Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, received research and training funding from Allergan, F Hoffmann-La Roche, Medtronic Neuromodulation, Merz, Neurocrine Biosciences, Nuvelution, Revance, and Teva and consulting/advisory board honorariums from Abide, Lundbeck, Retrophin, Parexel, Teva, and Allergan.)
This article includes discussion of the motor aspects of gait disorders, gait disturbances, gait failure, walking disorders, brainstem gait disorders, cautious gait disorders, cerebellar gait disorders, cortical-basal gait disorders, extrapyramidal gait disorders, frontal gait disorders, functional (psychogenic) gait disorders, myelopathic gait disorders, myopathic gait disorders, neuropathic gait disorders, orthopedic gait disorders, pyramidal gait disorders, sensory-deprivation gait disorders, subcortical astatic gait disorders, and subcortical gait disorders. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
Disorders of gait and balance are among the most disabling disorders, particularly affecting the elderly (Jankovic 2015). In this article, the author discusses the various causes of gait disorders and how to evaluate and treat them.
• Slowness of gait is a normal consequence of aging, which can be accelerated in the setting of Parkinson disease or other parkinsonian disorders.
• Lower-body parkinsonism usually indicates the presence of vascular etiology, usually a multi-infarct state.
• Most gait disorders in the elderly are of multifactorial origin, including prior strokes, orthopedic or arthritic problems, peripheral neuropathy, and a fear of falling.
Historical note and terminology
Gait is the act and manner of walking. Normal human walking is a learned motor skill that can be performed automatically and without conscious effort. It is also a complex phenomenon that requires action, interaction, and integration of many different parts of the musculoskeletal and nervous systems (Capaday 2002; Dietz 2002a; Dietz 2002b; Nielsen 2003; Zehr and Duysens 2004). Fossil evidence indicates that humans have used the bipedal form of locomotion for more than 1 million years (Napier 1967). Bipedal gait, along with language and speech, are the abilities that differentiate humans from their ancestors. Normal gait is critical to an individual's quality of life. Therefore, disorders of gait are a source of considerable handicap and distress. Although particularly common among the elderly, gait disorders can affect people of any age. However, because of reduced reserves to support balance and gait, the elderly are more prone to gait disturbances and falls (Tinetti 2003).
Gait disturbances must have been recognized and treated throughout history, but cases with primary gait disturbance have been documented in the literature only in the last hundred years. Bruns was the first to use the term "frontal ataxia" to describe severe disequilibrium due to mass lesions in the frontal lobe (Bruns 1892). Petrén reported patients with start hesitation, freezing, and turning pauses and termed the condition "trepidant abasia" (Petren 1901). Von Malaise described the gait pattern marché á petit pas in patients with frontal lobe disorders (Von Malaise 1910). Critchley noted gait abnormalities associated with cerebrovascular disease. In their review, Nutt and colleagues summarized some of the historical perspectives in gait disorders (Nutt et al 1993). Newer classification of gait disorders has been proposed (Tables 1 and 2) (Jankovic et al 2001).
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