gait apraxia

Bruns apraxia
Classification and external resources
MeSH	D020235

WordNet

a horses manner of moving
a persons manner of walking
inability to make purposeful movements

PrepTutorEJDIC

歩きぶり,足どり

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/17 16:52:39」(JST)

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Bruns apraxia, or frontal ataxia is a gait apraxia^[1]found in patients with bilateral frontal lobe disorders. It is characterised by an inability to initiate the process of walking, despite the power and coordination of the legs being normal when tested in the seated or lying position. The gait is broad-based with short steps with a tendency to fall backwards. It was originally described in patients with frontal lobe tumours, but is now more commonly seen in patients with cerebrovascular disease.^[2]

It is named after Ludwig Bruns.^[3]^[4]

Symptoms

Unlike ataxias of cerebellar origin, Bruns apraxia exhibits many frontal lobe ataxia characteristics, with some or all present.

Difficulty in initiating movement
Poor truncal mobility
Falls due to minor balance disturbances
Greatly hindered postural responses
Characteristic magnetic gait, the inability to raise one's foot off of the floor.
Wide base, poor balance control when in stance
Short stride
En bloc turns

Often patients with frontal lobe ataxia may experience minute cognitive changes that accompany the gait disturbances, such as frontal dementia and presentation of frontal release signs (Plantar reflex). Urinary incontinence may also be present.^[5] ^[6] Bruns apraxia can be distinguished from Parkinsonian ataxia and cerebellar ataxia in a number of ways. Patients typically afflicted with Parkinsonian ataxia typically have irregular arm swing, a symptom not typically present in frontal ataxia. Walking stride in cerebellar ataxia varies dramatically, accompanied by erratic foot placement and sudden, uncontrolled lurching, not generally characteristic of Bruns apraxia.^[7]

Cause

Frontal lobe ataxia is often associated with damage to the frontopontocerebellar tract (Arnold's bundle) that connects the frontal lobe to the cerebellum. This pathway normally sends information from the cortical regions to the cerebellum, particularly information used to initiate planned movement.^[8] Many neurologists describe frontal lobe ataxia as really an apraxia, in which voluntary control of initiating movement is greatly hindered, but normal movement is present when elicited involuntarily or reflexively.^[9] This indicates that cerebellar function is intact and that the presented symptoms of Bruns apraxia are due to damage located within frontal lobe regions and pathways leading from there to the cerebellum.^[10]

Diagnosis

Diagnosis consists of a variety of tests, including but not limited to:

Measurement of orthostatic blood pressure
Coordination
- rapid, alternating movements
- stroking of heel from along the opposite shin from knee to ankle
- finger-to-nose testing.
Primary sensory modalities are examined with the following methods, searching for focal sensory loss, graded distal sensory loss, or levels of decreased sensation, hyperesthesia or dysesthesia.
- light touch
- pin-prick
- temperature
- position
- vibration ^[11]
Focused gait examination, which examines stationary position and walking abnormalities. Walking generally exposes any faults within the complex neurological communication between systems as weight is shifted from one foot to the other.^[12]

Treatment

Treatment consists of physical rehabilitation programs designed to improve overall function, increase strength and improve balance. The ultimate goal is to increase the patient's degree of independence, thus improving the patient's quality of life. Exercise typically begins with simple movements, gradually transitioning into more complex actions. Various aspects of treatment are assessed based on the individual patient's condition, utilizing many assessment tools:

Functional Reach Test
External Perturbation Test – Push, Release
External Perturbation Test – Pull
Clinical Sensory Integration Test
Single Leg Stance Test
Five Times Sit to Stand Test ^[13]

Various scales are also utilized

Brief Ataxia Rating Scale
Friedreich's Ataxia Impact Scale
Scale For Assessment and Rating of Ataxia ^[14]

References

^ Dorland's (2012). Dorland's Illustrated Medical Dictionary (32nd ed.). Elsevier. p. 256. ISBN 978-0-19-856878-0.
^ William Pryse-Phillips. Companion to clinical neurology. Oxford University Press, 2003, page 136. ISBN 978-0-19-515938-7.
^ Barry G. Firkin, Judith A. Whitworth. Dictionary of Medical Eponyms. Informa Health Care, 2001, page 51. ISBN 978-1-85070-333-4.
^ Bruns' ataxia at Who Named It?
^ Frontal lobe ataxia; Thompson, PD. Handbook Clinical Neurology. 2012;103:619-22. doi: 10.1016/B978-0-444-51892-7.00044-9.
^ Ataxia: Physical Therapy and Rehabilitation Applications for Ataxic Patients, 2014. http://cirrie.buffalo.edu/encyclopedia/en/article/112/#s4
^ Jody Corey-Bloom; Ronald B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, pages 115-116. ISBN 978-1-933864-35-8.
^ David McDougal; Dave Van-Lieshout; John Harting. “Pontine Nuclei and Middle Cerebellar Peduncle” Medical Neurosciences 731. UW-Madison Medical School. http://www.neuroanatomy.wisc.edu/virtualbrain/BrainStem/16Pontine.html
^ Jody Corey-Bloom; Ronal B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, page 115. ISBN 978-1-933864-35-8.
^ George Milbry Gould; James Hendrie Lloyd. “The Philadelphia Medical Journal, Volume 6”. The Philadelphia Medical Publishing Company, 1900, page 374.
^ Jody Corey-Bloom; Ronal B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, page 114. ISBN 978-1-933864-35-8.
^ Jody Corey-Bloom; Ronal B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, page 114. ISBN 978-1-933864-35-8.
^ Ataxia: Physical Therapy and Rehabilitation Applications for Ataxic Patients, 2014. http://cirrie.buffalo.edu/encyclopedia/en/article/112/#s4
^ Ataxia: Physical Therapy and Rehabilitation Applications for Ataxic Patients, 2014. http://cirrie.buffalo.edu/encyclopedia/en/article/112/#s4

UpToDate Contents

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1. 高齢者における神経性歩行障害 neurologic gait disorders of elderly people
2. 成人における小脳性運動失調の概要 overview of cerebellar ataxia in adults
3. 大脳皮質基底核変性症 corticobasal degeneration
4. 毛細血管拡張性運動失調症 ataxia telangiectasia
5. 舞踏病の概要 overview of chorea

English Journal

Apraxia in anti-glutamic acid decarboxylase-associated stiff person syndrome: link to corticobasal degeneration?

Bowen LN1, Subramony SH, Heilman KM.
Annals of neurology.Ann Neurol.2015 Jan;77(1):173-6. doi: 10.1002/ana.24245. Epub 2014 Dec 8.
Corticobasal syndrome (CBS) is associated with asymmetrical rigidity as well as asymmetrical limb-kinetic and ideomotor apraxia. Stiff person syndrome (SPS) is characterized by muscle stiffness and gait difficulties. Whereas patients with CBS have several forms of pathology, many patients with SPS h
PMID 25100431

Apraxias in neurodegenerative dementias.

Chandra SR1, Issac TG2, Abbas MM1.
Indian journal of psychological medicine.Indian J Psychol Med.2015 Jan-Mar;37(1):42-7. doi: 10.4103/0253-7176.150817.
BACKGROUND: Apraxia is a state of inability to carry out a learned motor act in the absence of motor, sensory or cerebellar defect on command processed through the Praxis circuit. Breakdown in default networking is one of the early dysfunction in cortical dementias and result in perplexity, awkwardn
PMID 25722511

Fear of falling and gait variability in older adults: a systematic review and meta-analysis.

Ayoubi F1, Launay CP2, Annweiler C3, Beauchet O4.
Journal of the American Medical Directors Association.J Am Med Dir Assoc.2015 Jan;16(1):14-9. doi: 10.1016/j.jamda.2014.06.020. Epub 2014 Sep 16.
BACKGROUND: Fear of falling (FOF) and increased gait variability are both independent markers of gait instability. There is a complex interplay between both entities. The purposes of this study were (1) to perform a qualitative analysis of all published studies on FOF-related changes in gait variabi
PMID 25230892

Japanese Journal

多発性脳梗塞を呈し緩徐な経過をたどった血管内大細胞型B細胞リンパ腫の1例

光武明彦,金本忠久,鈴木洋司,酒井直樹,久力権
臨床神経学 55(2), 101-106, 2015
症例は66歳の女性である．回転性めまい，難聴で受診し，新規発症の多発性脳梗塞があり，心原性脳塞栓症と考え抗凝固療法を導入した．その後約1年間無症状で経過したが，左不全片麻痺を発症し再度多発性脳梗塞と診断された．左不全片麻痺は徐々に改善したが，失調性歩行，失行症状が出現し亜急性に進行した．血液検査で乳酸脱水素酵素，可溶性インターロイキン2受容体が高値で，悪性リンパ腫をうたがった．ランダム皮膚生検，開 …
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脳梁離断症候群を示したインフルエンザワクチン接種後急性散在性脳脊髄炎の1例

荒井元美,高木大輔,長尾亮介
臨床神経学 54(2), 135-139, 2014
症例は48歳，右ききの女性である．インフルエンザワクチンを接種した20日後から異常行動，歩行障害などが現れた．頭部MRI検査で脳梁の膝部，体部から膨大部上部にかけての単一病変がみられ，急性散在性脳脊髄炎（acute disseminated encephalomyelitis; ADEM）と診断した．単一物品の使用障害をふくむ観念性失行が左手だけにみられた．また，左手の一側性失書は漢字よりも仮名の …
NAID 130004505560

Related Pictures

[1] Dorland's (2012). Dorland's Illustrated Medical Dictionary (32nd ed.). Elsevier. p. 256. ISBN 978-0-19-856878-0.

[2] William Pryse-Phillips. Companion to clinical neurology. Oxford University Press, 2003, page 136. ISBN 978-0-19-515938-7.

[3] Barry G. Firkin, Judith A. Whitworth. Dictionary of Medical Eponyms. Informa Health Care, 2001, page 51. ISBN 978-1-85070-333-4.

[4] Bruns' ataxia at Who Named It?

[5] Frontal lobe ataxia; Thompson, PD. Handbook Clinical Neurology. 2012;103:619-22. doi: 10.1016/B978-0-444-51892-7.00044-9.

[6] Ataxia: Physical Therapy and Rehabilitation Applications for Ataxic Patients, 2014. http://cirrie.buffalo.edu/encyclopedia/en/article/112/#s4

[7] Jody Corey-Bloom; Ronald B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, pages 115-116. ISBN 978-1-933864-35-8.

[8] David McDougal; Dave Van-Lieshout; John Harting. “Pontine Nuclei and Middle Cerebellar Peduncle” Medical Neurosciences 731. UW-Madison Medical School. http://www.neuroanatomy.wisc.edu/virtualbrain/BrainStem/16Pontine.html

[9] Jody Corey-Bloom; Ronal B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, page 115. ISBN 978-1-933864-35-8.

[10] George Milbry Gould; James Hendrie Lloyd. “The Philadelphia Medical Journal, Volume 6”. The Philadelphia Medical Publishing Company, 1900, page 374.

[11] Jody Corey-Bloom; Ronal B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, page 114. ISBN 978-1-933864-35-8.

[12] Jody Corey-Bloom; Ronal B. David. “Clinical Adult Neurology”. Demos Medical Publishing, 2009, 3rd ed, page 114. ISBN 978-1-933864-35-8.

[13] Ataxia: Physical Therapy and Rehabilitation Applications for Ataxic Patients, 2014. http://cirrie.buffalo.edu/encyclopedia/en/article/112/#s4

[14] Ataxia: Physical Therapy and Rehabilitation Applications for Ataxic Patients, 2014. http://cirrie.buffalo.edu/encyclopedia/en/article/112/#s4

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