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.


CONCLUSIONS
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.
Okun
Michael S
MS
Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida 32610, USA. okun@neurology.ufl.edu
Rodriguez
Ramon L
RL
Foote
Kelly D
KD
Fernandez
Hubert H
HH
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009069:Movement Disorders / Q000503:physiopathology; D009460:Neurologic Examination / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000523:psychology