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Neurological Examination of Malingering
Published in Alan R. Hirsch, Neurological Malingering, 2018
Jose L. Henao, Khurram A. Janjua, Alan R. Hirsch
A classic sign which will help physicians investigate malingering is astasia-abasia. This appears as an almost drunken gait with near falls, but no actual falls to the ground (Carone and Bush, 2013b) (Figure 3.13a). This type of display takes more acrobatic maneuvering than regular walking. This sign should be a red flag for nonorganic gait disorder. People with true disease would not be able to control the way they walk or be able to stop themselves from falling to the ground. Patients with cerebellar disease tend to fall towards the side of the lesion during tandem walking, compared to patients with false disease who fall in all directions (Figure 3.13c). Patients are unable to walk forwards but can walk backwards or run without difficulty indicate malingering patients (Campbell, 2016).
MRCPsych Paper A1 Mock Examination 1: Answers
Published in Melvyn WB Zhang, Cyrus SH Ho, Roger Ho, Ian H Treasaden, Basant K Puri, Get Through, 2016
Melvyn WB Zhang, Cyrus SH Ho, Roger CM Ho, Ian H Treasaden, Basant K Puri
Explanation: Her condition is catatonia. Clinical features of catatonia are all of the aforementioned options except astasia-abasia. Other signs of catatonia include stupor, posturing, negativism, stereotypy, mannerism, echolalia, echopraxia and logorrhoea. Causes of catatonia include schizophrenia, mood disorders, organic disorders (e.g. central nervous system [CNS] infection), epilepsy, recreational drugs (cocaine) and medications (ciprofloxacin). Astasia-abasia is a gait disturbance seen in conversion disorder.
Unusual gait disorders: a phenomenological approach and classification
Published in Expert Review of Neurotherapeutics, 2019
Vijayashankar Paramanandam, Karlo J. Lizarraga, Derrick Soh, Musleh Algarni, Mohammad Rohani, Alfonso Fasano
Several unusual patterns been reported in FGD (Table 3). ‘Astasia-abasia’ was first described in a group of patients who were unable to maintain an upright posture. ‘Trepidant abasia’ and ‘staso-basophobia’ represent old descriptions of functional fear of falling, whereby the same patient can walk normally if held by someone or lean against furniture’s [96,97]. Analysis of 279 videos of patients with psychogenic movement disorders revealed that excessive slowness of gait was the most common feature in patients who had FGD as part of psychogenic movement disorders. Knee buckling and astasia-abasia were the most common patterns in patients with pure FGD [98]. The excessive slowness of gait has been reported as ‘moonwalk gait’ due to its similarity with astronauts walking on the moon [99]. Importantly, ‘moonwalk gait’ does not refer to the dance move in which the dancer moves backwards while seeming walking forwards (popularized by Michael Jackson in the 80’s). If a gait pattern resembles those moves, the ‘Michael Jackson gait’ is still up for grabs.
Functional Gait Disorders: Clinical presentations, Phenotypes and Implications for treatment
Published in Brain Injury, 2023
Sara Issak, Richard Kanaan, Glenn Nielsen, Natalie A. Fini, Gavin Williams
Over the years many subtypes of FGD have been described. The term “astasia-abasia,” first used in the nineteenth century, is an early description of a functional gait disorders, with astasia relating to the inability to stand upright and independently, and abasia denoting the inability to walk in a coordinated manner (35). Charcot described clinical observations of “dragging gait” in patients with functional paralysis where the affected leg was dragged behind with the forefoot in contact with the ground (36,37). This phenotype is still reported today (6), which suggests the stability of this phenotype over time.