Gait disturbance resident survival guide

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

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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

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### Life Threatening Causes

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

* Intoxications
* Head trauma
* Carbon monoxide poisoning

### Common Causes

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* Osteoarthritis
* Pelvic girdle pain
* Ataxia

* Hip dysplasia
* Polio
* Multiple sclerosis

* Cerebellar lesions
* Cerebellar degeneration

* Parkinson's disease

## Diagnosis

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

| Gait disturbance|

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| 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

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Treat the underlying cause.

* To view the specific treatment of Ataxia click here.
* To view the specific treatment of Multiple sclerosis click here.
* To view the specific treatment of Polio click here.
* To view the specific treatment of Osteoarthritis click here.
* To view the specific treatment of Hip dysplasia click here.

## Do's

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* 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

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* Do not delay brain imaging when TBI is suspected.
* Do not perform walking tests in patients with severe acute gait disturbance.

## References

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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".