GAIT AND BALANCE

DISORDERS
GAIT:
Series of rhythmical,alternating
movements of the trunk and limbs which
result in the forward progression of the
center of gravity.
Gait disorders have been described in
15% of individuals older than 65yrs.
Gait disorders approaches to 40% in 85yr
Physiology of gait :
Station is the way patient stands
and gait is the way patient
walks.
In human ,bipedal gait and
erect position over narrow base
require more efficient
maintenance and control of
equilibriun and have more
complex mechanism than
quadruped animals.
VARIOUS CNS CENTRES AND
THEIR ROLE:
Central pattern generators in spinal cord
and brainstem found in lower animals.
These are group of interneurons that co-
ordinate with motor neurons to produce
patterned movements like walking.
Their exiatence is unproven in human but
locomotion likely depends on their
activity.
 Theiractivity is modulated by higher
centres in subthalamaus and mid-brain
especially pedunculopontine nucleus
through reticular fibres.
 Commamd and control centres in
brainstem,cerebellum and forebrain
modify action of spinal pattern generators
to promote stepping.
Step generation is dependent on
locomotor centres in pontine
tegmentum,midbrain and subthalamic
regions.
Locomotor synergies are established
through reticular formation and
decending pathways in ventromedial
spinal cord.
 Gaitdisorders have been classified
descriptively on the basis of abnormal
physiology and biomechanics.

Thegait disorder observed clinically must

be viewed as the product of neurologic
deficit and a functional adaptation.
CAUTIOUS GAIT :
Isused to describe the patient who walks
with an abbreviated stride and lowered
center of mass,as if walking on a slippery
surface.
This is common and non specific.
There may be a/w fear of falling.
STIFF-LEGGED GAIT
{SPASTIC GAIT}:
stiffness in the legs ,imbalance of muscle
tone
Tendency to circumdate
Scuff the feet.

Gait suggests compromise of

corticospinal command and overactivity
of spinal reflexes.
 UMN signs are present on examination.
Disorders may be cerebral or spinal in
origin.
 SPINAL CAUSES OF SPASTIC GAIT:
1. MYELOPATHY
2. HERIDITARY SPASTIC PARAPLEGIA
3. TROPICAL SPASTIC PARAPARESIS
4. TUMOR
5. SPINAL VASCULAR MALFORMATION
 CEREBRAL CAUSES OF SPASTIC GAIT :
1. VASCULAR DISEASE(STROKE)
2. MULTIPLE SCLEROSIS
3. PERINATAL INJURY TO THE NERVOUS
SYSTEM
DYSTONIA:
Sustained muscle contractions

Repititive
twisting movements and
abnormal posture
AUTOIMMUNE STIFF PERSON
SYNDROME:
Exaggerated lumbar lordosis and over
activation of antagonist muscles restrict
trunk & lower limb movement

wooden or fixed posture

SPASTIC GAIT:
FREEZING GAIT:
Brief
,episodic absence of forward
progression of feet despite the intention to
walk.
 COMMON CAUSES OF FREEZING GAIT:
1. PARKINSINS DISEASE(M/C)
2. PROGRESSIVE SUPRANUCLER PALSY
3. MULTIPLE SYSTEM ATROPHY
4. CORTICOBASAL DEGENERATION
FREEZING GAIT:
FRONTAL GAIT DISORDER:
(GAIT APRAXIA)
Shuffling ,freezing gait with imbalance
and other sigs of cerebella dysfuntion.
Wide base support +shuffling along the
floor+difficulty with starts and turns
 CAUSES OF FRONTAL GAIT DISORDER:
1. Subcortical small vessel disease
{Lesions found in deep frontal white matter
and centrum ovale}
2. Ischaemic lesions of deep hemisphere
white matter.
3. Communicating hydrocephalus
CEREBELLAR GAIT ATAXIA:
Wide base of support
Lateral instability of the trunk
Erratic foot placement
Decompensation of balance while
attempting walk on narrow base.
 CAUSES OF CEREBELLAR ATAXIA:
1. STROKE
2. TRAUMA
3. TUMOR
4. NEURODEGENERATIVE DISORDER
5. HERIDITARY CEREBELLAR DEGENERATION
CEREBELLAR ATAXIA:
SENSORY ATAXIA: