:50proprioceptive sensation brain stem
23. 0:53function cerebellar basal ganglia
24. 0:54function and tonic naked and
25. 0:56labyrinthine reflex vestibular function
26. 0:58and normal escalator system will be
27. 1:01required to maintain the normal gait and
28. 1:04station
29. 1:06now for the assessment of gate and
30. 1:08station we will tell the child to
31. 1:10extends from the lying down or sitting
32. 1:12position then we will observe if the
33. 1:14child is able to stand erect head up
34. 1:17chest out abdomen
35. 1:18and they fit together and there should
36. 1:20be no unsteadiness
37. 1:22then we will tell the child to stands
38. 1:24with the eyes closed if the child is not
39. 1:28able to maintain the balance with the
40. 1:30eyes closed
41. 1:31that means rombach sign is positive
42. 1:34details of the rombak sign i have
43. 1:36already explained with the eighth
44. 1:38cranial nerve examination
45. 1:40now we have to observe the gait cycle
46. 1:44and also reciprocal arm swing with the
47. 1:46walk is there or not then we will
48. 1:49measure the base width it is the
49. 1:51distance between both medial malleoli it
50. 1:53is normally approximately two inches if
51. 1:55it is less than or more than this that
52. 1:58means it is abnormal if it is more than
53. 2:01two inches we label as a white base gate
54. 2:04then we will tell the child to walk
55. 2:06with the eyes open then with the eyes
56. 2:09closed
57. 2:10and after that in more than nine years
58. 2:13age group children's we will tell the
59. 2:15child to
60. 2:16perform the tandem walk so in this video
61. 2:19you can see how to perform the tandem
62. 2:21walk
63. 2:22so
64. 2:23the age of this child is 11 years so
65. 2:26child is performing the tandem walk
66. 2:29by keeping the
67. 2:30heel of the foot
68. 2:32in front of the toes of the another foot
69. 2:36if the child is able to perform that
70. 2:38means child is having the normal gait
71. 2:42in
72. 2:43cerebral or atexia child will not be
73. 2:45able to perform this walk then we will
74. 2:47tell the child to perform the toes and
75. 2:50heel walk it is again possible after the
76. 2:52age of 5 years
77. 2:54so in this video you can see child has
78. 2:56performed the toe work now performing
79. 2:58the heel walk
80. 2:59then we will tell the child to walk
81. 3:01briskly and again suddenly we will tell
82. 3:03the child to stop it
83. 3:05and turn to the right side left side and
84. 3:08backward
85. 3:09so by this way we have to observe the
86. 3:11gate and the station of the child
87. 3:15now i am going to show you some of the
88. 3:17abnormal gates and the characteristics
89. 3:20of all these abnormal gates in next few
90. 3:22slides
91. 3:24so first abnormal gate is a or
92. 3:26the seasoning gate and this child is
93. 3:29having the seasoning of legs
94. 3:31that's why known as scissoring gate
95. 3:33wooden shoulder it is seen in the
96. 3:35congenital diaphragm diaplasic
97. 3:37cp child chronic myelopathy and cervical
98. 3:40spondylosis
99. 3:42so in this video you can see the child
100. 3:44is having the slow walking with support
101. 3:47bilateral hip and the knee joint are
102. 3:49adducted and partially flexed child is
103. 3:51dragging the feet because of the stiff
104. 3:53leg
105. 3:54and also walking on the toes because of
106. 3:56the equinox position of the feet
107. 3:59and heel core shortening so this is the
108. 4:01characteristic of seasoning gate seen in
109. 4:05the
110. 4:05commonly diaplegic sleepy child
111. 4:09another characteristic abnormal gait is
112. 4:11the circumduction gate
113. 4:13it is known as circumduction because
114. 4:15child left the league in the form of
115. 4:17circle or arc it is seen in the
116. 4:20hemiparesis
117. 4:22and in this image you can see child is
118. 4:24keeping the upper limb
119. 4:26close to the body
120. 4:28legs and adducted shoulder raised elbow
121. 4:30joints are there and the affected lower
122. 4:33limb is stiff and in extended position
123. 4:38so in this video you can see the child
124. 4:39is having circumduction gate and when
125. 4:42child will lift the affected limb hip
126. 4:45will be higher than the normal side and
127. 4:47child is dragging the foot
128. 4:50and the circumduction is there lifting
129. 4:52the leg in the form of arc or circle
130. 4:56so this is characteristic of
131. 4:59circumduction gate seen in
132. 5:01hemiparesis
133. 5:05another abnormal gate is the high
134. 5:07stepping or stippage or equine gate
135. 5:11because child will raise the foot higher
136. 5:13than the normal foot that's why it is
137. 5:15known as high stepping gate it is seen
138. 5:18in the foot drop and in sensory atexia
139. 5:22in this video you can see the child is
140. 5:24having the right sided unilateral foot
141. 5:26drop
142. 5:27and to raise the foot from the floor
143. 5:30child is flexing the hip and the knee
144. 5:32joint
145. 5:34in the exaggerated manner
146. 5:36to lift the foot from the floor
147. 5:40and there will be a double tape sound
148. 5:43it is because toes strike the ground
149. 5:46first then the heel
150. 5:48and
151. 5:48in normal walk
152. 5:50heel strike first
153. 5:55high stepping gate
154. 5:57can be seen in the unilateral foot drop
155. 5:59due to the peripheral neuropathy
156. 6:01peroneal nerve palsy l5 radiculopathy or
157. 6:04polio myelitis
158. 6:06sometimes child is having the bilateral
159. 6:08food drop because of the muscular
160. 6:10dystrophy bilateral food dorsiflexor
161. 6:13weakness
162. 6:14charcoal mary 2 disease amyotrophic
163. 6:17lateral sclerosis
164. 6:19even in the sensory atexia child will
165. 6:21have the high stepping gate but in
166. 6:24sensory atexia
167. 6:26there will be heal strike first than the
168. 6:29toes
169. 6:32another abnormal gate is the atexic or
170. 6:35broad base gate also known as staggering
171. 6:38or reeling gate in this child walk like
172. 6:41a drunk card name that's why known as
173. 6:43drunken sailor so in this video you can
174. 6:46see
175. 6:47the child is having the atexia so child
176. 6:50is walking
177. 6:52in broad base placing the feet wide
178. 6:54apart and child is having the clumsy
179. 6:57unsteady swaying or lurching or
180. 6:59uncoordinated gait child cannot walk in
181. 7:02the straight line and when you will tell
182. 7:05the child to perform the tandem walk or
183. 7:07walk in a straight line child will have
184. 7:09the
185. 7:11unsteady gate and child can even fall on
186. 7:14the affected side or child will lose the
187. 7:16balance it is seen in the cerebellar
188. 7:18dysfunction posterior column disease and
189. 7:20the
190. 7:21vestibular disease
191. 7:25another abnormal gait is the
192. 7:27ataxi gate in this child will have the
193. 7:30both the component of the spasticity and
194. 7:33the atexia it is also known as jiggling
195. 7:36or bobbing gate
196. 7:38in this video you can see the child is
197. 7:41having the atoxic gate and there
198. 7:44will be the
199. 7:46up and down body moments also
200. 7:49associated with this and child will have
201. 7:52the stimulus bouncing movements
202. 7:54and when both
203. 7:55corticospinal tract and the posterior
204. 7:58column are involved then this type of
205. 8:01gait is seen in the vitamin b12
206. 8:03deficiency
207. 8:04or in multiple sclerosis or amyotrophic
208. 8:07lateral sclerosis
209. 8:11another abnormal gate is the wedding or
210. 8:14the myopathy gate it is seen in the
211. 8:17proximal myopathies muscular dystrophy
212. 8:20whenever there is a hip curdle muscle
213. 8:22weakness
214. 8:23so if the child is having unilateral
215. 8:26muscle weakness child will have the
216. 8:28trendelberg sign
217. 8:30due to the hip abductor weakness in this
218. 8:33abnormal drop of the pelvis on the
219. 8:35affected side occur
220. 8:37we label as a wedding gate whenever
221. 8:39there is a bilateral hip girdle muscle
222. 8:41weakness as
223. 8:43there will be
224. 8:44exaggerated pelvic swing and child will
225. 8:47have the exaggerated hip motion or the
226. 8:50rotation of the pelvis also hyperlodic
227. 8:53posture will be there
228. 8:54and child will walk with the broad base
229. 8:58known as wedding or the myopathic aid
230. 9:01child will also have the difficulty in
231. 9:04climbing stairs because of the proximal
232. 9:06muscle weakness also child will have the
233. 9:09govern sign so in this video you can see
234. 9:12child is standing from the sitting
235. 9:14position and the govern sign is there
236. 9:16child is taking the help of the hand
237. 9:19two stents
238. 9:21it is characteristically seen in the dmd
239. 9:24also child will have the toe walking
240. 9:26so in this video you can see the child
241. 9:28is
242. 9:30walking on the toes because of the
243. 9:32proximal muscle weakness it is again
244. 9:34seen in the proximal myopathies
245. 9:40hyperkinetic gate seen whenever child is
246. 9:42having abnormal limbs movement either
247. 9:44chorea athetosis or the dystonia so in
248. 9:48this video you can see the child is
249. 9:50having
250. 9:51coric movement in the limbs and also
251. 9:54having the
252. 9:56abnormal body movements
253. 9:58this child was suffering from syndendam
254. 10:00korea and having the hyperkinetic gate
255. 10:03also can be seen in the huntington
256. 10:05disease or any other disease in which
257. 10:08child is having abnormal limbs movement
258. 10:11some other gaits are intelligent
259. 10:14whenever child is having pain or the
260. 10:16fracture in the lower limbs
261. 10:19hypokinetic gait is seen in the adult
262. 10:21those who are suffering from parkinsonis
263. 10:24in which gate will be slow stiff
264. 10:26shuffling and
265. 10:27walk with small steps
266. 10:30and decrease arm swing will be there
267. 10:32also having the rigidity bradycarnation
268. 10:35loss of associated movements
269. 10:38we label the tentative gate whenever
270. 10:40child is having the weakness or
271. 10:42hypotonia of the lower extremity
272. 10:49so this is all about the
273. 10:52gate and the station
274. 10:54thank you so much