Reading the Gait in Children

What this deck covers

Reading the Gait in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. A boy who climbs up his own legs to stand
2. A waddle, and a pelvis that drops with every step
3. A boy who has always walked on his toes
4. A toddler whose knees catch on each other
5. A girl who swings one leg out to clear the floor
6. Unsteady on a wide base, and much worse in the dark
7. A high step, and a foot that slaps the floor
8. A limp that spends as little time as possible on one leg
9. A gait that changes when nobody is watching
10. A toddler whose feet point inward
11. Fine in the morning, awful by bedtime
12. A walk that looks normal until he runs

What this deck teaches

• A gait is an examination you can only do by watching. No scan reproduces it. The child has to walk, and then run, across enough floor for a pattern to appear.
• Gowers measures proximal power. Turning prone to stand means the hip and thigh extensors cannot lift the trunk, so the arms are borrowed to do it – whatever the underlying cause.
• The pelvis drops opposite the weak hip. The abductors of the leg being stood on hold the pelvis level, so the side that falls is the side that is working.
• Spasticity gives way, a contracture does not. Steady pressure separates a tone problem that can be treated from a fixed shortening that has to be released.
• Romberg is a sensory test, not a cerebellar one. Steady with the eyes open and unsteady with them shut means vision was replacing lost position sense. A cerebellar gait is unsteady before the eyes ever close.
• Foot drop lifts the knee and slaps the forefoot. The high step clears a foot that cannot be dorsiflexed, and absent ankle jerks place the fault in the lower motor neurone.

Exam pearls from this deck

• Gowers is not a test of balance. It is a measurement of proximal power.
• The pelvis drops on the side OPPOSITE the weak hip. Watch from behind, one leg at a time.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all neurology illustrated case decks · neurology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.