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Shell shock: Psychogenic gait and other movement disorders—A film review Cover

Shell shock: Psychogenic gait and other movement disorders—A film review

Open Access
|Mar 2013

Figures & Tables

TABLE 1

Hurst’s Description

Film 1Retrograde amnesia, hysterical paralysis, contractures, mutism, and universal anesthesia. He is completely unaware of the vigorous efforts to overcome the rigidity of his ankles.
Film 2Amnesia, word blindness and word deafness, except to the word “bombs”.
Film 3Facial spasm.
Film 4Lateral tremor of the head.
Film 5Hysterical gait, swaying movement and nose-wiping tic.
Film 6 (2 cases)Private King: hysterical gait and speech. Sandall developed additional symptoms by imitating King.
Film 7Hysterical dancing gait. Leg movement normal while sitting.
Film 8Hysterical shuffling gait following spinal concussion after burial.
Film 9Hysterical pseudo-spastic gait following spinal concussion after burial.
Film 10Hysterical wire spring gait following spinal concussion after burial.
Film 11Hysterical slippery ice gait, with organic basis, after spinal concussion from burial.
Film 12Hysterical ataxic gait following appendicitis in trenches.
Film 13Hysterical gait following rheumatism and burial.
Film 14Film showing the 6 previous patients.
Film 15Hysterical gait following shell shock whilst suffering from trench fever.
Film 16Complete hysterical monoplegia following salvarsan injection.
Film 17Hysterical pseudo-pseudohypertrophic muscular paralysis.
Film 18Hysterical gait following sciatica.
Film 19Hysterical gait following a flesh wound in the thigh.
Film 20Hysterical contracture of the hand persisting 35 months after receiving a wound near elbow.
Film 21War hyperthyroidism–hyperadrenalism.
Film 22Occupational therapy.
Film 23The Battle of Seale Hayne.
TABLE 2

Revised Description

Film 1Possible psychogenic myoclonus along with generalized weakness, rigidity, and the film also attempts to demonstrate hemibody anesthesia. The examiner is attempting to perform forced dorsiflexion movements of the feet but he finds it difficult. Later, the patient presents a complete recovery and he is shown ascending and descending stairs, running, and moving his arms in complex motions.
Film 2The patient does not attempt to speak, and is observed to be unresponsive to language. When the examiner uses the word “bomb”, the patient hides under the bed. There is no movement disorder in this case.
Film 3The patient presented hyperkinetic movements of his bilateral eyelids (up position), left ear (up position) and the frontalis muscle (up position). The eyelid and ear movements were arrhythmic.
Film 4The patient presents very high frequency and inconsistent no-no head tremor, and a masked facies with lips parted.
Film 5The patient presents with astasia abasia and a very wide based gait pattern. During walking he was weaving back and forth with a slight preference to the right. He had increased right sided arm movements, bizarre postures, and atypical wiping of his nose.
Film 6 (2 cases)The two men presented with astasia abasia with a normal based, but drifting, gait. They were orating, talking and were observed walking together. King presented with an excessive amount of hand movements, rocking forward and back, and continuous speaking. Sandall (the other man) presented with atypical myoclonic-like tremor in his upper extremities. When walking his right arm appeared to swing more than his left. He had notable gait shuffling and seemed to be attempting to imitate King.
Film 7This patient is observed skipping and jumping with an astasia gait pattern. He was also using a cane. While sitting he could move his legs normally. After treatment he does not use the cane to walk.
Film 8The patient presented with an atypical magnetic type of gait with drifting to the left. He had an abnormal very fast tremor in the legs, and a balance disturbance. The tremor in the legs appeared possibly as upper motor neuron clonus.
Film 9The patient presented with a drifting and a shuffling gait pattern, and also with imbalance. He had a high frequency bilateral lower limb tremor in both legs, and an overall decrease in right arm movement.
Film 10The patient was observed as shaking, drifting, and shuffling with an abnormal astasia abasia gait pattern. There was a notable decrease in arm movement on the right side. He presents with balance impairment.
Film 11The patient presented with very slow overall movements (akinesia), and a wide based shuffling gait pattern. The gait was cautious, and there was an overall decrease in arm movements.
Film 12There was a shuffling gait and an internal rotation of his right foot. The trunk was rotated to the right, and there was a decrease in arm swing. There was an abnormal posture of the left arm that may have been a contracture.
Film 13The patient was assisted by two canes and he ambulated with a wide based gait. He had a stooped posture, and slow arrhythmic head nodding. After treatment the patient was observed walking without a cane and with good arm swing, and with the absence of the atypical yes-yes tremor.
Film 14The group of patients, previously seen with gait disturbance, walk a straight line with relatively normal gait patterns, normal arm swing, and no hyperkinetic movements. This series of clips support the hypothesis of psychogenic movement disorders.
Film 15The patient presented with a wide based gait with an astasia pattern and he had shaking during walking. His gait was supported by two canes. He had an abnormal arm swing, and was shown to have balance impairment. He was then shown to be walking with a completely normal gait pattern. He held a single cane and had no shaking, and his balance appeared normal. This was likely a psychogenic pattern of movement disorders.
Film 16The patient presented with difficulty when arising from a chair. He required assistance in standing. He had an astasia abasia gait pattern, and a high frequency and a high amplitude tremor predominantly in his right leg. He was holding onto the examiner and also had trunk tremor. When he was lying down in bed, he had a persistent right sided high frequency and high-amplitude arrhythmic and atypical tremor. Following treatment the tremor resolved when he was lying down and the examiner performed passive movements. He was also able to lift his right leg without any tremor and he was shown walking. In the last film clip he was shown arising from bed and walking in the hall of the hospital with an almost normal gait, perhaps with some stiffness. This pattern was most consistent with a psychogenic disorder, but based on the images we could not exclude the possibility of an underlying neurological disorder.
Film 17The patient appears to have a generalized dystonia and has hyperkinetic movements present in the legs, trunk and arms. He appears stiff, especially in his lower limbs. He is seen falling to the floor, and is also shown to have difficulty arising. After 1 hour of treatment he appears as upright and possibly stiff. Following a week of treatment he appears completely normal. He is shown standing, walking and moving. He no longer appears stiff. This pattern is consistent with a psychogenic disorder.
Film 18The patient had an astasia abasia gait pattern and appeared rigid, with a decreased arm swing, and retroflexion of the back. When bending at the hips he flexed one knee but not both. He had balance impairment and used a cane. Following treatment he was able to walk, and to run up and down stairs. He is able to bend the trunk normally with symmetric knee flexion. He is also shown hopping normally.
Film 19The patient presented with an astasia abasia gait pattern, and he walked with a stiff right leg. He had an atypical straight kicking movement on walking. He had an abnormal posture, and an increase in his arm swing on the left. He descended stairs and walked normally after treatment. This pattern was consistent with a psychogenic movement disorder.
Film 20The patient had a contracture of the left hand and was holding his hand, imitating the position of holding a gun. The posture was completely reducible by the examiner. Following treatment the phenomenology changed to dystonia- myoclonus. The movement did not appear to resolve. Though this appeared psychogenic with a changing phenomenology, an underlying neurological disorder could not be excluded.
Film 21The patient presented with a masked face, lips parted and bulging eyes. There was no frontalis muscle contraction. The examination and treatment were not shown. This is possibly not a psychogenic disorder.
Film 22A group of patients was seen exercising , working on the farm, walking, weaving baskets, picking fruits, plowing, seeding a field, herding cattle, washing a pig and carrying objects on a farm.
Film 23This is a clip showing an example re-enactment of the soldiers during war. They are shown marching, in the trenches, being gassed, fighting, and being rescued.
TABLE 3

Diagnosis, Treatment and Results

DiagnosisTreatmentResult
Film 1Amnesia/myoclonus/rigidityOccupational therapy (teaching/making basket)Sudden recovery of memory. Complete recovery 2.5 years after onset.
Film 2Amnesia/word deafnessn/an/a
Film 3Facial spasmHypnosisMovements resumed at hypnosis cessation.
Film 4TremorRelaxation/passive movementsComplete recovery.
Film 5Gait disturbanceRe-education/occupational therapyThe hyperkinetic movements completely resolved; however, he still presented with increased arm swing and a wide based gait.
Film 6 (2 cases)Gait disturbance/tremor/myoclonusSuggestion/occupational therapySandall recovered 2 hours later. King never recovered.
Film 7Gait disturbanceRe-educationImprovement in the same day.
Film 8Gait disturbance/tremorn/aSome improvement after 6 weeks.
Film 9Gait disturbance/tremorn/aImprovement after 3 months.
Film 10Gait disturbance/tremorn/aImprovement after 9 months.
Film 11Gait disturbance/akinesian/aImprovement after 3 months.
Film 12Gait disturbance /dystonian/aImprovement after 2 months.
Film 13Gait disturbance /tremorn/aImprovement after 3 months.
Film 14Group of previous patientsn/an/a
Film 15Gait disturbance/tremorPersuasion/ re-educationCured in the same day.
Film 16Gait disturbance/tremorSuggestion/ re-educationCured in the same day.
Film 17Gait disturbance/dystonian/aCured in the same day.
Film 18Gait disturbance/dystonian/aCured in the same day.
Film 19Gait disturbance/rigidityn/aCured in the same day.
Film 20Dystonia/myoclonusPassive movementsCured in the same day.
Film 21War hyperthyroidism- hyperadrenalismn/an/a
Film 22Occupational therapyn/an/a
Film 23The Battle of Seale Haynen/an/a

[i] Abbreviations: n/a, not available.

DOI: https://doi.org/10.5334/tohm.132 | Journal eISSN: 2160-8288
Language: English
Submitted on: Jul 2, 2012
Accepted on: Dec 4, 2012
Published on: Mar 28, 2013
Published by: Columbia University Libraries/Information Services
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2013 Mariana Moscovich, Danny Estupinan, Muhammad Qureshi, Michael S. Okun, published by Columbia University Libraries/Information Services
This work is licensed under the Creative Commons License.