HOW TO IDENTIFY PSYCHOGENIC DISORDERS OF STANCE AND GAIT - A VIDEO STUDY IN 37 PATIENTS
HOW TO IDENTIFY PSYCHOGENIC DISORDERS OF STANCE AND GAIT - A VIDEO STUDY IN 37 PATIENTS
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DOI：
10.1007/bf00319680
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发表时间：
1991-01-01
影响因子：
6
通讯作者：
HUPPERT, D
中科院分区：
文献类型：
--
作者：
LEMPERT, T;BRANDT, T;HUPPERT, D
对 37 名患有心因性站立和步态障碍的患者进行了临床评估、视频记录和临床现象学分析。确定了特征性、暗示性和非特异性特征。事实证明，六个特征对于心理发生的诊断最有价值，因为它们单独或组合出现在 97% 的患者中：（1）姿势和步态的瞬时波动，通常是对建议的反应； (2) 与神经系统疾病不相容的运动过度缓慢或犹豫； (3)“心因性”Romberg 测试，在静默潜伏期后摇摆幅度增加或通过分心得到改善； (4) 不经济的姿势，浪费肌肉能量； (5)“冰上行走”步态，其特点是小步谨慎，踝关节固定； (6)膝盖突然屈曲，通常不伴有跌倒。百分之七十三的患者有额外的暗示性特征。发现对特征亚型进行分类没有用，因为主要特征因患者而异，并且以各种组合出现。对 13 名健康戏剧学生的人为站立和步态障碍进行了研究。与临床心因性障碍相比，模拟步态功能障碍似乎不太明显且更难以诊断。
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.