Gait disturbance resident survival guide

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.

• Intoxications
• Head trauma
• Carbon monoxide poisoning

Common Causes

• Osteoarthritis
• Pelvic girdle pain
• Ataxia

• Hip dysplasia
• Polio
• Multiple sclerosis

• Cerebellar lesions
• Cerebellar degeneration

• Parkinson's disease

Diagnosis

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

Gait disturbance

When?

Occurs consistently with locomotion (can vary in severity)

Occurs intermittently during locomotion (may vary in severity and frequency)

Suffers from more than one continuous disturbance, or continuous and episodic disturbances, for example, are possible.

Continuous

Episodic

Mixed

Transient inability to create effective stepping

Unintentional increase in speed, usually with small steps

Transient loss of balance

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, axial postural deformities

Secondary to musculo-skeletal or central pain

Higher level

Sometimes it may be difficult to classify the continuous nature of the gait disturbance

Ataxic

Spastic

Bradykinetic/hypokinetic

Dyskinetic/Choreic/Dystonic

Paretic

Trunkal

Antalgic

Frontal

Undetermined

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according to the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.