Gait, propulsive [Festinating gait]
Propulsive gait is characterized by a stooped, rigid posture—the patient's head and neck are bent forward; his flexed, stiffened arms are held away from the body; his fingers are extended; and his knees and hips are stiffly bent. During ambulation, this posture results in a forward shifting of the body's center of gravity and consequent impairment of balance, causing increasingly rapid, short, shuffling steps with involuntary acceleration (festination) and lack of control over forward motion (propulsion) or backward motion (retropulsion). (See Identifying gait abnormalities, page 274.)
Propulsive gait is a cardinal sign of advanced Parkinson's disease; it results from progressive degeneration of the ganglia, which are primarily responsible for smooth-muscle movement. Because this sign develops gradually and its accompanying effects are usually wrongly attributed to aging, propulsive gait commonly goes unnoticed or unreported until severe disability results.
History and physical examination
Ask the patient when his gait impairment first developed and whether it has recently worsened. Because he may have difficulty remembering, having attributed the gait to “old age” or disease processes, you may be able to gain information from family members or friends, especially those who see the patient only sporadically.
Also, obtain a thorough drug history, including medication type and dosage. Ask the patient if he has been taking tranquilizers, especially phenothiazines. If he knows he has Parkinson's disease and has been taking levodopa, pay particular attention to the dosage because an overdose can cause an acute exacerbation of signs and symptoms. If Parkinson's disease isn't a known or suspected diagnosis, ask the patient if he has been acutely or routinely exposed to carbon monoxide or manganese.
Begin the physical examination by testing the patient's reflexes and sensorimotor function, noting abnormal response patterns.
Medical causes
Parkinson's disease.The characteristic and permanent propulsive gait begins early as a shuffle in Parkinson's disease. As the disease progresses, the gait slows. Cardinal signs of the disease are progressive muscle rigidity, which may be uniform (lead-pipe rigidity) or jerky (cogwheel rigidity); akinesia; and an insidious tremor that begins in the fingers, increases during stress or anxiety, and decreases with purposeful movement and sleep. Besides the gait, akinesia also typically produces a monotone voice, drooling, masklike facies, a stooped posture, and dysarthria, dysphagia, or both. Occasionally, it also causes oculogyric crises or blepharospasm.
Other causes
Carbon monoxide poisoning.A propulsive gait commonly appears several weeks after acute carbon monoxide intoxication. Earlier effects include muscle rigidity, choreoathetoid movements, generalized seizures, myoclonic jerks, masklike facies, and dementia.
Drugs.Propulsive gait and possibly other extrapyramidal effects can result from the use of phenothiazines, other antipsychotics (notably haloperidol, thiothixene, and loxapine) and, less commonly, metoclopramide and metyrosine. Such effects are usually temporary, disappearing within a few weeks after therapy is discontinued.
Manganese poisoning.Chronic overexposure to manganese can cause an insidious, usually permanent, propulsive gait. Typical early findings include fatigue, muscle weakness and rigidity, dystonia, resting tremor, choreoathetoid movements, masklike facies, and personality changes. Those at risk for manganese poisoning are welders, railroad workers, miners, steelworkers, and workers who handle pesticides.
Nursing considerations
▪ If the patient has problems performing activities of daily living, assist him as appropriate, while at the same time encouraging his independence, self-reliance, and confidence.
▪ Maintain a safe environment.
▪ Assist with ambulation, as needed.
▪ Refer the patient to a physical therapist for exercise therapy and gait retraining.
Patient teaching
▪ Advise the patient and his family to allow plenty of time for walking to avoid falls.
▪ Instruct the patient on the use of assistive devices, if appropriate.
Pictures
![Gait, propulsive [Festinating gait] - 5601.1.png](/bookimages/16/5601.1.png)
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Walking symptoms
Read excerpts from these other book chapters related to Walking symptoms:
Medical Books Excerpts
- ATAXIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Ataxia
- "In a Page: Signs and Symptoms" (2004)
- [ read ]
- Ataxia
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Ataxia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Ataxia
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Ataxia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Ataxia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Ataxia
- "Field Guide to Bedside Diagnosis" (2007)
- [ read ]
- Ataxia
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Ataxia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Ataxia
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Ataxia
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Walking symptoms
» Next page:
Gait, scissors (Nursing: Interpreting Signs and Symptoms)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
