Gait and Balance (OSCE)

Balance

 * patient to sit in a chair with back straight against the back of the chair
 * keep arms folded while standing
 * note:
 * sit without leaning or sliding
 * arise from chair in single movement without using arms
 * sit down in a smooth motion without falling

Stance

 * patient to place feet together without any support
 * note:
 * stand for > 30sec
 * stand without loss of balance with eyes closed (Romberg’s Test)
 * turn head to both sides and look up without losing balance
 * maintain balance when nudged gently (nudge 3 times on the sternum)
 * stand on one leg
 * reach up to get an object and down to get an object without loss of balance

Gait

 * patient to walk across room, turn and walk back as quickly as possible
 * note:
 * INITIATE gait immediately (if no, dopamine deficiency/ substantia nigra lesion)
 * maintain normal step HEIGHT, clearing the floor with their feet (maximum of 5 cm)
 * > 5 cm → high stepping
 * maintain a step LENGTH between stance toe and swinging heel that is length of foot
 * step symmetry and CONTINUITY (raises heel of one foot as other foot touches down)
 * maintain a straight path and normal truncal STABILITY (no swaying back, knee flexion or arm abduction)
 * observed from behind: normal walk stance with feet almost touching


 * STOP without difficulty
 * TURN without discontinuity of steps

Pathological Gaits

 * Parkinsonian	→ shuffling gait, lack of arm swinging, difficulty initiating/stopping.
 * foot drop		→ compensate with high-stepping.
 * spastic hemiparesis	→ leg is extended, foot is plantarflexed
 * sensory ataxia	→ wide, unsteady gait that is worse with eyes closed.
 * cerebellar ataxia	→ unsteady, wide based gait, difficulty with turns, veers towards side of lesion
 * antalgic		→ painful, short contralateral step