Parkinsonian gait

Mô tả: The parkinsonian gait is characterised by a reduced arm swing, increased tremor of the upper extremity during walking, turning en bloc and slow, shuffling gait on a narrow base.28,43 Patients may initiate walking with a series of rapid, short, shuffling steps prior to breaking into a normal stepping pattern (i.e., start hesitation).28 Once walking is initiated, it may be interrupted by short shuffling steps or cessation of movement (i.e., freezing) if an obstacle is encountered.28 RELEVANT NEUROANATOMY AND TOPOGRAPHICAL ANATOMY

Nguyên nhân: Common • Parkinson’s disease • Drugs – dopamine antagonists (e.g. haloperidol, metoclopramide) Less common • Lacunar infarction, basal ganglia • Basal ganglia haemorrhage • Multisystem atrophy • Progressive supranuclear palsy • Corticobasilar degeneration

Cơ chế: Postural changes in parkinsonism (e.g. stooped posture, shoulder flexion) move the patient’s centre of gravity forward, worsening balance during locomotion. During initiation of movement, patients may take a series of small, rapid steps (i.e., festination) to accommodate for balance disequilibrium caused by the generalised flexion posture.28 See also ‘Bradykinesia’ in this chapter.