Lempert T, Brandt T, Dieterich M, Huppert D
Neurologische Universitätsklinik, München, Federal Republic of Germany.
J Neurol. 1991 Jun;238(3):140-6. doi: 10.1007/BF00319680.
Thirty-seven patients with psychogenic disorders of stance and gait were clinically evaluated, recorded on video, and analysed with regard to clinical phenomenology. Characteristic, suggestive and unspecific features were identified. Six characteristic features proved most valuable for diagnosis of psychogenesis, as they occurred alone or in combination in 97% of patients: (1) momentary fluctuations of stance and gait, often in response to suggestion; (2) excessive slowness or hesitation of locomotion incompatible with neurological disease; (3) "psychogenic" Romberg test with a build-up of sway amplitudes after a silent latency or with improvement by distraction; (4) uneconomic postures with wastage of muscular energy; (5) the "walking on ice" gait pattern, which is characterized by small cautious steps with fixed ankle joints; (6) sudden buckling of the knees, usually without falls. Seventy-three percent of patients had additional suggestive features. Classification into characteristic subtypes was not found useful because predominant features varied from patient to patient and occurred in various combinations. Factitious impairment of stance and gait was studied in 13 healthy drama students. Simulated gait dysfunction appeared less conspicuous and more difficult to diagnose than the clinical psychogenic disorders.
对37例姿势和步态的心理性障碍患者进行了临床评估，拍摄了视频，并对临床现象学进行了分析。确定了特征性、提示性和非特异性特征。六个特征性特征被证明对心理性诊断最有价值，因为它们单独出现或组合出现于97%的患者中：(1)姿势和步态的瞬间波动，通常对暗示有反应；(2)与神经系统疾病不相容的过度缓慢或运动犹豫；(3)“心理性”闭目难立试验，在无声潜伏期后摇摆幅度增加或通过分心改善；(4)浪费肌肉能量的不经济姿势；(5)“在冰上行走”步态模式，其特征为脚踝关节固定的小而谨慎的步伐；(6)膝盖突然屈曲，通常不跌倒。73%的患者有其他提示性特征。由于主要特征因患者而异且以各种组合出现，因此发现分类为特征性亚型并无用处。对13名健康的戏剧学生进行了姿势和步态的人为损伤研究。模拟的步态功能障碍比临床心理性障碍显得不那么明显且更难诊断。
