NCS Balance and Gait Rehabilitation 3 — Questions and Answers
Question 1: A patient with Parkinson's disease presents with short, shuffling steps, reduced arm swing, and a forward-flexed trunk posture. This is best classified as:
- Antalgic gait
- Scissor gait
- Parkinsonian (hypokinetic) gait (Correct answer)
- Steppage gait
Correct answer: Parkinsonian (hypokinetic) gait
Parkinsonian gait (hypokinetic gait) is characterized by reduced stride length, shuffling steps, diminished arm swing, and camptocormia (forward trunk flexion) reflecting basal ganglia dysfunction.
Question 2: Freezing of gait (FOG) in Parkinson's disease most commonly occurs during which situations?
- Mid-stride on straight, unobstructed pathways
- Gait initiation, turning, and passing through narrow spaces (Correct answer)
- Exclusively during backward walking tasks
- Only in low-light environments
Correct answer: Gait initiation, turning, and passing through narrow spaces
FOG is triggered by attentional demands or sensorimotor conflict, occurring most at gait initiation, during turns, in narrow spaces (doorways), and at destinations.
Question 3: Which cueing strategy has the strongest evidence for managing freezing of gait in Parkinson's disease?
- Verbal commands to walk faster
- Rhythmic auditory stimulation using a metronome (Correct answer)
- Reducing ambient lighting to minimize visual distractions
- Shortening step length to match the freezing pattern
Correct answer: Rhythmic auditory stimulation using a metronome
Rhythmic auditory stimulation provides an external temporal cue that bypasses the defective internal rhythm-generation mechanism in the basal ganglia to initiate and sustain gait.
Question 4: A post-stroke patient with spastic hemiplegia swings the affected leg in a wide lateral arc during the swing phase. This compensatory pattern is best described as:
- Trendelenburg gait
- Circumduction (Correct answer)
- Festination
- Vaulting
Correct answer: Circumduction
Circumduction (lateral arc swing) compensates for inadequate hip and knee flexion during swing phase, allowing foot clearance in the presence of spastic hemiplegia.
Question 5: In multiple sclerosis, which gait change is most characteristic of central fatigue during prolonged walking?
- Trendelenburg gait due to hip abductor weakness
- Progressive foot drop and reduced cadence worsening over time (Correct answer)
- Circumduction increasing with distance
- Festinating gait mimicking Parkinson's disease
Correct answer: Progressive foot drop and reduced cadence worsening over time
MS central fatigue causes progressive deterioration in gait quality with sustained activity, most commonly manifesting as worsening foot drop and declining cadence as the walk continues.
Question 6: Cerebellar ataxia produces which characteristic gait pattern?
- Narrow-based, shuffling steps with reduced arm swing
- Wide-based, staggering gait with irregular step lengths and lateral instability (Correct answer)
- Circumducting gait with ipsilateral arm posturing
- High-steppage gait with excessive hip flexion
Correct answer: Wide-based, staggering gait with irregular step lengths and lateral instability
Cerebellar ataxia causes a wide-based, staggering gait with variable step lengths due to impaired coordination and timing, resembling the appearance of intoxication.
Question 7: A patient with Brown-Séquard syndrome (right-sided spinal cord hemisection at T10) would exhibit which combination of deficits relevant to gait assessment?
- Right motor weakness and loss of proprioception; left loss of pain and temperature (Correct answer)
- Bilateral loss of all sensation and motor function below T10
- Left motor weakness; right loss of all sensation below T10
- Right loss of pain and temperature; left motor weakness and loss of proprioception
Correct answer: Right motor weakness and loss of proprioception; left loss of pain and temperature
Brown-Séquard syndrome produces ipsilateral (right) loss of motor function, proprioception, and vibration sense, and contralateral (left) loss of pain and temperature sensation below the lesion.
NCS Balance and Gait Rehabilitation 3
A patient with Parkinson's disease presents with short, shuffling steps, reduced arm swing, and a forward-flexed trunk posture.
This is best classified as: