Can you see something strange in this gait ? You gotta look closely, there are several things that should bother you.
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
Not every gait problem is related to faulty shoes, bad feet or impaired arm swing.
This is a case of CIDP that walked (terribly) into our clinic. We did not initially know what this was but as you can see from this gait, if you look closely enough, something is just missing and wrong.
Arm swing is very problematic and there is no anti-phasic shoulder/pelvic girdle motions. There are subtle demonstrations of both wide based gait steps and cross-overs. The gait is syncopated, sort of. We had to shorten the clip for patient ID preservation, we wish we could have shown you more, it is really quite obvious that there is a systemic neurologic coordination problem in this patient. With demyelinating polyneuropathies as the peripheral receptors become more and more impaired the brain eventually starts to lose more and more signals from the peripheral joints as to where the body parts are in space. IF the brain cannot find the parts, it cannot control them. If the brain just gets some of the signal the cerebellum cannot use its EFFERENT copy of the motor program, which is send out into the limbs, to orchestrate smooth coordinated tasks. Go watch the video again, look at the global feel of the video, it is ratchety and syncopated.
CIDP is an acquired immune-mediated inflammatory disorder of the peripheral nervous system. The myelin sheath is slowly destroyed in this disease so nerve conduction is gradually lost. Some sources compare this disease to Guillian Barre disease.
From wikipedia:
Chronic inflammatory demyelinating polyneuropathy[3] is believed to be due to immune cells, cells which normally protect the body from foreign infection, but here begin incorrectly attacking the nerves in the body instead. As a result, the affected nerves fail to respond, or respond only weakly, to stimuli, causing numbing, tingling, pain, progressive muscle weakness, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. The likelihood of progression of the disease is high.
After seeing the client a few times, it was clear that there were several fixed neurologic parameters which could not be mediated and the client was sent an EMG/NCV and the specific diagnosis was made. The client was put on a monthly immunogloblulin IV drip and has remarkably stabilized.
Not all gaits are from a bad ankle, a slumbering cerebellum or cruddy arm swing. Trust your clinical judgement, if it doesn’t feel right, refer up or laterally.
Shawn and Ivo
