TAILIEUCHUNG - Chapter 024. Gait and Balance Disorders (Part 1)

Harrison's Internal Medicine Chapter 24. Gait and Balance Disorders Prevalence, Morbidity, and Mortality Gait and balance problems are common in the elderly and contribute to the risk of falls and injury. Gait disorders have been described in 15% of individuals over the age of 65. By age 80, one person in four will use a mechanical aid to assist ambulation. Among those 85 and older, the prevalence of gait abnormality approaches 40%. In epidemiologic studies, gait disorders are consistently identified as a major risk factor for falls and injury. A substantial number of older persons report insecure balance and experience falls and. | Chapter 024. Gait and Balance Disorders Part 1 Harrison s Internal Medicine Chapter 24. Gait and Balance Disorders Prevalence Morbidity and Mortality Gait and balance problems are common in the elderly and contribute to the risk of falls and injury. Gait disorders have been described in 15 of individuals over the age of 65. By age 80 one person in four will use a mechanical aid to assist ambulation. Among those 85 and older the prevalence of gait abnormality approaches 40 . In epidemiologic studies gait disorders are consistently identified as a major risk factor for falls and injury. A substantial number of older persons report insecure balance and experience falls and fear of falling. Prospective studies indicate that 20-30 of those over age 65 fall each year and the proportion is even higher in hospitalized elderly and nursing home patients. Each year 8 of individuals 75 suffer a serious fall-related injury. Hip fractures often result in hospitalization and nursing home admission. For each person who is physically disabled there are others whose functional independence is constrained by anxiety and fear of falling. Nearly one in five of elderly individuals voluntarily limit their activity because of fear of falling. With loss of ambulation there is a diminished quality of life and increased morbidity and mortality. Anatomy and Physiology Upright bipedal gait depends on the successful integration of postural control and locomotion. These functions are widely distributed in the central nervous system. The biomechanics of bipedal walking are complex and the performance is easily compromised by injury at any level. Command and control centers in the brainstem cerebellum and forebrain modify the action of spinal pattern generators to promote stepping. While a form of fictive locomotion can be elicited from quadrupedal animals after spinal transection this capacity is limited in primates. Step generation in primates is dependent on locomotor centers in the pontine .

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