A shuffling gait is detected in secondary parkinsonism, corticobasal degeneration, various types of multisystem atrophy, Parkinson's disease, Binswanger's, Pick's, Wilson's, Creutzfeldt-Jakob's, and some other extrapyramidal and mixed disorders. Sometimes it is found in old age in the absence of neurological diseases, it develops with depression. The cause is determined by the results of the survey, neurological examination, imaging and laboratory techniques. Treatment includes antiparkinsonian, vascular, neurotropic drugs, surgical interventions.
The shuffling (hypokinetic) gait is characterized by stiff, slow movements of the legs, a tense posture, and a decrease in the amplitude of arm movements. The stride length is reduced, the legs almost do not come off the surface, they “shuffle” on the floor. This type of gait is often combined with propulsion and stiffness when walking: difficulty in starting to move, marking time.
Hypokinesia is a mandatory symptom of Parkinson's disease, manifested by shuffling movements of the legs, a decrease in the amplitude and slowing down of steps, impoverishment of facial expressions and gestures. In the initial stages, it can be mildly expressed, it is detected using special tests. Subsequently, it gradually progresses, supplemented by asymmetric muscle rigidity and rest tremor, postural disorders.
The condition develops against the background of diseases and injuries of the central nervous system, resembles Parkinson's disease, but differs from it in accelerated progression, symmetry of manifestations and variability of symptoms. In the clinical picture, not all signs of Parkinson's disease may be present or symptoms typical of other cerebral pathologies may be detected.
The shuffling gait in secondary parkinsonism appears early enough. It is determined in persons who have undergone TBI, some infectious diseases and cerebral hypoxia. It is noted in a number of degenerative lesions of the central nervous system, found in patients who have not received timely medical care for poisoning with carbon monoxide, methanol and some other compounds.
Shuffling gait in Parkinson's disease
Shuffling gait is noted in all three variants of the disease: striatonigral degeneration (SDI), olivopontocerebellar atrophy (OPCA), and Shy-Drager syndrome. The most typical for SND, in the clinic of which the phenomena of parkinsonism predominate. In OPCA, cerebellar ataxia predominates in the beginning, muscle rigidity and hypokinesia join in the later stages of the disease.
Shy-Drager syndrome manifests itself with orthostatic disorders, extrapyramidal disorders occur at the same time or somewhat later, are detected in more than half of patients. A shuffling gait is associated with bradykinesia, muscle rigidity, small-scale tremor, and bladder atony. Cerebellar syndrome is found in 40% of patients.
Progressive subcortical encephalopathy is formed as a result of vascular disorders against the background of arterial hypertension and some angiopathy. Dementia, gait disturbances, and pelvic organ dysfunction predominate. The shuffling gait develops gradually. First, the length of the step decreases, shuffling occurs. Then the pattern is broken so much that walking resembles movement on ice. There are starting difficulties, slowing down, instability when cornering.
Lacunar cerebral infarction is accompanied by mild or moderate symptoms, but in the long term it can provoke parkinsonism, cognitive decline, and mental disorders. The difference is the absence of cerebral and meningeal symptoms in the acute period. Accompanied by hemiparesis, speech disorders, pelvic disorders. Sometimes a lacunar stroke is asymptomatic. The latter option is considered to be prognostically unfavorable, since it often accompanies multilacunar lesions and excludes the possibility of providing medical care immediately after the formation of an ischemic focus.
Shuffling gait can be caused by normotensive hydrocephalus (Hakim-Adams syndrome), characterized by a triad of symptoms: dementia, urinary disorders, and changes in walking pattern. A shuffling gait is one of the first manifestations of the disease, accompanied by a slowdown in the pace of movements, balance disorders, and difficulties in starting to move. Intellectual decline joins after 6-12 months.
Other shuffling gait conditions include:
In senile people, changes in gait are of a polyetiological nature, they develop as a result of age-related changes in the nervous system and the musculoskeletal system. In depression, the leading mechanism is the inhibition of motor activity against the background of disturbances in the psycho-emotional state.
The definition of the etiology of the violation is carried out by a neurologist. Clinical examination involves distinguishing between secondary parkinsonism and Parkinson's disease, clarifying the form of multisystem atrophy, identifying symptoms that indicate the development of parkinsonism-plus or signs of hereditary diseases. The diagnostic program includes:
The scheme of conservative treatment includes drugs of the following groups:
To reduce rigidity, stimulate metabolic processes in muscle tissue, massage is performed. To maintain a sufficient level of motor activity and the ability to self-service, physical therapy is carried out with patients.
Patients with Parkinson's disease undergo electrical stimulation of the globus pallidus, destruction of the ventrolateral nucleus of the thalamus, or pallidotomy. The tactics of surgical treatment of circulatory disorders is determined by the nature of the vascular pathology, may include reconstructive interventions, removal of blood clots. If occlusion of the CSF pathways is detected in patients with normotensive hydrocephalus, endoscopic triventriculocisternostomy is performed. If treatment fails, shunting is indicated.