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.