‘Gunslinger’s gait’ should be included in differential diagnosis

By Eleanor McDermid, Senior medwireNews Reporter

Published on December 23, 2015

An analysis of the gait of top Russian officials has led researchers to warn neurologists against interpreting a probable behavioural adaptation as a pathological gait pattern.

As reported in the Christmas edition of TheBMJ, Bastiaan Bloem (Radboud University Medical Centre, Nijmegen, the Netherlands) and colleagues noted that five Russian officials, including President Vladimir Putin, all have a markedly reduced right-arm swing when walking.

Studying YouTube videos, the team found multiple examples of reduced right-arm swing in these officials, along with evidence of otherwise normal function of the right arm.

They highlight that much of their evidence came from ceremonial events, in which the officials took long walks along red carpets.

“We always tell our neurology residents that one cannot adequately assess gait (and especially arm swing) in the limited confines of the consulting room and urge them to take their patients out into the corridor”, they say.

Assuming that all five Russian officials were not, in fact, presenting early signs of Parkinson’s disease, Bloem and team uncovered an alternative explanation, in a KGB manual advising trainees to keep their right arm close to their chest when walking, to facilitate rapid access to their firearm.

They therefore suggest that the reduced right-arm swing is a behavioural adaptation, which they term “gunslinger’s gait”. Two of the Russian officials, including Putin, are former KGB officials and two others have strong links to the Russian military, suggesting that all four could have received firearms training. The fifth official has no known links, so the team suggests his reduced arm swing could be a different type of behavioural adaptation: “the ‘imitate the boss’ phenomenon”.

“We conclude that unawareness of weaponry training might lead clinicians to misdiagnose healthy individuals as having a pathological gait, perhaps even parkinsonian”, say the researchers.

“We recommend that neurologists, in particular those working in Russia, include ‘gunslinger’s gait’ in their differential diagnosis of an asymmetrically reduced arm swing, along with other known causes such as Parkinson’s disease and shoulder pathology.”

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