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Hemiplegia Walking Assessment Guide

The document provides an overview of evaluating and approaching patients presenting with difficulty walking. It outlines how to inspect the patient for clues about the cause, including looking for assistive devices, contractures, or muscle wasting. The examination involves testing for signs of upper motor neuron or lower motor neuron involvement like clonus or weakness. If the weakness is of vascular origin, the presentation and risk factors for stroke are considered. Relevant investigations and management of stroke are also discussed.

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Ruby Bhatty
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122 views78 pages

Hemiplegia Walking Assessment Guide

The document provides an overview of evaluating and approaching patients presenting with difficulty walking. It outlines how to inspect the patient for clues about the cause, including looking for assistive devices, contractures, or muscle wasting. The examination involves testing for signs of upper motor neuron or lower motor neuron involvement like clonus or weakness. If the weakness is of vascular origin, the presentation and risk factors for stroke are considered. Relevant investigations and management of stroke are also discussed.

Uploaded by

Ruby Bhatty
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPROACH TO THE PATIENT

WITH DIFFICULT IN WALKING


(HEMIPLEGIA)

COMPLIED BY DR ZAR CHI WAI LINN


DIFFICULTY IN WALKING
WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY


JUNCTION

CNS PNS
(UMNL) (LMNL)

BRAIN SPINAL CORD

CEREBRAL CORTEX EXTRAPYRIMIDAL

CEREBELLUM BASAL GANGLIA


WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY


JUNCTION

CNS PNS
(UMNL) (LMNL)

BRAIN SPINAL CORD

CEREBRAL CORTEX EXTRAPYRIMIDAL

CEREBELLUM BASALGANGLIA
WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY


JUNCTION

CNS PNS
(UMNL)
(LMNL)
ANTERIOR HORN CELL
BRAIN SPINAL CORD
REDICULOPATHY

PLEXOPATHY
CEREBRAL CORTEX EXTRAPYRIMIDAL
MONONEUROPATHY

CEREBELLUM BASALGANGLIA MONONEURITIS MULTIPLEX


DIFFICULT IN WALKING

• Nerve?

• Muscle ?

• Neuro -Mascular Junction?


NEUROPATHY

• CNS ?
• PNS?
CNS

• Brain : Hemiplegia?
• Spinal cord : Quadriplegia?
• Cerebeller lesion
• Basal ganglia lesion
PNS
• Flaccid paraplegia ?

• Peripheral neuropathy? Sensory (Glove and stocking)/Motor/Mixed

• Rediculopathy ?

• Plexopathy?

• Mononeuropathy?

• Mononeuritis Multiplex ?
NEUROPATHY
INSPECTION
LOOK FOR BEDSIDE CLUES:

ankle-foot orthosis (AFO)s may point towards foot drop.

A catheter bag may imply a spastic paraparesis.

Crutches suggest that upper limbs are strong.

Look around the bedside for a wheelchair, or walking aids.


INSPECT THE LIMBS CAREFULLY:
• General muscle bulk – look for wasting, fasciculations, and particularly at the
intrinsic muscles of the hand. If wasting is present, consider the distribution e.g.
symmetrical and distal or localized to a specific nerve. Pseudohypertrophy of the
calf suggests a dystrophy.

• Check for deformities such as contractures, pes cavus (suggesting a hereditary


sensorimotor neuropathy or polio) or Charcot’s joints (consistent with a sensory
neuropathy).

• Look at limb posture e.g. wrist drop of a radial nerve palsy, clawing of the hand
due to ulnar nerve palsy.

• Look for muscle biopsy scars (often deltoid, triceps, or lateral quadriceps) or
spinal procedure.
NEXT
WHAT DO YOU THINK?
HOW DO YOU START
THE EXAMINATION?
• If the patient can walk, start by Rhombergs Test
WALKING DIFFICULTY

NEUROPATHY NEUROMUSCULAR MYOPATHY


JUNCTION

CNS PNS
(UMNL) (LMNL)

BRAIN SPINAL CORD

PYRIMIDAL EXTRAPYRIMIDAL

BASALGANGLIA
HEMIPLEGIC CEREBELLUM
GAIT
HEMIPLEGIC GAIT
Written by Dr Sarah Kennedy

Be familiar with the NICE stroke algorithm ([Link] and the Bamford
classification of stroke and the CHA2DS2Vasc and HASBLED scoring systems and the National Institutes of
Health Stroke Scale.
IMPORTANT CLINICAL
SIGNS
CLONUS
HYPERREFLEXIA
EXTENSOR PLANTER
RESPONSE
UPPER LIMB
IF THE WEAKNESS IS
VASCULAR ONSET
PRESENTATION
WITH REGARDS TO AETIOLOGY:

The pulse was regular,


there was (no) carotid bruit or cardiac murmur/prosthetic sounds or
evidence of diabetic fingerprick marks or tar staining.
WITH REGARDS TO COMPLICATIONS: 

There was (no) DVT, pressure sores, catheter, NG tube


The patient had good/reduced function of the left hand.
INVESTIGATIONS FOR STROKE:
INVESTIGATIONS FOR STROKE:
INVESTIGATIONS FOR STROKE:
MANAGEMENT OF STROKE:
MANAGEMENT OF STROKE:
MANAGEMENT OF STROKE:
GOOD LUCK

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