Gait apraxia is almost always of gradual onset and is slowly progressive. In its early form the patient walks with her feet close together, takes small steps (each step being less than the length of her foot), and walks with her hips and knees flexed. There are frequent pauses followed by another series of small steps.
The gait deteriorates over months or years until the patient cannot walk at all. An attendant on either side of her or a mechanical walker in front of her makes no difference. Her feet appear glued to the floor. If you move one of her feet out in front of her at the usual distance of a normal stride and ask her to bring the other foot forward, she will inch it forward in multiple small slides up to, but not in front of, the formerly forward foot.
The obscurity of the disorder is compounded when, on examination, you find the normal restless movements of the feet and see the patient cross and uncross her legs in a normal way while sitting. There are no signs of upper motor neuron, sensory system, basal ganglion, or cerebellar disease. These patients can mimic normal walking movements or mimic pedaling a bicycle while lying supine on the examining table.
This gait disorder may be associated with dementia and frontal lobe signs. However, often the association is not present and many severely demented patients have normal gait.
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