What is Gait Disturbances?
Gait disturbances refer to any changes from the normal pattern of walking. There could be several different reasons or causes for these changes, and because they can appear in different forms, it’s important to be alert to notice them. The cause can usually be figured out through observing the symptoms and conducting diagnostic tests. Walking problems can be broken down into two main types: episodic and chronic disturbances.
Episodic disturbances are those that occur suddenly and to which the patient has not yet become accustomed. These are often a common cause of complications, such as unexpected falls. Examples of episodic disturbances include “freezing gait” (where a person temporarily can’t move), “festinating gait” (rapid, small, shuffling steps), and “disequilibrium” (a loss of balance). Most other walking problems fall under the chronic category. These are continuous disturbances that the patient has become used to due to long-term neurological dysfunction (problems with the nervous system).
Neurological causes are more widespread than non-neurological ones. Common neurological causes include sensory ataxia caused by polyneuropathy (loss of sensation due to nerve damage), Parkinson’s disease, subcortical vascular encephalopathy (brain disease due to problems with blood vessels), and dementia. On the other hand, conditions like hip and knee osteoarthritis, which cause pain and limit motion, are common non-neurological causes of walking disorders.
Walking disturbances can significantly impact patients, especially in terms of their quality of life and overall health. They can even increase the risk of death.
What Causes Gait Disturbances?
It’s important for doctors to understand the various causes of problems with walking, or what they call ‘gait disturbances’, in order to effectively diagnose and treat these conditions. Gait disturbances can come from a broad range of issues related to the nervous system, muscles and bones, and even body-wide disorders. Each of these has unique ways of changing how our body works, which can affect our walking patterns and ability to move.
Several diseases can affect our nervous system, which controls our movement, and this can ultimately affect our gait. This is because of the complex communication within our nervous system, even minor changes can lead to problems with walking. Conditions like Parkinson’s disease, Huntington’s disease, and a condition called normal pressure hydrocephalus can alter brain functions to the point where walking becomes difficult. Additionally, weakness in the hips and lower muscles can also lead to gait disturbances. Conditions like cerebral palsy, muscular dystrophy, Charcot Marie Tooth disease, ataxia-telangiectasia, spinal muscular atrophy, peroneal neuropathy, and microvascular white-matter disease can all cause significant problems with walking.
Problems with body salts, also known as electrolyte imbalances, including low sodium, potassium, and magnesium, can cause problems with walking. Low sodium is the most common and can cause severe nerve symptoms that affect gait. These electrolytes are very important for muscle function, which is vital for normal walking.
Not getting enough of certain vitamins can also contribute to gait imbalances, including folate, vitamin B12, vitamin E, and copper. The lack of these vitamins can cause nerve problems, which interfere with proper walking. For example, vitamin B12 deficiency can lead to a condition called subacute combined degeneration of the spinal cord, leading to numbness and tingling, which ultimately affects walking.
Mental health factors like anxiety and depression, as well as faking symptoms, also need to be ruled out.
There are other potential causes too, including pain, blood vessel conditions, injuries, autoimmune disorders, inflammation, metabolic disorders, cancer-related conditions, other cancer-related syndromes, and a condition known as tabes dorsalis.
Risk Factors and Frequency for Gait Disturbances
Gait disturbances, or issues with walking, become more prevalent as a person gets older. These problems can be due to a variety of reasons, which can be both neurological (related to the brain) and non-neurological. Studies indicate that although around 85% of individuals who are 60 years old have a normal walking pattern, this decreases to just 20% by the time they are 85 years old.
These walking issues are not usually seen in younger people unless they are caused by developmental or muscle-related problems. There is no significant difference between men and women in terms of how common these walking problems are. However, men typically face more walking disturbances tied to brain-related issues, while women encounter more problems not related to the brain.
- Gait disturbances become more common as we age
- These can be due to neurological (brain-related) or non-neurological causes.
- Around 85% of 60-year olds have a normal walking pattern, but only 20% of 85-year olds do.
- Gait disturbances are not often seen in younger people, unless caused by development or muscle issues.
- There’s no significant gender difference in the frequency of these issues.
- Men tend to have more brain-related walking issues, while women have more issues not related to the brain.
Signs and Symptoms of Gait Disturbances
If someone is having trouble walking, a thorough patient history can help to figure out the reason. This should include both their social and medical history. Understanding how long they’ve been having these symptoms and whether they came on all of a sudden or gradually got worse can also be helpful. Some key things to look out for are changes in someone’s diet, their ability to do everyday activities, and any physical limitations.
Clinical examinations for walking difficulties typically involve checking several aspects of a person’s movement:
- How they stand
- Their posture
- Their stance (whether it’s close together or wide)
- How they start to walk
- How they walk
- The length and speed of their steps
- Arm swing
- If they freeze while walking
- How they turn
- Walking in a straight line one foot right in front of the other (tandem gait)
- The Romberg test
- Walking with closed eyes (blind walk)
- Walking backward
- Turning fast
- Walking on their heels
- Walking on their toes
- If they can run.
While examining a patient, the healthcare professional can categorize the walking difficulty into two types: musculoskeletal (related to the muscles and skeleton) or neuromuscular (related to the nerves and muscles).
There are various kinds of gait disturbances – each having a different cause and appropriate treatment. Some of these include the Antalgic gait which is a limp caused by pain; Vaulting gait more common in children and caused by having one leg longer than the other; Trendelenburg gait where the pelvis drops to the unaffected side due to hip abductor weakness; and many others. Each gait disturbance has its specific treatment, usually focusing on addressing its underlying cause.
Testing for Gait Disturbances
Looking into issues with walking involves a thorough approach to figure out the underlying causes and how it affects the patient’s daily life. Simply observing how a patient walks can give a lot of information about what might be causing the problem. It’s important to watch how a patient moves during each step and spot where they might be adjusting their walk to make up for difficulties. Checks of how joints move, whether there’s pain in the joints, the amount of strength in the limbs, and coordination are all important steps in this process. The coordination of the knee, ankle, and foot need to be spot-on for a proper walk. It’s also important to assess the risk of falls for all patients with walking issues.
Lab tests can be very useful to rule out issues like imbalance of body chemicals or lack of certain vitamins. A full blood count and a check of the body’s basic chemical balance can show most of these imbalances. If there’s a strong suspicion of certain problems, further lab tests can be ordered and checked.
Tests that use imaging are important for diagnosing structural causes of issues with walking. The type of imaging test will depend on the patient’s symptoms. If the doctor suspects nerve or muscle issues, they might order nerve conduction studies. This is a test that measures how fast an electrical impulse moves through a nerve, helping to pinpoint any nerve damage.
Treatment Options for Gait Disturbances
If someone is having difficulty walking, often known as a “gait disturbance”, the first step to treatment is figuring out what is causing the problem. Once a proper diagnosis has been established, a tailored treatment plan can be created. This might involve physiotherapy, medications, or even a medical procedure like deep brain stimulation. The complexity and intensity of the treatment will depend on how severe the symptoms are and what is causing the walking problems.
For example, if the patient is experiencing gait disturbances due to a lack of certain vitamins, they can be educated about it and given supplements to increase their body’s vitamin levels. They’d also get regular blood tests to make sure that the supplements are working and their vitamin levels are back to normal. Lifestyle changes might also be suggested, like changing their diet to eat foods that are rich in the vitamins they’re lacking.
Some difficulties in walking can have neurological causes, meaning they originate from problems in the brain or nervous system. In these cases, different medications can be prescribed to alleviate symptoms and boost the levels of neurotransmitters, chemicals in the brain that are important for things like balance and coordination. In cases of degenerative cerebellar disease, a progressive condition that affects the part of the brain responsible for balance and coordination, intensive training on maintaining good posture and improving walking patterns may be recommended.
Interestingly, researchers have made the most progress in treating walking problems in patients with Parkinson’s disease. Effective medications, deep brain stimulation, and different physical therapy techniques have greatly improved walking in these patients. Particularly, external cueing physiotherapy intervention has been beneficial. This type of therapy uses visuals and sounds to help improve patients’ gait. Other options include treadmill walking, cognitive training, and exercises that can be done at home.
Patients can also benefit from a combination of different types of treatments like gait training, exercises for strength and balance, use of walking aids, and strategies to prevent falls. Certain types of exercises, such as strength, power, and resistance training, as well as coordination training, can help improve walking speed in older individuals.
What else can Gait Disturbances be?
If someone is having trouble walking normally, there are a lot of possible reasons why. To figure out what’s going wrong, doctors need to carefully question the person, examine them, and potentially order some tests. Conditions that could potentially cause walking problems include:
- Neurological issues – this could be a disease like Parkinson’s or Huntington’s, brain conditions like dementia or stroke, spinal conditions like multiple sclerosis or Guillain-Barré syndrome, or muscle diseases like muscular dystrophy or Charcot-Marie-Tooth disease.
- Musculoskeletal problems – including arthritis, hip abnormalities, and spinal stenosis.
- Metabolic disorders – like diabetes, obesity, or imbalances in some substances like vitamins or electrolytes in the body.
- Psychiatric conditions – including substance abuse, depression, and anxiety. It’s worth noting that some people could feign gait disturbances for various reasons.
- Other causes – the issue might relate to pain, side effects from medication, exposure to toxins, trauma, cancer, diseases of the blood vessels or the immune system, processes related to inflammation or cancer, or other processes in the body.
This list is only a starting point in diagnosing why someone might be having trouble walking. Each individual should consult their doctor for an accurate diagnosis and treatment plan.
What to expect with Gait Disturbances
How well you can walk, or your “gait,” can be impacted by many different things. How severe the issue is, what caused it, and your own personal health can all affect your ability to walk. Sometimes, spotting the problem early and correctly treating it can significantly improve your ability to walk and move around. For example, if a metabolic disorder (a problem with how your body turns food into energy) is causing your walking problem, you can usually get better once the disease is treated, often without any long-lasting effects.
However, if your walking problem is due to a long-term and worsening illness, such as Parkinson’s disease or multiple sclerosis, your walking may continue to get worse despite treatment. This can lead to complications such as falls, injuries, and a decline in physical functioning, especially for older individuals or people with other health conditions.
That being said, a team of health professionals, who work together to help you improve your walking, manage your other health conditions, and improve your overall quality of life, can positively impact your outcome by minimizing disability and helping you stay independent. The sooner this team of healthcare providers intervenes and comes up with a detailed, personalized care plan designed for your specific needs, the better your chances of improving your walking, and therefore your long-term health prospects.
Possible Complications When Diagnosed with Gait Disturbances
Gait disturbances, or problems with walking, can lead to more than just difficulty moving around. They can significantly impact various parts of patients’ lives. One of the main issues is that they increase the risk of falls, which can lead to a whole range of injuries. These could be anything from minor bruises to severe fractures or even head trauma. Often these injuries can result in hospitalizations, and a decline in ability to function.
Additionally, changes in the way a person walks can also lead to muscle imbalances, strains on joints, and long-lasting pain. These issues can further hinder a person’s mobility and overall quality of life. There are also psychological effects to consider, such as anxiety, depression, and fear of falling. These can lead to patients feeling isolated and can reduce their overall well-being.
Furthermore, problems with walking may hinder patients’ ability to carry out daily activities independently. This can lead to them losing their autonomy and having to rely more on caregivers or devices that assist them. Therefore, it’s important to have comprehensive management strategies that address both the physical and emotional aspects. They are essential to minimize the complications associated with gait disturbances and to improve patient outcomes.
Complications of Gait Disturbances:
- Increased risk of falls and related injuries
- Muscle imbalances
- Joint strains
- Chronic pain
- Anxiety, depression, and fear of falling
- Social isolation
- Inability to perform daily activities independently
- Loss of autonomy
- Increased reliance on caregivers or assistive devices
Preventing Gait Disturbances
The main ways to prevent walking problems are to identify and manage any things that can be changed and contribute to these issues. Doing regular exercise, particularly focusing on strength and balance, can help maintain muscle strength and collaboration. This can let you keep doing everyday tasks independently, lower your risk of falling, and decrease potential issues with walking, especially for elderly people.
Moreover, managing underlying health conditions like diabetes, peripheral neuropathy (a nerve condition that can cause numbness or weakness), and osteoarthritis (a type of joint disease that results from breakdown of joint cartilage and underlying bone) properly and adapting lifestyle habits can minimize their impact on your walking function. Changing your home environment, like removing hazards and adding handrails or grip bars, can increase safety and cut down on accidents caused by falls.
Furthermore, teaching patients and people who care for them about how to avoid falls and encouraging regular check-ups for vision and hearing can also help stave off walking difficulties and their related complications. Patients should have rehabilitation to correct their walking, receive gait training (training to help improve walking), and use tools to help them walk if needed.
