Gait disturbance resident survival guide: Difference between revisions

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==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of Gait disturbance according to the American Academy of Neurology guidelines:<ref name="pmid24132835">{{cite journal |vauthors=Giladi N, Horak FB, Hausdorff JM |title=Classification of gait disturbances: distinguishing between continuous and episodic changes |journal=Mov Disord |volume=28 |issue=11 |pages=1469–73 |date=September 2013 |pmid=24132835 |pmc=3859887 |doi=10.1002/mds.25672 |url=}}</ref> <br><br>
Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality|Gait disturbance]] according to the American Academy of Neurology guidelines:<ref name="pmid24132835">{{cite journal |vauthors=Giladi N, Horak FB, Hausdorff JM |title=Classification of gait disturbances: distinguishing between continuous and episodic changes |journal=Mov Disord |volume=28 |issue=11 |pages=1469–73 |date=September 2013 |pmid=24132835 |pmc=3859887 |doi=10.1002/mds.25672 |url=}}</ref> <br><br>


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==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according to the [...] guidelines.  
Treat the underlying [[Causes|cause]].  
==Do's==
==Do's==


*The content in this section is in bullet points.
*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.<ref name="Deppen2007">{{cite journal|last1=Deppen|first1=R|title=From the CORE to the Floor—Interrelationships|year=2007|pages=145–173|doi=10.1016/B978-044306642-9.50013-7}}</ref>
*Perform a bottom-up orientation evaluation to assess [[ankle]], [[Subtalar joint|subtalar]], midfoot, and [[hallux]] [[Motion (physics)|motion]] [[symmetry]], [[quantity]], and quality.<ref name="Deppen2007" />
*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.<ref name="urlFunctional Gait Assessment - Physiopedia">{{cite web |url=https://www.physio-pedia.com/Functional_Gait_Assessment#cite_note-Rehab-2 |title=Functional Gait Assessment - Physiopedia |format= |work= |accessdate=}}</ref><ref name="urlRehabilitation Measures | Shirley Ryan AbilityLab">{{cite web |url=https://www.sralab.org/rehabilitation-measures?ID=893 |title=Rehabilitation Measures &#124; Shirley Ryan AbilityLab |format= |work= |accessdate=}}</ref>
*Be aware of the patients' surroundings and be always aware for possible [[Falling (accident)|falls]].<ref>{{cite journal|year=2013|doi=10.1016/C2009-0-64011-3}}</ref>
*Three dimensional analysis systems may be used as a tool as it is currently the gold standard for measuring [[Spatiotemporal Epidemiological Modeler|spatiotemporal]] variables and joint kinematics.<ref>{{cite journal|year=2019|doi=10.1016/C2016-0-03480-0}}</ref>
*Innovative pressure measurement technology may provide unique insight on mechanical dysfunctions and [[gait]] abnormalities.<ref name="urlGait Analysis Systems | Tekscan">{{cite web |url=https://www.tekscan.com/gait-analysis-systems?utm_source=google&utm_medium=cpc&utm_term=gait+analysis&utm_content=eta4&utm_campaign=medical&gclid=Cj0KCQjwreT8BRDTARIsAJLI0KJcw66kGRfB_G1kvNywAVn5-qi5wv0IYFD9Yb9sMUm0xLcNIiF-ORAaAraREALw_wcB |title=Gait Analysis Systems &#124; Tekscan |format= |work= |accessdate=}}</ref>


==Don'ts==
==Don'ts==

Revision as of 14:03, 28 October 2020

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

Synonyms and Keywords: disequilibrium, ataxia, spasticity, paresis, hypokinesia, imbalance

Overview

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

Causes

Life Threatening Causes

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

Common Causes

Diagnosis

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

Treat the underlying cause.

Do's

  • 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

  • The content in this section is in bullet points.

References

  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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