Gait and Balance (OSCE)

Balance

• 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

• 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

• 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

• 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