GAIT

From Big Medical Encyclopedia

GAIT — set of the signs characterizing walking of the person. A number of motive components P. has inborn character and is included in difficult coordinate activity of muscles and extremities in the course of movement (locomotions). P.'s regulation at the person is carried out by cortical, subcrustal and trunk and cerebellar structures of a brain. By the item it is connected also with emotional (motivational) mechanisms of movement which are controlled by limbic system of a brain (see. Limbic system ) and cortical regulation of statodinamichesky balance of the moving person. All this gives to P. the expressive coordination reflecting personal features of this person (character, temperament) and creates a manner walking (see). In the course of P.'s life gains new lines which at the person are connected with features of his work, education, etc.

Normal P.'s types are not systematized since a large number of the components defining P. complicates systematization.

Pathology

P.'s Disturbances can take place at dysfunctions of a musculoskeletal system. In these cases the organism adapts to the changed conditions of walking, and P. gets a certain form depending on the nature of a disease. Also psychogenic changes of P. observed at hysteria, traumatic neurosis are possible. They are not limited only astasia abasia (see) are also very different, and are sometimes fancy. E.g., the patient makes legs the difficult, elaborate movements, drags the foot as a foreign subject as if he sweeps it a floor (Todd's gait), etc. Allocate spastic, hemiplegic, paralytic, akinetiko-rigid, atactic and other Items.

The spastic gate results from defeat pyramidal system (see) it is also observed at multiple sclerosis (see), myelitis (see), myelipathies (see), parasagittal to a meningioma (see), etc. At these diseases increase in a tone of muscles of legs, rigidity in joints is characteristic that sharply slows down the movements and slows down the Item. As spasticity prevails in razgibatel of a shin and sgibatel of feet, legs at the patient are as if extended, feet are fixed in a condition of bending; the patient moves small elastic short steps, socks of feet as if scrape on the ground, almost without coming off a floor; at increase in a tone of adductors of a hip the crossing of legs during the walking is observed.

The hemiplegic gate forms at patients after cerebral strokes more often.

Because on the party of a hemiplegia the leg is unbent in all joints, extended, and foot is bent and turned inside (pronirovana), the patient during the walking, taking out the straightened leg forward, describes foot a semicircle of a knaruzha, shuffling on a floor («mows with a leg»). At this P. special position of hands is characteristic: the shoulder girdle is lowered, the shoulder is given to a body, the forearm is bent in an elbow joint, pronirovano, a brush and fingers of a polusognuta that is characteristic of Vernike's pose — Mann (see. Hemiplegia ).

Paralytic the campaign - to and results from defeat of the peripheral motor-neuron which is followed by sluggish paralysis or paresis of muscles of the lower extremities (see. Paralyses, paresis ), it is also observed at a polyneuropathy (see. Polyneuritis ), acute, subacute poliomyelitis (see), myopathies (see) and other diseases. Distinguish several types of paralytic P., including cock, calcaneal, duck, etc.

Cock P. occurs at patients with sluggish paralysis or paresis of hl. obr. muscles of razgibately foot and fingers, resulting from damage of the general fibular nerve, it is also noted often at a paralytic form of a sciatica (see Radiculitis) and neural amyotrophy of Sharko — Mari — Here (see. Amyotrophy ). Because of weakness of muscles of razgibatel of stop droops down and during the walking touches the earth. To avoid it, patients at each step, compensating this defect, highly lift and throw out a leg forward, strongly bending it in knee and coxofemoral joints, then the leg with a characteristic slap falls by a floor. At bilateral damage of a fibular nerve this type of P. is called also a steppage (horse gait).

At sluggish paresis or paralysis of the muscles innervated by a tibial nerve the Item is observed so-called calcaneal. Because of weakness of muscles of sgibately foot there is no its bottom bending, during the walking of the patient as if stamps a floor a heel.

At paresis or paralysis of muscles of a girdle of inferior extremity (deep muscles of a basin) and sgibatel of a hip so-called duck P. is observed: the stomach is stuck out forward, an upper part of a trunk is unbent, the basin alternately rolls over aside, opposite to the taken-out leg. This P. is characteristic of the progressing muscular dystrophy (see. Myopathy ), it can be observed at a pseudo-myopathic syndrome, congenital dislocation of a hip (see. Hip joint ) and other diseases.

Akinetiko-rigidnaya gait results from defeat of extrapyramidal system and is observed at parkinsonism (see) various etiology and Wilson's disease — Konovalova (see. Hepatocerebral dystrophy ). The pose of the patient (a pose of the applicant) caused by high rigidity of certain muscular groups is characteristic: the head and a trunk are inclined forward, rukp are given to a trunk, bent in elbow joints, brushes are bent, legs of a polusognuta. For overcoming the general constraint walking often begins with marking time, patients move the small shuffling steps with tendency to acceleration (gait jog) and the phenomena of propulsion, lateropulsion, retropulsion (impossibility at once to stop at the movement respectively forward, aside, back). During the walking there are no consensual movements of hands (acheirokynesis). In some cases the nature of akinetiko-rigid gait can change in connection with paradoxical kinesias: mobility of patients amplifies, they become straight, go a wide step, change situation. Through short time the former type of gait is returned.

The ataxic gate is observed at the diseases which are followed by an ataxia. This P. depending on localization patol, the center has specific features. So, at damage of frontal lobes, red kernels and a cerebellum it becomes uncertain, shaky, with wide carrying out of legs, swing of a trunk here and there. At hemilesion of a frontal lobe of a brain of the patient during walking turns aside, opposite to localization of the center of defeat.

At Mari's disease (see. Ataxy ), olivopontotserebellyarny atrophy (see), a panencephalitis, multiple sclerosis, etc. P. contains components of asynergias (disturbance of consensual activity of muscles during the performance of movements): during of a leg the trunk tolchkoobrazno deviates back. Defeat of back roots and sensitive fibers of spinnokhmozgovy nerves, back cords of a spinal cord that is noted at a polyneuropathy, a pseudo-tabes of the alcoholic (see. Psevdotabes ), back to tabes (see), Fridreykh's ataxy (see. Ataxy ), etc., also leads to emergence of the ataxic gate reminding P. of the drunk person, at the same time patients go in the dark worse and blindly since visual control of the movement is removed.

Combinations of different types of disturbances of gait in clinic meet quite often. Also other types of the Item are observed, e.g., spastiko-atactic, spastiko-paraliti-cheskaya. Emergence of such mixed P. is caused by simultaneous defeat of the central and peripheral system of the movement and coordination.

Methods of a research

In a wedge, conditions use special methods of registration of P.: an ikhnografiya (studying of prints of feet and fingers during the walking), a tsiklografiya (photoregistration of gait by means of the shining bulbs strengthened on a body and extremities of investigated), cinematography of gait by method slow motion with the subsequent slowed-down projection of shots (see. Cinematography in medicine ), electromyography (see) with registration of biopotentials of muscles of legs.

Treatment of disturbances of gait at the heart of the pathogenetic is also directed to a basic disease. Also orthopedic treatment with use of orthopedic footwear is carried out (see. Footwear ), corsets, splints, prostheses (see. Prostheses , Orthoses ), LFK, auto-training is applied (see. Psychotherapy ).



Bibliography: Bernstein of N. A m. Sketches on physiology of movements and physiology of activity, M., 1966; Davidenkov S. N. Clinical lectures on nervous diseases, century 1, page 156, JI., 1952; Clinic of parkinsonism, under the editorship of JI. S. Petelina, p.1 — 2, M., 1977; The Multivolume guide to neurology, under the editorship of S. N. Davidenkov, t. 2, page 92, M., 1962; With e p p E. K. Istoriya of development of a nervous system of vertebrata, M., 1959; Physiology of movements, under the editorship of V. S. Gurfin-kel, etc., D., 1976.


L. S. Petelin.

Яндекс.Метрика