TAILIEUCHUNG - Chapter 024. Gait and Balance Disorders (Part 2)

Disorders of Gait The heterogeneity of gait disorders observed in clinical practice reflects the large network of neural systems involved in the task. There is the potential for abnormalities to develop, and walking is vulnerable to neurologic disease at every level. Gait disorders have been classified descriptively, based on the abnormal physiology and biomechanics. One problem with this approach is that many failing gaits look fundamentally similar. This overlap reflects common patterns of adaptation to threatened balance stability and declining performance. The gait disorder observed clinically must be viewed as the product of a neurologic deficit and a functional adaptation | Chapter 024. Gait and Balance Disorders Part 2 Disorders of Gait The heterogeneity of gait disorders observed in clinical practice reflects the large network of neural systems involved in the task. There is the potential for abnormalities to develop and walking is vulnerable to neurologic disease at every level. Gait disorders have been classified descriptively based on the abnormal physiology and biomechanics. One problem with this approach is that many failing gaits look fundamentally similar. This overlap reflects common patterns of adaptation to threatened balance stability and declining performance. The gait disorder observed clinically must be viewed as the product of a neurologic deficit and a functional adaptation. Unique features of the failing gait are often overwhelmed by the adaptive response. Some of the common patterns of abnormal gait are summarized below. Gait disorders can also be classified by etiology as listed in Table 24-1. Table 24-1 Etiology of Gait Disorder Cases Percent Sensory deficits 22 Myelopathy 20 Multiple infarcts 18 Parkinsonism 14 Cerebellar degeneration 8 Hydrocephalus 8 Toxic metabolic 3 Psychogenic 4 Other 6 Unknown cause 17 Total 120 100 Source Reproduced with permission from Masdeu et al. Cautious Gait The term cautious gait is used to describe the patient who walks with an abbreviated stride and lowered center of mass as if walking on a slippery surface. This disorder is both common and nonspecific. It is in essence an adaptation to a perceived postural threat. A fear of falling may be associated. In one study this disorder was observed in more than one-third of older patients with a higher level gait disturbance. Physical therapy often improves walking to the degree that follow-up observation may reveal a more specific underlying disorder. Stiff-Legged Gait Spastic gait is characterized by stiffness in the legs an imbalance of muscle tone and a tendency to circumduct and scuff the

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