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Gait disturbance resident survival guide

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Gait disturbance Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.

Synonyms and Keywords: gait disturbance management, gait disturbance workup, gait disturbance approach, approach to disequilibrium, approach to imbalance

Overview[edit | edit source]

Gait disturbance refers to an impaired sense or absence of balance or equilibrioception that primarily occurs during standing or walking. Gait disturbance usually occurs without any cephalic sensations like headache, nausea, and vomiting. It may also causes dizziness, but it is typically a more complex category with more continuous symptoms in comparison to the other causes of dizziness, like presyncope and vertigo.

Causes[edit | edit source]

Life Threatening Causes[edit | edit source]

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes[edit | edit source]

Diagnosis[edit | edit source]

Shown below is an algorithm summarizing the diagnosis of Gait disturbance according to the American Academy of Neurology guidelines:[1]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gait disturbance
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
When?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Always with movement (may vary in severity)
 
 
 
 
 
 
 
Intermittently during movement (may vary in severity and frequency)
 
 
 
Continuous and intermittent disturbances are present at least once
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Continuous
 
 
 
 
 
 
 
Episodic
 
 
 
Mixed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Transient inability to create effective stepping?
 
Unintentional increase in speed, usually with small steps?
 
Transient imbalance?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Freezing
 
Festination
 
Disequilibrium
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Disequilibrium and hypermetria of stance and gait?
 
Associated with increased postural tone?
 
Slow or small steps and/or slow or small postural?
 
Involuntary movements?
 
Associated with muscle weakness or paralysis?
 
Static or axial postural deformities?
 
Secondary to musculoskeletal or central pain?
 
Present at a higher level?
 
Difficult to classify the continuous nature of the gait disturbance?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ataxic
 
Spastic
 
Bradykinetic/hypokinetic
 
Dyskinetic/Choreic/Dystonic
 
Paretic
 
Trunkal disturbance
 
 Antalgic
 
Frontal disturbance
 
Undetermined
 


Treatment[edit | edit source]

Treat the underlying cause.

Do's[edit | edit source]

  • Perform a top-down visual orientation evaluation to assess symmetry, quantity, and quality of arm swing; pelvic rotation; knee motion; pelvic tilt; and lateral trunk shift.[2]
  • Perform a bottom-up orientation evaluation to assess ankle, subtalar, midfoot, and hallux motion symmetry, quantity, and quality.[2]
  • Perform a thorough evaluation of gait, measuring gait on a level surface, change in gait speed, gait with horizontal head turns, gait with vertical head turns, gait with pivot turn, step over obstacle, gait with narrow base of support, gait with eyes closed, ambulating backwards, and steps.[3][4]
  • Be aware of the patients' surroundings and be always aware for possible falls.[5]
  • Three-dimensional analysis systems may be used as a tool as it is currently the gold standard for measuring spatiotemporal variables and joint kinematics.[6]
  • Innovative pressure measurement technology may provide unique insight on mechanical dysfunctions and gait abnormalities.[7]

Don'ts[edit | edit source]

References[edit | edit source]

  1. Giladi N, Horak FB, Hausdorff JM (September 2013). "Classification of gait disturbances: distinguishing between continuous and episodic changes". Mov Disord. 28 (11): 1469–73. doi:10.1002/mds.25672. PMC 3859887. PMID 24132835.
  2. 2.0 2.1 Deppen, R (2007). "From the CORE to the Floor—Interrelationships": 145–173. doi:10.1016/B978-044306642-9.50013-7.
  3. "Functional Gait Assessment - Physiopedia".
  4. "Rehabilitation Measures | Shirley Ryan AbilityLab".
  5. . 2013. doi:10.1016/C2009-0-64011-3. Missing or empty |title= (help)
  6. . 2019. doi:10.1016/C2016-0-03480-0. Missing or empty |title= (help)
  7. "Gait Analysis Systems | Tekscan".

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