easy to fall
Introduction
Introduction Due to the effects of certain diseases, patients are prone to clinical manifestations of falls. Gait disorders are one of the reasons for falling. Gait refers to the posture of the patient while walking. It is a complex exercise process that requires a high degree of coordination between the nervous system and the muscles, and involves many spinal reflexes and adjustments of the large and cerebellum, as well as the complete coordination of various posture reflexes, sensory systems, and motor systems. Therefore, observing gait often provides important clues to neurological diseases. Different diseases can have different special gaits, but gait is not the basis for diagnosis, but has a reference for diagnosis. Care should be taken to exclude gait abnormalities caused by bone deformities and bone, joint, muscle, blood vessels, skin and subcutaneous tissue.
Cause
Cause
Causes of falling easily:
There are many reasons for the elderly to fall, such as the surrounding environment, vision loss and so on. Old people leave their homes and are unfamiliar with temporary accommodations or places of activity. If the road is uneven, wet, lack of light, irregular stairs, loose carpets, and broken, they are prone to fall. With the increase of age, the elderly often have vision loss, and often suffer from cataract, glaucoma, macular degeneration, and visual acuity is more likely to be tripped by obstacles due to reduced sensitivity or decreased night vision.
Examine
an examination
Related inspection
Magnetic resonance imaging (MRI) CT examination
Easy to fall inspection diagnosis:
First, medical history: Observing gait often provides clues to important neurological diseases. Should pay attention to the timing of gait abnormalities, incentives, age of patients, gait abnormalities are persistent or intermittent, with or without other symptoms such as limb pain, infection, inflammation, tumor. Nutritional deficiencies, history of arthroplasty, family history, history of cerebrovascular disease, history of syphilis infection, etc.
Second, physical examination: the patient can be walked regularly during the examination, and if necessary, closed eyes can also be checked. Further examination can cause the patient to suddenly turn, stop, and so on. Pay attention to the conditions of starting and stopping, the posture of stretching and falling, the size of the steps, the rhythm and the direction.
Third, auxiliary inspection:
1, drunken gait: more common cerebellar lesions, clinical choice of brain CT or MRI, if you consider brain stem involvement should choose brain MRI, can also be supplemented with EEG.
2, sensory ataxia gait: the possibility of spinal cord lesions should choose spinal MRI, cerebrospinal fluid examination, electromyogram and somatosensory evoked potential.
3, spastic hemiplegic gait: more common cerebrovascular disease sequelae can choose brain CT or MRI.
4, spastic paraplegia gait: depending on the situation, spinal or brain CT or MRI examination can be selected.
5, panic gait: you can choose brain CT or MRI, EEG examination.
6, cross-threshold gait: can do EMG examination.
7, swing gait: can do EMG, myelopathy X-ray film.
8, dance gait: can do brain CT or MRI, erythrocyte sedimentation, blood routine, anti-chain "O", autoantibody examination.
9, star trail gait: can do vestibular function check.
10, spinal cord intermittent break: should be used for spinal CT or MRI, spinal angiography, lower extremity arterial blood flow map.
Diagnosis
Differential diagnosis
Differential diagnosis of symptoms that are prone to fall:
1. Drunk gait: Because the center of gravity is not easy to control, the distance between the legs is widened when walking. After lifting the leg, the body swings to the sides and the upper limbs often swing horizontally or forward or backward. Sometimes you can't stand still, it's more stable when you change your position, you can't take a straight line. This gait is also called " gait", which is seen in the ataxia caused by cerebellar lesions, such as cerebellar tumor, cerebrovascular disease, tumor, inflammation, degeneration, cerebellopontine angle tumor, olive bridge cerebellar degeneration, alcohol toxicity Cerebellar degeneration, cancerous spinal cerebellar degeneration. Cerebellar atrophy, cerebellar encephalitis, brainstem tumor, posterior inferior cerebellar artery thrombosis, frontal lobe lesion, inner ear vertigo, vestibular neuronitis, etc.
2, sensory ataxia gait: This refers to people with deep sensory impairment. It is characterized by a large stride when walking, a wide spacing between the legs, a high foot lift, a strong foot hitting the ground, two eyes gazing at the two feet, partial relief when blinking, unstable or even walking when closing the eyes. Often accompanied by sensory disturbances, Romberg sign positive, seen in subacute combined degenerative spinal cord paralysis.
3, spastic hemiplegia gait: the hemiplegia of the affected side of the lower limb due to high extensor muscle tension and longer, and flexion is difficult. When the patient walks, the coordinated swinging motion of the upper limbs of the hemiplegia disappears, and the adductor, pronation and flexion postures are performed. The lower limbs are straightened and externally rotated. When the steps are raised, the pelvis is raised, and the toe is dragged outward to move forward and then to the front. Therefore, it is also called a circle-like gait. It is caused by damage of one side of the pyramidal tract, which is more common in cerebrovascular diseases.
4, sputum paraplegia gait: due to the increased tension of the lower extremity adductor muscle group caused by walking the legs to the inside when walking, shaped like scissors, it is also called scissors gait. Found in transverse spinal cord injury, cerebral palsy and so on.
5, flustered gait: due to increased muscle tension, slow start, walking small steps, rubbing the feet, the two upper limbs swinging back and forth movement lost, the trunk leaned forward, the center of gravity moved forward, so small steps Rush forward, such as chasing the center of gravity and can not stop immediately, like a panic, also known as chasing the heart gait or rushing gait. Seen from tremor paralysis and diseases that can cause tremor paralysis syndrome.
6, cross-threshold gait: due to the sagging of the diseased foot, in order to make the toes off the ground, the limbs are lifted very high, such as crossing the threshold. Seen in the general nerve paralysis and so on.
