Gait and Balance (OSCE)

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Balance[edit | edit source]

  • patient to sit in a chair with back straight against the back of the chair
  • keep arms folded while standing
  • note:
    • sit without leaning or sliding
    • arise from chair in single movement without using arms
    • sit down in a smooth motion without falling

Stance[edit | edit source]

  • patient to place feet together without any support
  • note:
    • stand for > 30sec
    • stand without loss of balance with eyes closed (Romberg’s Test)
    • turn head to both sides and look up without losing balance
    • maintain balance when nudged gently (nudge 3 times on the sternum)
    • stand on one leg
    • reach up to get an object and down to get an object without loss of balance

Gait[edit | edit source]

  • patient to walk across room, turn and walk back as quickly as possible
  • note:
    • INITIATE gait immediately (if no, dopamine deficiency/ substantia nigra lesion)
    • maintain normal step HEIGHT, clearing the floor with their feet (maximum of 5 cm)
      • > 5 cm → high stepping
    • maintain a step LENGTH between stance toe and swinging heel that is length of foot
    • step symmetry and CONTINUITY (raises heel of one foot as other foot touches down)
    • maintain a straight path and normal truncal STABILITY (no swaying back, knee flexion or arm abduction)
  • observed from behind: normal walk stance with feet almost touching
  • STOP without difficulty
  • TURN without discontinuity of steps

Pathological Gaits[edit | edit source]

  • Parkinsonian → shuffling gait, lack of arm swinging, difficulty initiating/stopping.
  • foot drop → compensate with high-stepping.
  • spastic hemiparesis → leg is extended, foot is plantarflexed
  • sensory ataxia → wide, unsteady gait that is worse with eyes closed.
  • cerebellar ataxia → unsteady, wide based gait, difficulty with turns, veers towards side of lesion
  • antalgic → painful, short contralateral step

Other OSCE modules[edit | edit source]