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Examination of Gait in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Prateek Behera, Nirmal Raj Gopinathan
“Doctor, my child is not walking normally – Please help!” is not an uncommon complaint an orthopedist encounters in outpatient clinics. The examiner must evaluate the underlying reason for the gait abnormality. To satisfactorily answer the questions and alleviate the parents’ anxiety, one must be well-versed in normal and abnormal gait patterns. The learning objectives of this chapter are to learn about the basics of gait and identify different gait patterns and the possible associated conditions.
Balance Disorders in Children
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Louisa Murdin, Gavin A.J. Morrison
Neurological examination of the limbs should be undertaken to seek signs of spasticity, myopathy, sensory neuropathy or other causes of gait abnormality. Rotation testing is easily carried out on an office chair with the child on the parent’s lap. Cerebellar ataxia is seen on heel-toe tandem gait with dysmetria, but with normal ranges of lower limb motion and unchanged gait velocity and stride length. Characteristically, gait is wide based with dys-synergia and dysrhythmia, and balance is poor.4
Answers
Published in Calver Pang, Ibraz Hussain, John Mayberry, Pre-Clinical Medicine, 2017
Calver Pang, Ibraz Hussain, John Mayberry
DMD is a condition where no dystrophin is produced. Dystrophin is a protein that plays an important role in sarcolemma stability. Therefore it typically presents with progressive proximal muscular dystrophy with distinctive pseudohypertrophy of the calves. Gait abnormality is also common. Be aware of other muscular dystrophy conditions especially Becker’s muscular dystrophy where there is abnormal dystrophin. Practise drawing and interpreting pedigrees as these are common as well.
Neuroprotective effect of standardized extracts of three Lactuca sativa Linn. varieties against 3-NP induced Huntington’s disease like symptoms in rats
Published in Nutritional Neuroscience, 2022
Jai Malik, Supreet Kaur, Maninder Karan, Sunayna Choudhary
Gait abnormality: Gait abnormality was assessed in order to evaluate the motor coordination, particularly of the hind limbs. Narrow bean walk apparatus, that has been very effective in detecting the motor incapabilities in rats, was used for assessing gait abnormalities. The apparatus consists of 50 cm wooden strip supported by two pedestals, elevated at a height of 1 m above the ground, at each end (with a box at one end) so that the animal attempts to reach the box due to acrophobia. The rats were allowed to transverse the narrow beam, and the time taken to transverse the narrow beam from the start point to the box was recorded with a cutoff time of 120 s after which the animal was removed and placed in the cage. All the rats were given a prior training session during −1 and 0 day before starting their evaluation which was done on day 1, 5, 10 and 15.21
Clinical decision making and application of an active rehabilitation program for a person with the neuromuscular symptoms of Allgrove syndrome: a case report
Published in Physiotherapy Theory and Practice, 2020
The patient’s gait abnormality was addressed through bilateral non-articulating solid ankle-foot orthotics (AFO). She received her AFOs at week 4 of treatment, immediately increasing ambulation distance presumably due to decreased energy expenditure, increased stability, and a reduction of compensatory movements during gait. Gait analysis with AFOs donned showed decreased lateral weight shifting with decreased lateral COG movement. The PT chose solid AFOs for the purpose of increased stability in stance-phase of gait that otherwise could not be achieved because of her weak distal lower extremity. Her orthotics was non-articulating to prevent excessive plantarflexion during swing phase and to decrease the amount of compensatory hip flexion required to clear the ground. After donning AFOs, the PT altered her rehabilitation program to increase ambulation distance during therapy sessions, and gait training to emphasize a longer forward stride through repetitive practice. In particular, she had to learn to flex her hip less to clear the ground during swing phase and to shift her weight less during stance phase of gait. Once she demonstrated safe use of the AFOs including independence in orthotic donning and doffing, the PT instructed her to wear her AFOs during all outdoor activities.
Cutaneous Granulomatosis and Class Switching Defect as a Presenting Sign in Ataxia-Telangiectasia: First Case from the National Iranian Registry and Review of the Literature
Published in Immunological Investigations, 2020
Parisa Amirifar, Reza Yazdani, Tannaz Moeini Shad, Alireza Ghanadan, Hassan Abolhassani, Martin Lavin, Soheila Sotoudeh, Asghar Aghamohammadi
Gait abnormality is usually the first diagnostic criterion of A-T, appearing in the first years of life. Telangiectasia is the second important clinical manifestation of the disease, having its onset commonly after the age of 3 years (Jozwiak 2005). Measurement of serum AFP concentration is another diagnostic hallmark, as it is increased in more than 90 to 95% of patients with A-T (Stray-Pedersen et al. 2007). In our patient, despite a large deletion in the ATM gene, predicted to result in ATM protein loss, the first clinical symptoms were skin lesions and autoimmunity, while ataxia and telangiectasia appeared after 6 years of age. This atypical manifestation caused at hree-year delay between the appearance of initial symptoms and the final diagnosis of A-T. Early diagnosis improves both the quality of life and survival in patients with A-T by antibiotic therapy and vaccination, IVIg substitution, limitation of exposure to ionizing radiation, and physiotherapy for respiratory symptoms (Navratil et al. 2015). Moreover, early diagnosis helps genetic counseling for the identification of the carriers who have an elevated risk of malignancy, especially breast cancer in women and may also reduce the risk of another child with A-T in the family (Swift et al. 1991).