Clinical signs in functional (psychogenic) gait disorders: a brief survey

Sokol, Leonard L.; Espay, Alberto J.

doi:10.1186/s40734-016-0031-1

Cited by 20 publications

(7 citation statements)

References 13 publications

(10 reference statements)

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“…If these patients do fall, they typically do not incur injuries. Recently, effort-associated behavior disproportionate to the severity of gait impairment (the huffing and puffing sign) have been identified as highly specific for functional gait disorders [ 50 ]. Other clinical signs potentially pointing towards a functional nature of a gait disorder are manipulation-resistant dorsiflexion of the first toe, fixed plantar flexion and inversion of one foot or both feet and the “swivel chair sign”.…”

Section: Gait Disorders Associated With Brain Dysfunctionmentioning

confidence: 99%

“…Other clinical signs potentially pointing towards a functional nature of a gait disorder are manipulation-resistant dorsiflexion of the first toe, fixed plantar flexion and inversion of one foot or both feet and the “swivel chair sign”. The latter denotes a marked discrepancy between disturbed upright walking and normal forward motion when using a swivel chair [ 50 ].…”

Section: Gait Disorders Associated With Brain Dysfunctionmentioning

confidence: 99%

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Gait disorders in adults and the elderly

Pirker

Katzenschlager

2016

Wien Klin Wochenschr

477

300

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SummaryHuman gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems. The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives. The prevalence of gait disorders increases from 10 % in people aged 60–69 years to more than 60 % in community dwelling subjects aged over 80 years. Sensory ataxia due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait disorders. With advancing age the proportion of patients with multiple causes or combinations of neurological and non-neurological gait disorders increases. Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions. This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.

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Section: Gait Disorders Associated With Brain Dysfunctionmentioning

confidence: 99%

Section: Gait Disorders Associated With Brain Dysfunctionmentioning

confidence: 99%

Gait disorders in adults and the elderly

Pirker

Katzenschlager

2016

Wien Klin Wochenschr

477

300

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“…Psychogenic or functional gait disorder used to be considered as a diagnosis of exclusion but more recently, clinical inconsistency has come to be accepted as its hallmark [2]. The patient may present with any other kind of gait disorder but frequently it is bizarre, with exaggerated effort ("huffing and puffing" sign [65]) and an uneconomic posture. Clinical findings may not be reproducible if the patient is re-examined when distracted or unaware [66].…”

Section: Psychogenicmentioning

confidence: 99%

Gait Disorders in Older Adults - A Structured Review and Approach to Clinical Assessment

Nnodim¹,

Nwagwu²,

Nnodim-Opara³

2020

Geriatr Med Gerontol

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“…Assessment of patients with suspected RD includes a history and physical examination with special attention to the musculoskeletal and neurological systems. The differential diagnosis of RD includes a focal dystonia presenting as the initial symptom of primary generalized dystonia, a secondary process (stroke, Parkinson’s disease), trauma, and functional (psychogenic) causes ( 45 , 53 , 54 ). If not previously performed, the diagnostic work up may include electrodiagnostic testing, spine/brain/skeletal imaging, and laboratory studies including metabolic and, potentially, genetic testing.…”

Section: Clinical Featuresmentioning

confidence: 99%

Research Priorities in Limb and Task-Specific Dystonias

et al. 2017

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Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including: the development of diagnostic criteria for limb dystonia, more precise phenotypic characterization and innovative clinical trial design that considers clinical heterogeneity, and limited available number of participants.

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Clinical signs in functional (psychogenic) gait disorders: a brief survey

Cited by 20 publications

References 13 publications

Gait disorders in adults and the elderly

Gait disorders in adults and the elderly

Gait Disorders in Older Adults - A Structured Review and Approach to Clinical Assessment

Research Priorities in Limb and Task-Specific Dystonias

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