Upper Motor Neuron Disease

Unilateral The hemiplegic gait is identified by arm and leg posture and performance. The arm does not swing and the fingers, wrist, and elbow are flexed. The arm is usually adducted, with the forearm across the abdomen.

The thigh is abducted at the hip, swung out and forward, with fixed plantar flexion and inversion of the foot. There is weakness of both foot dorsiflexion at the ankle and thigh flexion at the hip. For both of these reasons, the entire lower limb is swung out from the hip and then brought forward, thus keeping the toe from dragging on the floor.

Bilateral In bilateral upper motor neuron disease the legs are stiff and the steps are small with the knees adducted and little movement at the ankle, ir respective of which foot is holding the weight or is coming forward. Walking requires a lot of effort, and the toes are often dragged on the floor. There is often a compensating movement of the trunk or upper limbs with each labored movement of the lower limbs.

The apt expression jiggling describes a mixed spasticity and cerebellar ataxia and is most frequently seen in patients with multiple sclerosis. The intention tremor of the lower limbs as each foot comes down to the floor plus the stiffness results in a whole body movement that is a fine tremble or "jiggle," mostly in the vertical dimension.

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