November 6, 2024

76 year-old male, increasing six month fall history

By Med-Challenger · 1 minute read

A 76 year-old man is brought to your office by his daughter because he has had 3 or 4 falls over the past six months. He and she both wish to know what he can do to reduce the chance of falling.

He doesn’t take any medications. He drinks one glass of wine each evening. He states that his walking is normal and he thinks the falls are the result of not carefully watching his feet and what is in front of them.

You assess his gait by asking him to walk down and back the 60-foot corridor from your office to the door to the waiting room. He has a slow, shuffling gate with a body position that is forward-flexed.

Which of the following conditions is most likely?

cerebellar lesion
hemiplegia
Parkinson disease
sensory ataxia

The correct answer is:

Parkinson disease

A shuffling gait, short steps, forward-flexed posture, is a typical finding in patients with Parkinson’s disease.

A shuffling gait with short steps and forward-flexed posture is an almost universal finding in patients with established Parkinson’s disease. In the later stages of the disease, the gait may be interrupted by periods of freezing up, and the patient may be unable to move forward. Other features of the disease include muscle rigidity, reduced facial expressions, and festination (inability to stop, once forward motion has been established).

Patients with sensory ataxia have a wide-based gait. Patients with a cerebellar lesion also have a wide-based gait, but their walking has a lurching and staggering quality. The sole of their foot hits the floor forcibly with a slapping sound, an indication of the loss of proprioception. Patients who have experienced hemiplegia following stroke may have a swinging gait.

This question appears in Med-Challenger Adult-Gerontology Primary Care Nurse Practitioner Review with CME.

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