Gait

“ Several of the forms of paralysis have each its significant gait. For instance, if a patient comes in with a firm, rather precise, calculated sort of gait, "clumping" each foot upon the floor as if he had struck it an inch sooner than he had expected, and clamping it there firmly for a moment before he lifts it again, as though he were walking on ice, with more knee action than seems necessary, you would have a strong suspicion that you had to deal with a case of locomotor ataxia, in which loss of sensation in the soles of the feet is one of the earliest symptoms. ”

“ The narrow high-heeled shoe, on the other hand, by displacing the supporting base, causes both piers of the double-spanned arch to strike at the ground simultaneously. In consequence of which the gait, instead of being undulating, is stiff and hobbling, and the body advances by jerks. ”

“ Upon the ground their gait is distinguished by a most absurd assumption of dignity, the upper portion of the body being held considerably raised, whilst they gesticulate with the head in a most laughable attempt to keep time with the movements of the feet. ”

“ The condition is met with chiefly in adolescent males, is nearly always associated with flat-foot, and is then usually bilateral. The patient's gait, in addition to having the characteristic features associated with flat-foot, is peculiarly wooden and inelastic, as instead of rising on the balls of the toes with each step, he puts down and lifts the sole as if it were a rigid plate. The pain is increased by walking. The boot tends to become worn away at the point of the toes and at the posterior edge of the heel, and the usual crease across the dorsum is absent. ”

“ In cases of shoulder lameness the gait alone should be sufficient to render liability of error small, for with nearly every case there is a manifest inability to 'get the limb forward', and this is best seen at a side view when the animal is trotting past the observer. ”

“ Lengthening and shortening the gait at a walk and trot.—Lengthening and shortening of gaits must be executed gradually and by the steady use of the aids. The lowering of the head and the extending of the neck assist in producing a lengthened gait. The raising of the head and curving of the crest favor a shortening of the gait. ”

“ Thus also the largeness of the pelvis, and the approximation of the knees, influence the gait of woman, and render it vacillating and unsteady. Conscious of this, women, in countries where the nutritive system in general and the pelvis in particular are large, affect a greater degree of this vacillation and unsteadiness. An example of this is seen in the lateral and rotary motion which is given to the pelvis in walking, by certain classes of the women of London. ”

“ When this has become easy, hold one foot front or back, and have the other leg do the lifting.
The under part of the thigh, in the ordinary occupations and recreations of life, does not get as much exercise as the front muscles. A slovenly, shambling gait is characterized by a feebleness of this muscle, while a strong, elastic step is accompanied by a well developed under thigh. ”

“ Its special symptom is the peculiar high-stepping gait, the power of locomotion not being properly under the control of the will, and when the eyes are closed, it seems impossible for the afflicted person to walk forward without falling. Like other diseases of its class, it is primarily due to innutrition, the result of imperfect elimination, and has hitherto defied regular medical treatment. ”

“ In locomotion the muscles of the limbs act in coordinately and there is a marked alteration of the gait, which is now halting and now leaping, and the child may be tripped by one limb being suddenly jerked in front of the other. ”

“ The attitude and gait are remarkably altered, the child standing with shoulders thrown back, small of the back deeply curved inwards, and legs wide apart, while walking is accompanied with a peculiar swinging or rocking movement. The calves of the legs, the buttocks, the muscles of the back, and occasionally other muscles, are seen to be unduly enlarged, and contrast strangely with the general feebleness. ”

“ He walks rather quick in the erect posture, but with a waddling gait, and is soon run down if, whilst pursued, he has no opportunity of escaping by climbing.... When he walks in the erect posture, he turns the leg and foot outwards, which occasions him to have a waddling gait and to seem bow-legged. ”

“ In the examination of young animals, unused to harness and to other strange incumbrances, one is obliged to make allowance for impediments of gait, which are not occasioned by diseased conditions. Such affections have been termed "false lameness." ”

“ The narrow point in front pinches our toes, and compels them to override one another; the narrow sole compresses the arch; while the high heel, by throwing all the weight forward on the toes, strains the ankle, and, by sending the pressure where Nature did not design it to fall, causes that joint to become enlarged. The body bends forward to meet the demand of this new motion, and thus loses its uprightness and beauty, making our gait stiff and ungraceful. ”

“ There may be a numbed feeling on the inner side of the arm, and muscular incoordination may affect the upper limb as well as the lower, although there is no wasting or any electrical change. The ataxic gait is very characteristic, owing to the loss of reflex tonus in the muscles, and the absence of guiding sensations from all the deep structures of the limbs, muscles, joints, bones, tendons and ligaments, as well as from the skin of the soles of the feet; therefore the sufferer has to be guided by vision as to where and how to place his feet. ”

“ In bilateral cases the trunk appears well grown in contrast to the short lower limbs, the hollow of the back is exaggerated, the abdomen protrudes, the perineum is broadened, and the buttocks are unduly prominent. The gait is waddling like that of a duck, the trunk lurching from one side to the other with each step. In untreated cases the deformity and disability become more pronounced as the capsular and round ligaments are further stretched, the shortening and limp become more marked, the patient is easily fatigued by walking or standing, and is usually unfitted for earning a living. ”

“ But this unsymmetrical development is a thing to be avoided, as it is usually productive of certain deformities, such as stoop shoulders and certain peculiarities of gait, which are plainly noticeable in men employed in certain avocations. ”

“ As to the pains and bowel and bladder disturbances, their handling will be discussed in considering the treatment of the next or middle stage of tabes. In this period the ataxic symptoms are most prominent; the gait has become so unsteady that the patient needs canes to walk at all and must constantly watch his feet. He walks a little better when well under way, but at starting or when standing still he sways and totters. ”

“ It is astonishing, too, to notice how a man accustomed for years to a poor shambling sort of a gait will, with strict attention to taking a clean and strong step over a certain distance daily, with a determination to take no other sort of gait, soon improve the strength and shape of his thighs. ”

“ Far the commonest and most serious cause of a poor, easily tired gait and a bad carriage is tight shoes, which, by being too short, or too narrow, or both, prevent the arches of the foot from "giving" and expanding. ”

“ They have no thwarts in their canoes to sit upon, but squat down upon the bottom, or bend on their knees. This causes the legs to dwindle when young and to become decidedly crooked. This, too, is the cause of their decidedly shambling gait when walking. ”

“ The effect on the gait is very apparent in any one who walks in high-heeled shoes. The foot itself does not appear to be greatly harmed by the wearing of high heels provided the shoes are otherwise well fitting. ”

“ This is due rather to the stiffness of the limb resulting from the morbid muscular spasm. As the limbs are rigid, the steps are short; the leg not being flexed, and consequently not being lifted from the ground, the gait consists in an awkward shuffle.91 The feet are in continuous contact with the ground, and it is observed that there is a tendency to walk on tiptoe, owing to the contracture of the gastrocnemius, in this respect resembling the pes-equinus position. ”

“ But other parts of the body down to the feet are valuable; great care is bestowed on their postures, and the gait is invaluable in distinguishing classes of persons and their deeds. Darkness need not artificially be induced ”

“ The imperfect supply of blood to the muscles of the extremities sometimes brings about an unsteadiness of gait in the hind limbs when the animal is trotted for a short distance and sometimes cramps supervene. ”

“ Doubtless there is much expression in a torso; in many cases a weakly condition is indicated by a stooping attitude, with a lolling over to one side. It is difficult to indicate in precise terms the positions and movements of the spine, and perhaps this is one reason why so little is known about the action of the muscles of the back. With regard to the lower extremities, the gait and manner in walking may be characteristic of brain or cord disease. ”

“ Agility, for instance, quickness of action and immediate control of the muscles, is far less common in the country than is supposed, although there is probably no lack in the actual power of the muscles. It is common observation that among farmers an erect carriage is less frequently seen than an awkward, shuffling gait. ”

“ I have described, in the second chapter, the gait and appearance of a dog when cheerful, and the marked antithesis presented by the same animal when dejected and disappointed, with his head, ears, body, tail, and chops drooping, and eyes dull. ”

“ Walking, it has been said, agrees with every body. But as it brings into play chiefly the lower limbs and muscles of the loins, and affords little scope for the play of the arms and muscles of the chest, it is of itself insufficient to constitute adequate exercise. To render it most beneficial, the shoulders should be drawn back, and the chest should be enlarged by taking deep inspirations of pure air. The muscles of the chest, and of every part of the body, should be free to move and unconfined by tight clothing. ”

“ Leg exercises are useful for purposes of relieving the engorged veins of the fatigued leg, because the movements of such large masses of muscles as those of the legs and thighs demand large supplies of blood, and consequent quick action on the part of the heart to supply it, and this blood, pouring swiftly back to the lungs for purification, requires frequent and deeper inspirations on their part to effect the purification; leg exercises cause greater development of the chest than do arm exercises. ”

“ Light gymnastics within doors, a brisk walk or horseback ride without, both taken in garments suspended from the shoulders, and devoid of all constriction so that the abdominal viscera can partake in the general movement of the body, are advisable. For invalids or those incapacitated for active exercise, friction or massage treatment daily, including a vigorous kneading of the abdomen, or a relaxation of the entire muscles of the body with especial thought directed to the desired result, are often of great service. ”

“ In an erect posture the abdominal muscles tend to remain taut and to afford proper support or pressure to the abdomen, including the great splanchnic circulation of large blood-vessels. In an habitual slouching posture, the blood of the abdomen tends to stagnate in the liver and the splanchnic circulation, causing a feeling of despondency and mental confusion, headache, coldness of the hands and feet, and chronic fatigue or neurasthenia, and often constipation.
A slouching attitude is often the result of disease or lack of vitality ”

“ Lying face downward with a pillow under the abdomen presses the blood out of the congested splanchnic circulation.
Breathing and Posture
Breathing exercises are also very useful for correcting the chronic evils of bad posture. Exercises taken when lying on the back, by raising the legs or head, strengthen the abdominal muscles. Slow, deep breathing, through the nose, while lying on the back, with a weight on the abdomen, such as a bag of sand—2 to 4 lbs.—is beneficial. ”

“ If a walk be so listless that there is not sufficient movement of the muscles to overcome the pernicious influence of gravity acting on the column of blood contained in the veins of the abdomen, thighs, and legs, the vessel-walls may become permanently overstretched and varicose. The exercise must be sufficiently active for the muscular contractions to empty the lymph-spaces and hasten the circulation. It usually raises the general bodily, as well as the local, temperature of the parts, and so facilitates the removal of the waste-products. ”

“ The fatigue is small, because, in the first place, of the abundant supply of oxygen; the will is scarcely used, and walking is almost automatic, partly because the muscle areas used are large, and each movement prepares for the next. Walking is a heart and lung exercise of a very excellent sort.
The Effect of Walking on the Movements of the Blood in the Legs.—The circulation of the blood depends on the pumping of the heart, which is in turn affected by the suction action of the lungs and the muscular movements of contraction and relaxation which go on rhythmically. ”

“ If a person lean, or stoop forward, the distance between the pelvic bones and the diaphragm is diminished. This prevents the depression of the diaphragm, while the stomach, liver, pancreas, and other abdominal organs, suffer compression, which induces many severe diseases of these organs. As healthy and well-developed muscles keep the spinal column in an erect position, which conduces to the health of the organs of digestion, the child should be taught to avoid all positions but the erect, while studying or walking. ”

“ This, of course, develops and gives tone to the abdominal muscles.
When the woman has conquered these first principles of respiration, she is ready to put them into practice in the standing posture. They should be learned before a mirror, and after that taken before an open window. The hands should be placed on the hips; first elevating the collar-bones and the shoulders to the utmost, while still holding the breath, she expands the chest, always breathing in from above downward, and, lastly, the diaphragm is depressed. ”