Bedside Patterning

Gait pattern localizer

Use stride geometry, base width, turning burden, cue response, and eyes-closed stress to separate basal ganglia, cerebellar, sensory, corticospinal, and frontal gait syndromes.

Dominant phenotype: Hypokinetic gait

Clinical presets

Start from the gait grammar you want to teach

Some patterns are narrow-base and cue-responsive, others are broad, irregular, asymmetrically weak, or visually dependent. The point is to localize from the way the patient walks, not from one buzzword.

Footprint lane

Walkway pattern under the current phenotype

Step geometry

Symmetry versus width

Hemiparetic patterns exaggerate side-to-side stride differences, while cerebellar and sensory patterns broaden the lane and add irregularity.

Stressors

What makes this gait fall apart

start92%

turn95%

eyes closed26%

dual task82%

The highest bar is often the single bedside condition that separates one gait syndrome from another.

Phenotype

Parkinsonian freezing

Hypokinetic gaitcue response 76%

Short shuffling steps, reduced arm swing, and a marked start-turn burden that improves with external cueing.

Cadence

116/min

Step frequency alone can mislead if stride length and turning burden are ignored.

Base width

11 cm

Wide bases suggest balance calibration or sensory dependence more than basal ganglia hypokinesia.

Stride asymmetry

2 cm

Large asymmetry pulls you toward pyramidal or focal peripheral patterns.

Turn burden

8 steps

Turns expose gait programming and postural control better than straight walking alone.

Strongest localization

Circuit before disease label

Basal ganglia output network with impaired automatic gait scaling and reduced brainstem locomotor drive.

Stride length generation collapses more than raw strength. The patient can often step larger when the movement is externally cued, which argues for gait-scaling failure rather than pyramidal weakness.

Dominant clue

What the gait is telling you

Turning and gait initiation are much worse than seated leg power testing would predict.

A pure frontal gait-apraxia syndrome is weaker when rhythmic cueing reliably expands stride length and the base stays narrow rather than broad.

Bedside grammar

Findings worth verbalizing

Reduced arm swing and en bloc turning.
Step size is too small for the requested pace.
Doorways and turns provoke freezing more than straight walking does.

Bedside tests

Quick probes that settle the differential

Straight walk with cueing

Auditory or visual cues enlarge step length.

Supports gait scaling failure rather than fixed weakness.

Pull test and turn

Postural recovery is delayed and turns fragment into many small steps.

Highlights axial control failure and freezing susceptibility.

Dual-task walking

Conversation sharply shortens steps and worsens freezing.

Shows dependence on attentional compensation for automatic gait.

Rehab cueing

Practical teaching and support moves

Use external rhythm, floor stripes, or counting to widen steps.
Break turning into deliberate quarter turns rather than one pivot.
Reduce doorway clutter and cue the first step before movement starts.

Continue the loop

Connect gait to anatomy, stroke, loops, and tutoring

Motor Pathway Explorer

Clinical motor system localization

Brain Atlas

Post-clinical anatomical convergence

Stroke Vascular Territories

Acute neurovascular localization

Dopamine Prediction Error Lab

Computational clinical neuroscience

Basal Ganglia Loop Explorer

Movement-disorders circuitry

Neuro Tutor

Cross-module consult reasoning with explicit scoring