Gait, scissors

Resulting from bilateral spastic paresis (diplegia), scissors gait affects both legs and has little or no effect on the arms. The patient's legs flex slightly at the hips and knees, so he looks as if he's crouching. With each step, his thighs adduct and his knees hit or cross in a scissorslike movement. (See Identifying gait abnormalities.) His steps are short, regular, and laborious, as if he were wading through waist-deep water. His feet may be plantar flexed and turned inward, with a shortened Achilles tendon; as a result, he walks on his toes or on the balls of his feet and may scrape his toes on the ground.

History and physical examination

Ask the patient (or a family member, if the patient can't answer) about the onset and duration of the gait. Has it progressively worsened or remained constant? Ask about a history of trauma, including birth trauma, and neurologic disorders. Thoroughly evaluate motor and sensory function and deep tendon reflexes (DTRs) in the legs.

Medical causes

Cerebral palsy.In the spastic form of cerebral palsy, patients walk on their toes with a scissors gait. Other features include hyperactive DTRs, increased stretch reflexes, rapid alternating muscle contraction and relaxation, muscle weakness, underdevelopment of affected limbs, and a tendency toward contractures.

Cervical spondylosis with myelopathy.Scissors gait develops in the late stages of cervical spondylosis with myelopathy and steadily worsens. Related findings mimic those of a herniated disk: severe low back pain, which may radiate to the buttocks, legs, and feet; muscle spasms; sensorimotor loss; and muscle weakness and atrophy.

Multiple sclerosis.In multiple sclerosis, progressive scissors gait usually develops gradually, with infrequent remissions. Characteristic muscle weakness, usually in the legs, ranges from minor fatigability to paraparesis with urinary urgency and constipation. Related findings include facial pain, vision disturbances, paresthesia, incoordination, and loss of proprioception and vibration sensation in the ankle and toes.

Spinal cord tumor.Scissors gait can develop gradually from a thoracic or lumbar tumor. Other findings reflect the location of the tumor and may include radicular, subscapular, shoulder, groin, leg, or flank pain; muscle spasms or fasciculations; muscle atrophy; sensory deficits, such as paresthesia and a girdle sensation of the abdomen and chest; hyperactive DTRs; a bilateral Babinski's reflex; spastic neurogenic bladder; and sexual dysfunction.

Syringomyelia.Scissors gait usually occurs late in syringomyelia, along with analgesia and thermanesthesia, muscle atrophy and weakness, and Charcot's joint. Other effects may include the loss of fingernails, fingers, or toes; Dupuytren's contracture of the palms; scoliosis; and clubfoot. Skin in the affected areas is commonly dry, scaly, and grooved.

Nursing considerations

▪ Because of the sensory loss associated with scissors gait, provide meticulous skin care to prevent skin breakdown and pressure ulcer formation.

▪ Provide active and passive range-of-motion exercises.

▪ Refer the patient to a physical therapist for gait retraining and for possible in-shoe splints or leg braces to maintain proper foot alignment for standing and walking.

▪ Assist with ambulation.

Patient teaching

▪ Advise the patient and his family on complete skin care.

▪ Teach them about bladder and bowel retraining, if appropriate.

▪ Reinforce the proper use of splints or braces, if appropriate.

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.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Walking symptoms: Introduction (review 483 causes)
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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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