The defeat of the cortical-muscular pathway, regardless of the level, is clinically manifested by paralysis or paresis, however, their symptomatology sharply differs in the pathology of the central and peripheral motor neurons.
Peripheral paralysis (paresis)... It develops when a peripheral motor neuron is damaged in any part of it (anterior horns of the spinal cord or motor nuclei of the cranial nerves, anterior roots, spinal nerves, plexuses, peripheral and cranial nerves).
The main symptoms are:
- muscle atrophy (hypotrophy);
- fasciculations;
- muscle atony (hypotension);
- areflexia (hyporeflexia) of deep and superficial reflexes;
- reaction of rebirth, or degeneration.
Atrophy (hypotrophy) arises as a result of dissociation ("denervation") of muscles from the motor neurons that innervate them. The denervated muscle ceases to receive constant trophic impulses necessary to maintain normal metabolism. As a result, muscle fibers degenerate and die; they are replaced by adipose and connective tissue. The atrophic muscle decreases in volume and loses its elasticity; in the affected nerves and muscles, specific changes in electrical excitability develop - the reaction of degeneration, or degeneration (see below).
Fasciculations appear only in case of damage to the anterior horns of the spinal cord or motor nuclei of the cranial nerves. Pathological changes in motor neurons are accompanied by a violation of cellular electrogenesis, which leads to spontaneous involuntary twitching of individual parts of the muscle (the muscle seems to "play").
Atony (hypotension) is being carried out. The joints are "loose", so the movements in them are excessive. So, with muscular atony (hypotension) in the hand, the forearm is freely applied to the shoulder, and the wrist of the hand - to the shoulder joint; against the background of hypotension in the leg, it can be bent at the hip joint until the thigh is freely applied to the anterior abdominal wall, and the heels to the buttock. On the side of muscle hypotension in the leg, a positive symptom of Orshansky is noted: pressing the knee with his left hand and at the same time lifting the heel from the couch with his right hand, the doctor overextens the knee more strongly, and pulls the heel off the couch higher than on the other leg. When performing repeated passive movements in the atonic muscles, there is no feeling of resistance.
Areflexia (hyporeflexia) deep and superficial reflexes is due to the defectiveness of their segmental reflex arcs in the efferent part, which is the final common path of reflexes and the cortical-muscular path.
Rebirth reaction installed using magnetic diagnostics. Normally, the muscle responds by contraction to electrical or magnetic stimulation of the nerve that innervates it and the muscle fibers themselves. Electroexcitability of a nerve and muscle is manifested by lightning-fast muscle contraction in response to irritation. There are three types of rebirth reaction: partial, complete rebirth reaction, complete loss of electroexcitability.
Partial rebirth reaction characterized by quantitative changes in electrical excitability. The reaction of the nerve and muscle is weakened, but preserved; muscle contraction during irritation is sluggish, slow; to get a reaction, the strength of the magnetic field has to be increased.
Complete rebirth reaction: The muscle does not respond to nerve stimulation regardless of the strength of the magnetic field. It reacts to irritation of the muscle itself with a sluggish worm-like contraction.
Complete loss of electrical excitability characterized by "electrical silence" of the muscle to irritation of both the nerve and the muscle. The absence of electroexcitability in this case indicates the complete replacement of muscle fibers with adipose and connective tissue.
Types of peripheral paralysis. Peripheral paralysis (paresis) has well-defined clinical symptoms, but its distribution depends on the level of damage to the peripheral motor neuron. On this basis, the following types of peripheral paralysis or paresis are distinguished.
1. Neural. It occurs when peripheral and cranial nerves are damaged (neuritis, neuropathy). Symptoms of peripheral paralysis (paresis) are observed in the muscles innervated by the motor portion of this nerve, and are usually combined with sensory, vegetative-trophic, vasomotor-secretory disorders, as well as pain syndrome.
2. Polyneuritic. Such paralysis (paresis) is associated with the pathology of the distal parts of several peripheral or cranial nerves (polyneuritis, polyneuropathy). Peripheral paralysis (paresis) is observed in the distal muscle groups of the extremities (muscles of the hands, forearms, feet, legs) against the background of distal sensitive ("gloves" and "socks", sensitive ataxia), vegetative-trophic and vasomotor-secretory disorders.
3. Multiple paralysis(paresis) is observed in muscles innervated by nerves that originate from the entire plexus or its individual bundles (plexitis, plexopathy). Sensitive, vegetative-trophic, vasomotor-secretory disorders, pain syndrome are also revealed here.
4. Segmental. It occurs with pathology of the motor part of the segment (segments). The antero-root lesion, in contrast to the antero-root lesion, has several clinical features:
- the presence of fasciculations (electromyography - fasciculations and fibrillations);
- very early and rapidly progressing atrophy with a degeneration reaction;
- "mosaic" lesion within one muscle;
- predominantly proximal distribution of paralysis (paresis), usually in the muscles of the shoulder or pelvic girdles.
For the first time, the defeat of the anterior horns was described in detail in poliomyelitis, therefore, in the literature, the anterior horn process is often referred to as poliomyelitis syndrome.
5. Nuclear. It is observed when the motor nucleus (nuclei) of the cranial nerves are damaged on the side of the focus in the muscles receiving innervation from the affected nucleus (nuclei). Unilateral damage to the nucleus (nuclei) occurs in the so-called alternating syndromes (see below). Bilateral damage to the motor nuclei, roots or nerves of the lower group (IX, X, XII) leads to bilateral peripheral paralysis (paresis) of the muscles of the pharynx, soft palate, upper third of the esophagus, vocal cords, and tongue. The result is the so-called bulbar paralysis (paresis).
Central paralysis (paresis). It develops when the central motor neuron is damaged in any of its parts (the anterior central gyrus, the radiant crown, the inner capsule, the ventral part of the trunk, the anterior and lateral cords of the spinal cord). As a result, the nerve impulse conduction to the motor neurons of the anterior horns of the spinal cord (cortical-spinal path) or to the motor nuclei of the cranial nerves (cortical-nuclear path) is disrupted.
The main symptoms are:
- muscle hypertension, spasticity;
- deep hyperreflexia and areflexia (hyporeflexia) of skin reflexes;
- pathological reflexes;
- protective reflexes;
- pathological synkinesis.
Muscular hypertension. b becomes disinhibited and uncontrollable. The muscles are dense to the touch, tense, their relief is sharply contoured. Passive movements are made with sharp resistance; sometimes it is so pronounced that even the movement itself is quite difficult to perform (the so-called spasticity). Pyramidal hypertonicity has two specific features:
1) a sharp increase in resistance at the beginning of passive movement - the phenomenon of a "folding knife";
2) an uneven increase in muscle tone in certain muscle groups with the formation of a characteristic posture (Wernicke - Mann) and gait (circumferential).
The "folding knife" phenomenon is revealed as follows. The doctor takes the patient's unbent leg under the shin, and with the other hand sharply makes a "sweep" in the knee joint. Such a sharp and intense passive movement, with a positive symptom, first meets a pronounced resistance, then the resistance disappears, and the leg bends freely at the knee joint (as when folding a knife).
The uneven distribution of muscle hypertonicity is manifested by its predominance in the muscles - flexors of the arm and extensors of the leg. The arm is pressed to the body, bent at the elbow and pronated, the hand and fingers are also bent. The leg is extended at the hip, knee and ankle joints, the leg is "elongated" and the sole is turned inward. As a result, the gait is of a circumferential nature - in order not to touch the floor with the toe, the patient takes the foot to the side and describes a semicircle. The pose of Wernicke - Mann ("hand asks, leg squints") is formed, which is characteristic of central hemiparesis, especially at the stage of formation of reflex contractures.
Hyperreflexia of deep and areflexia (hyporeflexia) of skin reflexes ... They arise as a result of the separation of reflex arcs from the cerebral cortex. Deep reflexes cease to receive inhibitory influences from the cortex and therefore increase; skin reflexes, without receiving any lightening influences from the bark, decrease or disappear.
An increase in deep reflexes is characterized by an increase in the amplitude of response movement, an expansion of the reflexogenic zone and, finally, the appearance clonuses(an extreme degree of increased reflexes). Clonus is a rhythmic involuntary contraction of a muscle group resulting from stretching of their tendons. Most often, it is possible to detect the clonus of the foot and patella; clonus of the hand is rare.
Patella clonus is defined as follows. The patient lies on his back with legs straight. The doctor grasps the kneecap with his thumb and forefinger and moves it forcefully downward towards the lower leg. In response, there is a series of repeated contractions and relaxation of the quadriceps femoris muscle, entailing a series of rhythmic movements of the patella up and down.
Clonus of the foot is defined as follows. The patient lies on his back with straightened legs. The doctor places his own fist under the patient's knee, sharply and with force unbends the foot (dorsiflexion) - in response, there are several rhythmic contractions and relaxation of the gastrocnemius muscle, and the foot rhythmically bends and unbends.
Skin reflexes, unlike deep ones, cannot increase. Loss or decrease in cutaneous (primarily superficial abdominal) reflexes is usually combined with an increase in deep reflexes on the side of central paresis or pyramidal insufficiency.
Pathological reflexes found when the pyramidal pathways are affected. They are absent in healthy people. There are the following groups of pathological reflexes: the phenomena of oral automatism, pathological wrist, pathological foot. Protective reflexes constitute a special group.
I. Oral Automatism Phenomena are automatic involuntary movements, usually consisting of stretching the lips or sucking movements in response to irritation of various parts of the face. By the method of invocation, they are distinguished:
- nasolabial reflex (Astvatsaturova) - a light blow with a hammer is applied to the back of the nose;
- sucking (Oppenheim) - streak irritation or touching the lips with a hammer;
- proboscis (ankylosing spondylitis) - a light blow with a hammer is applied to the upper or lower lip;
- distance-oral (Karchikyan) - imitation of a hammer blow on the patient's lips;
- palmar-chin (Marinescu - Radovici) - streak irritation of the skin in the thenar area, causing a reciprocal contraction of the chin muscle on the side of irritation with displacement of the skin of the chin upward. This reflex is an expression of stem automatism - a rudimentary manifestation of ancient synergy (grasping and chewing).
Oral phenomena are a characteristic feature of pseudobulbar palsy - bilateral central paralysis of muscles innervated by the lower group of cranial nerves (IX, X, XII), due to bilateral damage to the cortical-nuclear (corticonuclear) pathways. They are quite often observed in patients with essential hypertension, with severe cerebral atherosclerosis, chronic cerebral vascular insufficiency. At the same time, it must be remembered that in infants, all of them are caused normally; the palmar-chin reflex often (according to some authors, in 50% of cases) occurs in an unsharp form in healthy people, and the palmar-chin and sucking reflexes are often determined in elderly people without clinical manifestations of brain pathology.
II. Pathological hand reflexes are manifested by flexion movements of the fingers. The following of them have the greatest clinical information content.
- The upper symptom of Rossolimo - a short blow with the doctor's fingertips or a hammer on the palmar surface of the slightly bent terminal phalanges of the II-V fingers with a pronated hand of the patient. In response, there is a slight flexion ("nodding") of the terminal phalanges II-V and the thumb. This reflex is more often called with a supinated hand (Rossolimo's reflex as modified by Venderovich).
- The upper symptom of Zhukovsky - a hammer is struck in the middle of the palmar surface of the hand. It is manifested by flexion of the II-V fingers ("nodding") in the terminal phalanges.
- The upper symptom of ankylosing spondylitis - a blow with a hammer is applied to the back of the hand in the area of the first - second metacarpal bones. It is manifested by flexion of the II-V fingers.
- Symptom Wartenberg - a blow with a hammer is applied to the doctor's index finger, stretching the slightly bent terminal phalanges of the II-V fingers of the patient's pronated hand. It is manifested by flexion of the II-V fingers.
- Hoffmann's symptom - caused by pinched irritation of the terminal phalanx of the third finger. It manifests itself similarly to other pathological hand reflexes.
Pathological hand reflexes (especially Rossolimo - Venderovich) are one of the early signs of defectiveness of the corresponding pyramidal pathway. At the same time, mildly pronounced hand reflexes on both sides may have no clinical significance or occur in functional disorders. In the literature, a number of hand "signs" are described (Klippel - Weil, Jacobson - Lask, etc.), but they have less clinical informational content.
III. Pathological foot reflexes are divided into two groups: extensor (extensor) and flexor (flexor).
A. Pathological extensor foot reflexes are a symptom of Babinsky and its modifications.
- Babinsky's symptom is caused similarly to the plantar reflex, that is, by dashed irritation of the outer edge of the sole. Normally, plantar flexion of all fingers occurs, and with a positive Babinsky symptom, extension (dorsiflexion) of the thumb and dilution of the II-V fingers - the so-called "fan sign". It is one of the earliest and most informative symptoms of defective pyramidal tract. In children in the first two years of life, it is determined normally; "Replacement" with the usual plantar reflex occurs in a child when he begins to stand and walk. The appearance of a symptom in adults is explained by the separation of the cerebral cortex from the segmental apparatus of the spinal cord; as a result, the rudimentary function characteristic of the hind limb of animals is disinhibited (MI Astvatsaturov).
- Oppenheim's symptom - holding with pressure with the thumb or both thumbs on the anterior-inner surface of the tibia.
- Gordon's symptom - compression by the doctor's hand of the mass of the gastrocnemius muscle.
- Schaeffer's symptom - pinched irritation or strong compression of the Achilles tendon.
With all these symptoms, as with Babinsky's symptom, extension (dorsiflexion) of the thumb occurs in response.
B. Pathological foot flexion reflexes are characterized by rapid plantar flexion ("nodding") of the fingers in response to various stimuli.
- Lower Rossolimo symptom - a short blow with a hammer or fingers is applied by the doctor to the terminal phalanges of the toes from their plantar side.
- Lower ankylosing spondylitis - Mendel's symptom - a blow with a hammer is applied to the dorsum of the foot.
- The lower symptom of Zhukovsky - a blow with a hammer is applied to the sole under the toes.
Protective reflexes represent an involuntary withdrawal of a paralyzed (and often insensitive) limb in response to its irritation.
The protective reflex of ankylosing spondylitis - Marie - Foix is caused by repeated stroking irritation, an injection, pinching or touching a cold object to the skin of the sole; a possible modification of the reflex induction is a sharp plantar flexion of the toes by the doctor. In response, the so-called triple shortening occurs - flexion of the paralyzed leg in the hip, knee and ankle (dorsiflexion) joints.
On the hands, protective reflexes are much less common. The appearance of protective reflexes indicates a deep lesion of the pyramidal pathways or their compression, more often in the spinal cord.
Pathological synkinesis. Synkinesias (friendly movements) are involuntary movements that occur against the background of arbitrary ones. Various physiological synkinesias can be noted in healthy people. So, clenching the hand into a fist is usually accompanied by its extension in the wrist joint; when walking, additional hand movements of the "signal" type appear.
Pathological synkinesias are involuntary movements in a paralyzed (paretic) limb that occur when performing voluntary movements in non-paralyzed muscle groups. The formation of pathological synkinesias is based on the irradiation of excitation from a functionally active motoneuronal pool to a number of neighboring segments of its own and the opposite side, which is normally inhibited by the cortex. With the defeat of the pyramidal pathways, this tendency to spread excitement ceases to be inhibited and therefore manifests itself with particular force. There are three types of pathological synkinesias: global, imitative, coordinating.
1. Global synkinesis is accompanied by massive movements or sharp tension in healthy muscles of the trunk or extremities (for example, the patient is asked to tightly clench a healthy hand into a fist). They are also observed when coughing, sneezing, yawning, laughing and crying, and forced breathing. In response, there is a "shortening" involuntary movement in the paralyzed limb, which the patient cannot voluntarily perform.
2. Simulated synkinesis consists in the fact that a paralyzed limb involuntarily "repeats" the movements of a healthy one, although it is not possible to perform the same movement voluntarily. Such synkinesis can be enhanced by resisting the movement of a healthy limb. A classic example is simulated synkinesis in the biceps brachii of the paralyzed arm - the doctor resists bending the healthy arm at the elbow, while the paralyzed arm involuntarily flexes.
3. Focal synkinesis are involuntary friendly movements in a paralyzed limb when performing voluntary movements in healthy muscles that are functionally associated with paralyzed ones.
Synkinesia Raimista- active adduction or abduction of the thigh is impossible or sharply limited due to paralysis or deep paresis, however, it involuntarily occurs in the paralyzed limb simultaneously with the performance of this active movement with the healthy leg.
Tibial Phenomenon Strumple- the patient cannot make extension (dorsiflexion) of the foot. If he flexes the paretic leg at the knee joint, especially with resistance, then at the same time, extension in the ankle joint is involuntarily performed.
Types of central paralysis. There are three main types of central paralysis (paresis).
1. Conductive spinal. It is caused by the pathology of the lateral cortical-spinal (corticospinal) pathway. In this case, central paralysis (paresis) is defined on the side of the focus in the muscles that receive innervation from the segments from the level of the lesion and below. Characterized by pronounced muscle hypertension, clonuses; pathological and protective reflexes are easily evoked. Movement disorders, as a rule, are combined with sensory conduction and (with bilateral lesion) pelvic disorders.
2. Conductive stem. Usually observed with lesions in one half of the trunk. Central hemiplegia (hemiparesis) occurs in the arm and leg on the opposite side of the body and is part of the structure of the alternating syndrome.
3. Conductive hemispheric. It occurs with damage to the inner capsule, the radiant crown and the cerebral cortex in the precentral gyrus. Its fundamental uniformity is determined by the presence of paralysis (paresis) contralateral to the focus. However, these movement disorders have a number of specific features, depending on the level of the lesion.
"Capsular" paralysis and paresis are characterized by the severity and uniformity of distribution in the arm and leg in combination with central paralysis (paresis) of the muscles of half of the tongue and the lower half of the facial muscles. In the paretic muscles, pronounced muscular hypertension is noted, the Wernicke-Mann posture, and a circumferential gait. Hemiplegia or deep hemiparesis is usually observed in combination with hemianesthesia and hemianopsia - the so-called tri-hemi syndrome.
Paralysis and paresis with the defeat of the radiant crown characterized, in contrast to capsular, uneven distribution in the arm or leg, up to monoparesis of the arm or leg. The so-called faciobrachial type of paresis is often observed - central paresis of the lower half of the facial muscles in combination with central paresis of the hand. The severity of paresis is generally less than with capsular foci, muscle hypertension is also less pronounced, clonuses are less often detected.
"Cork" paralysis and paresis are caused by damage to the precentral gyrus. These are, as a rule, monoparesis of the hand (a focus in the lower parts of the precentral gyrus of the opposite hemisphere) or legs (a focus in its upper parts). Paresis predominates in the distal muscle group of the paretic limb; the subtle, most differentiated movements suffer more. Muscle tone usually does not change (it may even be lowered); deep reflexes also may not change, and from pathological ones, only Babinsky's symptom is often determined.
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The hand (manus) is the distal part of the upper limb, which has complex sensory and motor functions. The border between the forearm and K. is the line of the wrist joint ...
News about Wernicke - Manna Pose
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Talking Wernicke - Manna Pose
- Two months ago he received a burn of his hands and forearms (electric arc). Now on the hands, especially on the bend of the hand, contractures have formed. Can they be removed non-surgically? Even on my left hand, my little finger does not fully unbend, the doctor said it will work out, but for three weeks there is practically no SD
Hello. The Wernicke-Mann pose or, as neurologists say, "squints the leg, the hand asks" is formed as a result of contracture due to spastic hemiparesis when the pyramidal pathway is damaged. The main reason for such a lesion is a stroke. Muscles are normally elastic and moderately soft. In a spastic state, they are constantly tense, rigid, the fibers are reduced.In the beginning, when flexing and extending, resistance is felt, and with the passage of time it increases so much that after 6-7 months it is impossible for a patient with whom work is not carried out to straighten the limbs. Considering all this, we conclude that the success of treatment depends on the age of the process - the longer it is, the more difficult it is to influence something.
Now directly about the therapy itself. It should be started as early as possible, within a day or two after stroke in the absence of contraindications (for example, leg vein thrombosis or atrial fibrillation) already in the intensive care unit and consists of three equivalent components. This is the support of muscle tissue (solved by massage and other methods of physiotherapy), restoration of motor functions (massage and exercise therapy) and ergonomic support (usually, exercise therapy specialists deal with these issues). The very first exercise available in the acute phase is posture treatment. There is only one principle - the patient is placed so that the spasmodic muscles are stretched. Duration of one session is up to 3 hours. Next comes passive gymnastics, it also needs to be used from the first days of the disease. An exercise therapy instructor or a trained relative repeatedly, rhythmically and smoothly moves the paralyzed limbs in all joints in turn. This promotes disinhibition, and in addition, sends impulses to the brain from the periphery, thereby improving the functioning of the nerve pathways. The third method is teaching the patient a muscle relaxation technique. First, he learns to do this on the healthy side, and then on the affected side.
In addition to physical exercise, orthopedic fixation devices are used. One or two joints are fixed with a longuette, elastic bandage or orthopedic shoes, in the muscles of which spasticity is most pronounced. Orthopedic shoes are also used.
It is very important to massage the patient. It helps to maintain muscle nutrition and relaxation.
The task of recovering from a stroke is challenging but doable. It takes a lot of patience and strength from both the patient and the relatives. But without carrying out this work, inability to self-service of different severity occurs in almost all cases. Good luck and patience!
Great encyclopedia of psychiatry. Zhmurov V.A.
Gait- posture and nature of body movements while walking. Some types of gait have a diagnostic value, their names indicate the nature of the disorder causing them or the psychological state of the individual:
- atactic ("drunk" or stamping) gait;
- hemiplegic or squinting gait (the injured leg is retracted to the side and, without bending, makes a semicircle);
- parkinsonian ("puppet") gait - in small steps, with an unbending body and without synergistic hand movements;
- cock gait (steppage) with damage to the peroneal nerve (the leg rises high, and then slaps on the floor;
- frontal ("fox") gait with the feet in one line;
- the hysterical gait of a "flying feather" (or Todd's gait) - with large steps, jumps and stops right in front of the obstacle;
- senile gait - small shuffling steps with insufficiently coordinated hand movements;
- sweeping gait with hysterical hemiplegia, when the paralyzed leg is dragged with a "broom", and not "raking", as is the case with true hemiplegia;
- dancing gait with choreiform hyperkinesis (legs are wide apart, a lot of unnecessary and uncoordinated movements are made, the patient is suddenly thrown from side to side);
- duck gait, observed with myopathy and subluxation in the hip joints (rolling from side to side due to hypotonia of the muscles of the pelvic girdle). The gait changes strongly and in a certain way in depression, mania, catatonic substitution and excitement, with neuroleptic syndrome, during an acute reaction to stress and, possibly, in many other painful conditions. Finally, important information for an observant person includes gait and about a person's character, lifestyle, profession, age, gender identity, mood.
- stealth gait (hands rest firmly in pockets during movement);
- determined gait (fast, with sweeping arm movements);
- depressed gait (head is down, legs are dragging, hands are in pockets);
- impulsive gait (energetic with hands on hips, alternating with lethargy - Churchill's gait);
- the dictator's gait (with his head raised up, stiff legs and emphatically vigorous hand movements - Mussolini's gait);
- the gait of the thinker (ritually unhurried, often with hands behind his back or with some familiar object in his hands - the Helmholtz gait).
Dictionary of Psychiatric Terms. V.M. Bleikher, I.V. Crook
Gait- a set of features of posture and movement when walking. Some types of gait are of diagnostic value, for example, atactic gait (see. Ataxia); hemiplegic (see. Hemiplegia, Hemiparesis) gait (the paretic leg is retracted to the side and, without bending, produces a semicircle - hence: a squinting, circulating gait). With parkinsonism, a puppet gait is observed - in small steps, without synergistic hand movements, with a rigid and non-bending body. With damage to the frontal lobes of the brain - fox P. (setting the feet in one line). In hysteria, the gait of a flying feather is observed - large steps, jumps, the patient stops only after bumping into an obstacle. Senile gait - small shuffling steps with uncertain, insufficiently coordinated friendly movements of the hands.
Walking gait- observed with hysterical pseudohemiplegia. The paralyzed leg is dragged with a broom, and does not "rake", describing an arc with a toe, as is the case with true hemiplegia.
Neurology. Complete explanatory dictionary. Nikiforov A.S.
Gait- a set of features of posture and movement when walking. May be essential in determining a topical diagnosis.
- Gait "stork"- with atrophy of muscles, distal parts of the legs, in particular with neural muscular atrophy of Charcot-Marie (see), the patient when walking sharply flexes the hips, raising the hanging feet high.
- Atactic gait- syn.: The gait is cerebellar. Drunk gait. A patient with a lesion of the cerebellum walks uncertainly, legs wide apart, steps are uneven in length, while he is "thrown" from side to side. In the case of a predominant lesion of the cerebellar hemisphere during walking, it deviates mainly towards the pathological focus. Instability is especially pronounced when cornering.
- Camel gait- gait of patients with torsion dystonia (see), caused by muscle spasms of the spine, pelvis and proximal legs.
- The Wernicke-Mann walk- see Hemiparetic gait.
- Hemiparetic gait- syn.: Walk of Wernicke - Mann. It is characterized by excessive abduction of the paretic leg to the side, as a result of which it describes a semicircle with each step (the leg "squints").
- Gait hysterical- perverted, usually changeable gait, not similar to the various variants of its disorders caused by organic neurological pathology. One of its options can be a throwing gait (see).
- Puppet gait- the patient walks in small steps (microbasia), while the feet are placed parallel to each other. General stiffness, forward bending of the trunk and absence of hand movements accompanying walking (acheirokinesis) are noted. It is observed with parkinsonism (see).
- Gait "fox"- the patient, when walking, crosses his legs a little, placing his feet on the same straight line. It is observed with lesions of the frontal lobes of the brain.
- Walking gait- syn.: Todd's gait. A gait in which the patient steps over with one leg, and the other, straightened, pulls up behind him. Usually a sign of hysteria. Described by the German physician R. Todd (1809-1860).
- Cerebellar gait- a patient with cerebellar damage due to ataxia (see) walks uncertainly, legs wide apart. In this case, in the case of damage to the cerebellar worm it "throws" from side to side, and in the pathological process in the cerebellar hemisphere, it deviates towards this hemisphere. The patient's tendency to fall is especially pronounced if, in the process of walking, he makes sharp turns.
- Peroneal gait- syn.: Cock gait. The "stamping" gait. steppage. With damage to the tibial nerve, the patient raises his leg high, throws it forward and sharply lowers it. It occurs with peripheral paralysis of the muscles innervated by the peroneal nerve.
- Cock gait- see gait peroneal.
- Sensitive atactic gait- syn.: Tabetic gait. The manifestation of a violation of proprioceptive (deep) sensitivity is usually with damage to the posterior cords of the spinal cord. The patient does not feel the position of the legs in space. While maintaining muscle strength while walking, the patient looks down all the time and visually controls the position of his legs. Due to the low muscle tone when walking, hyperextension of the knee joints (genu recurvatum) is manifested, which was noted, in particular, in dorsal tabes dorsalis. Walking movements are abrupt, steps are accompanied by a clapping sound, length and height discrepancy. Difficulty walking increases dramatically in the dark. It can be a manifestation of some intravertebral tumors, various types of spinocerebellar degeneration, funicular myelosis (a manifestation of vitamin B ## 12 ### deficiency).
- Senile gait- with age, against the background of discirculatory encephalopathy, certain changes in gait occur due to difficulty in maintaining balance. At the same time, during walking, the body leans forward, the shoulder girdle is lowered, the knees are slightly bent, the arm span (diadochokinesis) decreases, the step is shortened.
- Tabetic gait- see Atactic sensory gait.
- Todd's walk- see Walking gait.
- Trendelenburg gait- as a result of weakness of the muscles that provide the abduction of the thigh, the patient's pelvis becomes skewed when walking. Usually detected with myopathy.
- Trendelenburg gait is bilateral- see gait "duck".
- Duck gait- syn.: Trendelenburg's gait is bilateral. It occurs when the muscles of the pelvic girdle and proximal legs are affected. When walking, the patient waddles from foot to foot. It is characteristic of myopathy.
- Punching gait- see steppage.
Oxford Explanatory Dictionary of Psychology
there is no meaning and interpretation of the word
subject area of a term
Ludwig Mann (1866-1936)
Specific pathological changes in muscle tone in the affected limbs in the pathology of the pyramidal system. In acute unilateral lesion of the pyramidal tract on the upper limb more often the muscles that lift the belt of the upper limb, the abductor and outward rotating muscles of the shoulder, the extensors and instep supports of the forearm, the extensors of the hand and fingers are affected; on the lower limb- muscle groups abducting and adducting the thigh, flexing the knee and foot. When the sluggish stage of hemiplegia is replaced by the spastic one, the antagonists of these muscle groups are especially hypertonic. Spasticity, if severe enough, leads to contractures. As a result, the upper and lower extremities take the following position: the girdle of the upper limb is lowered, the shoulder is brought and rotated inward, the forearm is pronated and bent at the elbow joint, the hand and fingers are bent, the thigh is extended and adducted, the lower leg is extended, the foot is in the pes equino-varus position , as a result of which the paretic limb becomes, as it were, longer than the healthy one. In order not to touch the floor with the toe when walking, the patient, unable to raise the limb up, “mows” it, that is, takes it to the side, describing a semicircle with his foot (“hand asks, leg mows”). Pose Wernicke - Mann is more often observed with capsular hemiplegia (lesion of the pyramidal path in the region of the posterior leg of the inner capsule).