Identifying patterns of psychogenic gait by video-recording

Abstract

Objectives: Psychogenic gait is common in patients with medically unexplained neurological symptoms and provides significant challenges to healthcare providers. Clinicians may arrive at a correct diagnosis earlier if distinctive positive signs are identified and acknowledged. This study aims to offer a tool for identifying patterns of psychogenic gait based on positive signs in clinical settings. Design: A video study with assessment of inter-rater reliability. Patients: Thirty consecutive patients diagnosed with psychogenic gait disturbance by neurologist before inclusion. Methods: In a gait laboratory patients were first categorized into 3 categories by 2 of the authors. Another rater was given both oral and written guidance and the next 3 raters only written information. Inter-rater reliability was estimated between the first and the 4 other ratings. Results: The main finding was that psychogenic gait could be categorized into 3 categories. These were: limping of 1 leg, limping of 2 legs; and truncal imbalance. Inter-rater reliability of the classification in the various categories was high. Conclusion:The present study provides the clinician with 3 well-described patterns to examine for if a psychogenic gait disorder is suspected, thereby simplifying detection.

Psychogenic gait disorder: A randomized controlled trial of physical rehabilitation with one-year follow-up

“…Most of the included patients had a severe limp in one leg, often with dragging of the foot, which was rotated laterally or medially. other frequently observed characteristics were walking with small, slow steps, as if walking on ice, or/and truncal imbalance (14).…”

Functional (psychogenic) movement disorders – Clinical presentations

“…One subjective assessment that is often useful is that the balance of the patients is much better than the claim. There are common patterns of psychogenic gait disorders, such as knee buckling, and this can be helpful [20, 21]. …”

iPhone-responsive functional gait disorder: Table 1

“…They have several different clinical features, mostly based on distraction or use of a different motor ‘program’ (eg, running or walking backwards). Table 1 shows gait subtypes and clinical features distilled from the main published series 1 2 3 6. These are examples of the positive signs now required to make a diagnosis of conversion disorder (functional neurological symptom disorder) in DSM-5.…”