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What causes walking/gait disorders?

Causes of walking/gait disorders can range from arthritis to a neurological condition to something as simple as ill-fitting footwear. The variety of gait disorders call for different treatments. What is a gait disorder? Gait is a person’s pattern of walking.

Which involuntary movements interfere with gait disturbance?

Involuntary movements that interfere with gait include action tremor, chorea, myoclonus, ballism, and dyskinesia. Psychogenic gait disturbance is not uncommon and must be considered when the features of gait disturbance are incongruous with respect to its conventional forms and/or when the features and degree of gait disturbance vary over time.

How are gait disorders classified and treated?

Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions.

Which gait disorders are associated with cerebral small vessel disease (CSV)?

Loss of white matter integrity is associated with gait disorders in cerebral small vessel disease. Brain. 2011;134(Pt 1):73–83. doi: 10.1093/brain/awq343. [PubMed] [CrossRef] [Google Scholar] 38.

What is a high stepping gait?

A “high stepping” type of gait in which the leg is lifted high, the foot drops (appearing floppy), and the toes points downward, scraping the ground, when walking.

What are the different types of gait disorders?

The following gait disorders are so distinctive as to earn names: 1 Propulsive gait. This type of gait is seen in patients with parkinsonism. It is characterized by a stooping, rigid posture, and the head and neck are bent forward. Steps tend to become faster and shorter. 2 Scissors gait. This type of gait gets its name because the knees and thighs hit or cross in a scissors-like pattern when walking. The legs, hips, and pelvis become flexed, making the person appear as though he or she is crouching. The steps are slow and small. This type of gait occurs often in patients with spastic cerebral palsy. 3 Spastic gait. Common to patients with cerebral palsy or multiple sclerosis, spastic gait is a way of walking in which one leg is stiff and drags in a semicircular motion on the side most affected by long-term muscle contraction. 4 Steppage gait. A “high stepping” type of gait in which the leg is lifted high, the foot drops (appearing floppy), and the toes points downward, scraping the ground, when walking. Peroneal muscle atrophy or peroneal nerve injury, as with a spinal problem (such as spinal stenosis or herniated disc), can cause this type of gait. 5 Waddling gait. Movement of the trunk is exaggerated to produce a waddling, duck-like walk. Progressive muscular dystrophy or hip dislocation present from birth can produce a waddling gait.

What is spastic gait?

Common to patients with cerebral palsy or multiple sclerosis, spastic gait is a way of walking in which one leg is stiff and drags in a semicircular motion on the side most affected by long-term muscle contraction. Steppage gait.

What is the name of the disorder where the head and neck are bent forward?

The following gait disorders are so distinctive as to earn names: Propulsive gait. This type of gait is seen in patients with parkinsonism. It is characterized by a stooping, rigid posture, and the head and neck are bent forward. Steps tend to become faster and shorter. Scissors gait.

Why does walking make you gait?

Walking involves balance and coordination of muscles so that the body is propelled forward in a rhythm, called the stride. There are numerous possibilities that may cause an abnormal gait. Some common causes are: A degenerative disease (such as arthritis) An inner ear disorder. Stroke.

How to improve balance and flexibility?

Physical therapy and strengthening exercises may be appropriate in other cases to improve balance, strength and flexibility. You should also receive instruction in fall prevention. Maintaining proper foot alignment may require in-shoe splints or leg braces. A shoe lift may help in cases of an unequal leg length.

Which gait is faster?

Steps tend to become faster and shorter. Scissors gait. This type of gait gets its name because the knees and thighs hit or cross in a scissors-like pattern when walking. The legs, hips, and pelvis become flexed, making the person appear as though he or she is crouching. The steps are slow and small.

What does it mean when you have gait disorder?

Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives.

What is the gait pattern?

The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives. The prevalence of gait disorders increases from 10 % in people aged 60–69 years to more than 60 % in community dwelling subjects aged over 80 years. Sensory ataxia due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait disorders. With advancing age the proportion of patients with multiple causes or combinations of neurological and non-neurological gait disorders increases. Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions. This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.

How does gait affect quality of life?

Gait impairments may greatly affect the quality of life [ 2] and restrict the personal independence of those affected. Moreover, balance and gait problems may be precursors of falls, which are the most common cause of severe injuries in the elderly [ 3 ].

How does cognition affect walking?

Investigations over the past two decades have demonstrated the strong effects of cognition on gait [13], including the role of gait speed and gait disorders in older age as an indicator for the future development of dementia and of life expectancy [4–6]. Cognitive control is relevant for circumnavigating obstacles and for choosing the optimal route. Frontal executive functions, visuospatial perception and attention all contribute to walking safely. Psychological factors also influence gait. For instance, depression is associated with slower gait and anxiety may lead to an overly cautious gait. The role of cognition for gait is revealed in the multitask paradigm where persons are asked to perform mental tasks while walking. Elderly persons who stop walking while talking have a significantly higher risk of falling [14]. Further investigations have shown that patients with dementia walk slowly but in relation to their motor and cognitive deficits, they actually walk too fast leading to an increased risk of falling [15]. In situations where there is a risk of falling, healthy persons adopt a posture first strategy, which prioritizes the maintenance of balance over other tasks. This strategy is lost in patients with Parkinson’s disease [16]. These multiple interactions demonstrate that improving cognitive functioning may have an essential role in the rehabilitation of gait disorders.

What is the body system involved in walking?

Walking is a common activity of daily living and at the same time a very complex one. It involves all levels of the nervous system and many parts of the musculoskeletal apparatus as well as the cardiorespiratory system . A person’s gait pattern is strongly influenced by age, personality and mood.

How to start walking?

To start walking, one leg is raised and directed forward by flexing the hips and knee. Activa tion of the supporting contralateral leg and trunk muscles moves the body’s center of gravity over the weight-bearing leg and forward. The heel of the swinging leg is then placed on the ground. The body weight is gradually shifted to the sole and then onwards to the toes. During mid-stance, the opposite leg is lifted and moves forward until the heel strikes the ground. Meanwhile, the body is held upright, the shoulders and pelvis remain relatively level and each arm swings in the direction opposite to that of its ipsilateral leg. The gait cycle (Fig. 1) is divided into the stance and swing phase. The stance phase constitutes approximately 60 % of the gait cycle and is subdivided into initial contact (heel strike), loading response, mid-stance, terminal stance and pre-swing. Both feet are on the ground at the beginning and end of the stance phase. Each of these two double support periods lasts for approximately 10–12 % of the gait cycle. The swing phase takes up about 40 % of the gait cycle and is subdivided into initial swing (toe-off), mid-swing (tibia vertical) and terminal swing, terminated by the heel striking the ground [9, 10].

Why is walking so fast important for older adults?

The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life.