Bizarre posture and movement disorder with third ventricle astrocytoma

The "chair test" to aid in the diagnosis of psychogenic gait disorders

OBJECTIVE

To evaluate the chair test for diagnosis of psychogenic gait disorders.

BACKGROUND

The diagnosis of psychogenic gait disorders can be difficult. Contained in Paul Blocq's original descriptions of hysterical gait disorders in 1888 are 11 case descriptions of patients with astasia abasia. One description was of a patient who had a "hysterical" gait disorder but could propel a chair while seated normally.

METHODS

Based on Blocq's paper, we describe 9 consecutive patients who presented with a psychogenic gait disorder who underwent "chair testing." Each patient was asked to walk 20-30 feet forward and backward toward the examiner. Patients were then asked to sit in a swivel chair with wheels and to propel the chair forward and backward. These trials were compared with a control group of 9 consecutive movement disorder patients with nonpsychogenic gait problems.

RESULTS

Compared with their walking, 8 of the 9 patients in the psychogenic group performed well on the chair test, showing improved ability to propel a chair forward when seated. By contrast, all 9 control patients performed equally when walking or propelling utilizing the chair.

CONCLUSION

Although it will need more prospective study with better quantitative measurements to determine its true sensitivity and specificity, we believe many practitioners faced with differentiating psychogenic gait disorders from neurologic dysfunction will find the chair test, as well as the observation of a difference in leg function (sitting versus standing), useful diagnostic information.

One step forward and two steps back: the dangers of walking backwards in therapy

Walking backwards has been used in therapy to improve balance and gait. There has not been any systematic investigation into the effectiveness or safety of walking backwards. We present two cases in which walking backwards during physical therapy resulted in a fall and considerable morbidity. The only clear indication for treatment by walking backwards should be a task-specific need to do so, and only then if adequate safety can be assured.