Observation – Gait
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Anatomy and Physiology
A normal gait requires complex integration of a number of systems. The spinal cord controls primary movements while the brain stem controls reflexes. A gait center in the rostral brain stem controls coordination of the gait. Voluntary movement is controlled by the forebrain, primarily the cortex and basal ganglia. The vestibular, optic and proprioceptive pathways also play important roles. The cerebellum is in charge of adapting and adjusting the movements to shape the gait into a normal movement.
Review brain

Assessment – Patient must be able to move freely on a non-slip surface. Various speeds (trot, slow walk, circle, start and stop, or run) may amplify subtle defects. Walking the patient up and down stairs may worsen the problem.

Paresis – deficit of voluntary movement, but patient is able to walk
• Monoparesis – one limb
• Paraparesis – both pelvic limbs
• Tetraparesis – all four limbs
• Hemiparesis – thoracic limb and pelvic limb on the same side

Plegia – complete loss of voluntary ability to move, patient cannot stand, support itself, or walk

Paralysis – complete loss of motor function, term used when cranial nerve function is completely lost

Ataxia – failure of muscle coordination

Dysmetria – improper range and/or force of movement
• Hypermetria – overreaching intended goal. Goose-stepping or high stepping
• Hypometria – under reaching intended goal