Gait, spastic [Hemiplegic gait]
Gait, spastic [Hemiplegic gait]: Excerpt from Handbook of Signs & Symptoms (Third Edition)
Spastic gait — sometimes referred to as paretic or weak gait — is a stiff, foot-dragging walk caused by unilateral leg muscle hypertonicity. This gait indicates focal damage to the corticospinal tract. The affected leg becomes rigid, with a marked decrease in flexion at the hip and knee and possibly plantar flexion and equinovarus deformity of the foot. Because the patient’s leg doesn’t swing normally at the hip or knee, his foot tends to drag or shuffle, scraping his toes on the ground. (See Identifying gait abnormalities, pages 286 and 287.) To compensate, the pelvis of the affected side tilts upward in an attempt to lift the toes, causing the patient’s leg to abduct and circumduct. Also, arm swing is hindered on the same side as the affected leg.
Spastic gait usually develops after a period of flaccidity (hypotonicity) in the affected leg. Whatever the cause, the gait is usually permanent after it develops.
History and physical examination
Find out when the patient first noticed the gait impairment and whether it developed suddenly or gradually. Ask him if it waxes and wanes, or if it has worsened progressively. Does fatigue, hot weather, or warm baths or showers worsen the gait? Such exacerbation typically occurs in multiple sclerosis. Focus your medical history questions on neurologic disorders, recent head trauma, and degenerative diseases.
During the physical examination, test and compare strength, range of motion (ROM), and sensory function in all limbs. Also, observe and palpate for muscle flaccidity or atrophy.
Medical causes
Brain abscess
In brain abscess, spastic gait generally develops slowly after a period of muscle flaccidity and fever. Early signs and symptoms of abscess reflect increased intracranial pressure (ICP): a headache, nausea, vomiting, and focal or generalized seizures. Later, site-specific features may include hemiparesis, tremors, visual disturbances, nystagmus, and pupillary inequality. The patient’s level of consciousness may range from drowsiness to stupor.
Brain tumor
Depending on the site and type of tumor, spastic gait usually develops gradually and worsens over time. Accompanying effects may include signs of increased ICP (a headache, nausea, vomiting, and focal or generalized seizures), papilledema, sensory loss on the affected side, dysarthria, ocular palsies, aphasia, and personality changes.
Head trauma
Spastic gait typically follows the acute stage of head trauma. The patient may also experience focal or generalized seizures, personality changes, a headache, and focal neurologic signs, such as aphasia and visual field deficits.
Multiple sclerosis
Spastic gait begins insidiously and follows multiple sclerosis’ characteristic cycle of remission and exacerbation. The gait, as well as other signs and symptoms, commonly worsens in warm weather or after a warm bath or shower. Characteristic weakness, usually affecting the legs, ranges from minor fatigability to paraparesis with urinary urgency and constipation. Other effects include facial pain, paresthesia, incoordination, loss of proprioception and vibration sensation in the ankle and toes, and vision disturbances.
Stroke
Spastic gait usually appears after a period of muscle weakness and hypotonicity on the affected side. Associated effects may include unilateral muscle atrophy, sensory loss, and footdrop; aphasia; dysarthria; dysphagia; visual field deficits; diplopia; and ocular palsies.
Special considerations
Because leg muscle contractures are commonly associated with spastic gait, promote daily exercise and active and passive ROM exercises. The patient may have poor balance and a tendency to fall to the paralyzed side, so stay with him while he’s walking. Provide a cane or a walker, as indicated. As appropriate, refer the patient to a physical therapist for gait retraining and possible in-shoe splints or leg braces to maintain proper foot alignment for standing and walking.
Pediatric pointers
Causes of spastic gait in children include sickle cell crisis, cerebral palsy, porencephalic cysts, and arteriovenous malformation that causes hemorrhage or ischemia.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
More About Hereditary Spastic Paraplegia
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Paralysis and Paresis (A Pocket Manual of Differential Diagnosis)
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