Neurology · MU Sofia

10. Gait, synkinesias, speech and their disorders

Covers normal gait and how to examine it, then walks through common gait disorders such as hemiplegic, parkinsonian, cerebellar ataxic and steppage gait. Next it explains physiological and pathological synkinesias, including facial synkinesias after nerve regeneration, and describes speech as a complex function. It closes with speech disorders: dysarthria with its four subtypes and their lesion sites, the three forms of aphasia, and mutism with its causes. A mnemonic for Broca and Wernicke aphasia is included.

Inside: 1 section · 16 flashcards · 2 min

Topic 10 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 362 words (2 min of reading), with 16 flashcards.

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  1. Gait, synkinesias, speech and their disorders

Gait, synkinesias, speech and their disorders

Gait: Gait is the manner or pattern of walking. Normal gait requires intact motor, sensory, cerebellar, vestibular, and musculoskeletal systems.

Examination of Gait

  • Observe: Posture. Stride length. Arm swing. Balance. Speed. Turning. Tandem (heel-to-toe) walking

Common Gait Disorders

1.Hemiplegic (Spastic) Gait: Seen in UMN lesions (stroke). Affected leg is stiff and circumducts (swings outward). Flexed arm on affected side

2.Paraparetic (Scissor) Gait: Bilateral spasticity of legs. Legs cross while walking. Seen in spinal cord lesions, cerebral palsy

3.Parkinsonian Gait: "SHUFFLE" Stooped posture. Hesitation (freezing). Unsteady turning. Festination. Few arm movements. Little steps. En bloc turning

4.Cerebellar Ataxic Gait: Broad-based, unsteady gait. Swaying from side to side. Difficulty walking in a straight line

5.Sensory Ataxic Gait:High-stepping, stamping gait. Worse in darkness. Positive Romberg sign

6.Steppage Gait: Foot drop due to peroneal nerve or LMN lesion. Excessive lifting of the leg to avoid dragging toes

7.Waddling Gait: Proximal muscle weakness. Side-to-side pelvic movement. Seen in muscular dystrophies and myopathies

Synkinesias: Synkinesias are involuntary movements accompanying a voluntary movement.

Physiological Synkinesias: Normal associated movements.

  • Arm swinging during walking

Pathological Synkinesias

1.Global Synkinesias: Movement of a paretic limb during effort by the healthy limb.. Common after stroke

2.Imitative Synkinesias: Voluntary movement on one side produces similar movement on the opposite side.

3.Facial Synkinesias: Occur after facial nerve regeneration.. Eye closure causes mouth movement. Smiling causes involuntary eye closure

Speech: Speech is a complex function involving:

  • Cerebral cortex
  • Cranial nerves
  • Respiratory muscles
  • Phonation and articulation mechanisms

Speech Disorders

1. Dysarthria: Motor speech disorder due to impaired control of speech muscles.

  • Causes: Cerebellar disease. Parkinson disease. Stroke. Bulbar palsy
  • Types
  • Spastic Dysarthria: Slow, strained speech. UMN lesions
  • Flaccid Dysarthria: Nasal, weak speech. LMN lesions
  • Ataxic Dysarthria: Irregular, scanning speech. Cerebellar lesions
  • Hypokinetic Dysarthria: Monotonous, quiet speech. Parkinson disease

2. Aphasia: Language disorder caused by lesions of the dominant cerebral hemisphere.

  • Broca Aphasia (Motor Aphasia): Non-fluent speech. Comprehension preserved. Speech effortful and telegraphic ( Broca = Broken speech)
  • Wernicke Aphasia (Sensory Aphasia): Fluent but meaningless speech.Poor comprehension ( Wernicke = Wordy speech)
  • Global Aphasia: Severe impairment of speech production and comprehension

3. Mutism: Complete absence of speech despite preserved consciousness.

  • Causes: Frontal lobe lesions. Severe brain injury. Akinetic mutism

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