Marchas patológicas

Summary

This transcript discusses various neurological conditions affecting movement, particularly those involving the cerebellum, pyramidal pathways, and peripheral nerves. It covers symptoms like proprioceptive dysfunction, abnormal gait patterns, exaggerated limb movements, and the loss of motor control. Conditions mentioned include foot drop, pyramidal syndromes, and disorders affecting both motor pathways. The transcript also touches on compensatory mechanisms in gait, as well as the impact of basal ganglia and frontal lobe degeneration. The latter part shifts abruptly to a song lyric, adding a contrasting lighter tone.

Takeaways

• 🧠 Cerebellar dysfunction leads to loss of proprioceptive stimulus and poor control of movement, making alternating movements difficult.
• 🚶‍♂️ A dystrophic gait involves exaggerated lateral movements of the trunk with hip elevation, often linked to sciatic nerve dysfunction.
• 🦶 Foot drop syndrome results in exaggerated knee lifting and contacting the ground first with the toes due to sciatic popliteal nerve involvement.
• 🔁 Pyramidal syndrome shows increased tonic stretch reflexes and tendon reflexes due to hyperexcitability of the myotatic reflex.
• 🚶‍♀️ Unilateral pyramidal pathway lesions result in an extensor synergy where the lower limb remains extended, performing circumduction during walking.
• 🦵 Bilateral pyramidal tract injuries cause a sense of stiffness and heaviness in the lower limbs, making it hard to lift the feet, also called a 'dromedary gait.'
• 🤚 Lesions of both pyramidal tracts manifest as walking on tiptoes with slow movements and lateral shaking toward the affected side during stance phase.
• 🔄 There's a loss of awareness of how to use legs while walking, leading to short steps, separated legs, and difficulty maintaining lateral and backward balance.
• 💫 Combined degeneration of basal ganglia and frontal lobes can cause long, rapid steps with increased arm oscillation, or short, slow steps with a rigid flexed posture.
• ⚠️ Pain or discomfort during walking can result in an altered gait, with reduced arm swing and an attempt to avoid normal walking patterns.

Q & A

What is cerebellar dysfunction and how does it affect movement?

Cerebellar dysfunction refers to a disorder of the cerebellum, which results in a loss of proprioceptive stimulus and poor motor control. This can cause difficulty in performing alternating movements, leading to uncoordinated or exaggerated movements, such as lateral trunk movements and elevated hips.

What is a drop foot syndrome and what causes it?

Drop foot syndrome occurs when there is damage to the sciatic nerve or peroneal nerve (also called the external popliteal nerve). This causes the inability to dorsiflex the foot, leading to an exaggerated knee lift and the foot touching the ground first with the toe.

What characterizes pyramidal syndrome and its effect on motor control?

Pyramidal syndrome is characterized by increased tonic stretch reflexes and exaggerated tendon reflexes due to hyperexcitability of the myotatic reflex. In cases of unilateral pyramidal pathway lesions, it causes the lower limb to remain extended, and movement involves circumduction.

How do spinal cord injuries affecting both pyramidal tracts influence walking?

When both pyramidal tracts are affected by spinal cord injuries, it leads to a sensation of stiffness and heaviness in the lower limbs. Individuals have difficulty lifting their feet off the ground, often resulting in what is known as a 'dromedary gait,' where they rely on the external part of the foot for support.

What are the symptoms of basal ganglia and frontal lobe degeneration in relation to walking?

Degeneration of the basal ganglia and frontal lobes causes a gait characterized by long, rapid steps, exaggerated arm swing, and a rigid posture. Individuals may also experience difficulty maintaining balance, leading to increased oscillation in their movements.

What is a choppy gait and when does it occur?

A choppy gait is characterized by slow movements, flexed shoulders, elbow flexion, and lateral shaking. It occurs when there is an injury to the pyramidal tracts, leading to poor motor coordination.

What happens during a lateral swing gait and why does it occur?

A lateral swing gait involves the person leaning their body to the affected side during the support phase of the gait cycle. This occurs to compensate for muscle weakness or pain, shifting the center of gravity towards the affected limb to ease movement.

What is the cause of difficulty in using the legs for walking, as described in the script?

The difficulty in using the legs to walk, as described, results from loss of conscious awareness of leg movement. This condition is associated with gait instability, characterized by short steps, wide leg separation, and problems maintaining balance.

What is the effect of basal ganglia degeneration on walking speed and arm movements?

Basal ganglia degeneration can cause rapid walking with large strides, increased arm swing, and a rigid posture. This results from impaired control of movement initiation and motor coordination.

How does pain affect walking mechanics?

Pain or discomfort during walking can lead to a protective gait pattern, where individuals take shorter, slower steps and reduce arm swing. This altered gait compensates for the pain or the underlying condition causing discomfort.