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At least 19 recordsLinked to original sources
PubMed2007

Neurological gait disorders in elderly people: clinical approach and classification.

Gait disorders are common and often devastating companions of ageing, leading to reductions in quality of life and increased mortality. Here, we present a clinically oriented approach to neurological gait disorders in the elderly population. We also draw attention to several exciting scientific developments in this specialty. Our first focus is on the complex and typically multifactorial pathophysiology underlying geriatric gait disorders. An important new insight is the recognition of gait as a complex higher order form of motor behaviour, with prominent and varied effects of mental processes. Another relevant message is that gait disorders are not an unpreventable consequence of ageing, but implicate the presence of underlying diseases that warrant specific diagnostic tests. We next discuss the core clinical features of common geriatric gait disorders and review some bedside tests to assess gait and balance. We conclude by proposing a practical three-step approach to categorise gait disorders and we present a simplified classification system based on clinical signs and symptoms.

Aging↗
PubMed2001

Neurologic disorders of gait.

Gait disorders are important because of their prevalence, particularly among the elderly, and the associated risk of falls and injury. Neural networks that organize locomotion and maintain balance are briefly reviewed. Gait disorders can be classified based on observational features or by etiology. Several common disorders are discussed in more detail. Recent progress includes use of botulinum toxin for spastic gait in cerebral palsy, neurosurgical treatment of Parkinson's disease, and newer rehabilitation approaches to gait and balance training.

Gait Disorders, Neurologic↗
PubMed2005

Prevalence of gait disorders in hospitalized neurological patients.

The prevalence of gait disorders among neurological inpatients is unknown, although disturbed gait is a common symptom. Gait disorders often lead to loss of independence with restraints for the patients and caregivers and costs for the health system. We designed a prospective study and investigated all patients admitted to a neurological hospital during a 100-day period for the presence of a gait disorder. Clinical investigation and several disease-specific rating scales were carried out for 493 patients. In 60% of the patients, a disturbance of gait was diagnosed. Most frequent diagnoses were stroke (21%), Parkinson's disease (17%), and polyneuropathy (7%). Within these diagnoses, the rate of patients with disturbed gait was high in Parkinson's disease (93%), subcortical arteriosclerotic encephalopathy (85%), and motor neuron disease (83%). Advanced age, dementia, alcohol abuse, and treatment with antiepileptics, neuroleptics, benzodiazepines, and chemotherapeutics were identified as risk factors for a gait disorder. A decline of cognitive function was accompanied by a reduction of walking speed. According to these results, gait disorders are among the most frequent symptoms in neurology.

Adult↗
PubMed2006

From diagnostics to therapy--conceptual basis for real-time movement feedback in rehabilitation medicine.

Recently, locomotion therapy on a treadmill has become part of rehabilitation programs for neurological gait disorders (spinal cord injury, hemiplegia). Instrumental gait analysis is an important tool for quantification of therapy progress in terms of functional changes in a patient's gait patterns. Whereas most of current applications focus on diagnostic assessment of gait, the current paper presents an extension of movement analysis offering enhanced therapeutic options. Specifically, the conceptual basis for application of real-time movement feedback in rehabilitation medicine is outlined and is put into context with recent developments in the field. A first technical realization of these concepts is presented and first results are reported. Furthermore, open questions towards a universal environment for movement feedback in rehabilitation medicine are discussed and future lines of research are identified.

Biofeedback, Psychology↗
PubMed1993

[Differential diagnosis of chronic gait disorders of neurologic origin in old age].

The differential diagnosis of chronic gait difficulties with falls in the elderly, due to neurological diseases, is discussed. The spectrum is quite wide and encompasses central and peripheral pathologies of the nervous system. For centrally induced gait difficulties auxiliary examinations correspond to those used in the evaluation of dementia.

Aged↗
PubMed2006

[Psychomotor disadaptation syndrome].

PURPOSE: We describe the psychomotor disadaptation syndrome and report the last findings on its physiopathology and therapeutic. This syndrome was first described by Pr Gaudet's team in 1986 and named "psychomotor regression syndrome". This name has been recently changed into "psychomotor disadaptation syndrome". ACTUALITIES AND STRONG POINTS: The psychomotor disadaptation syndrome is a decompensation of postural function, gait and psychomotor automatisms due to the alteration of the posture and motor programming. That alteration is linked to subcortical-frontal lesions. Clinically, the psychomotor disadaptation syndrome is characterized by postural impairments (retro-propulsion or backward disequilibrium), non-specific gait disorders, neurological signs (akinesia, reactional hypertonia, alteration of both reactive postural responses and protective reactions) and psychological troubles. Psychological troubles include fear of standing and gait in its acute feature or slowness of cognitive processing and anhedonia in its chronic feature. The psychomotor disadaptation syndrome occurs as a failure to compensate for the effects of the following three factors which entail the reduction of motor functional reserves because of their impact on frontal subcortex: 1) aging, 2) chronic illness named predisposing factors (degenerative or vascular disorders) and both 3) functional and organic acute factors. The latter factors cause a reduction of cerebral blood perfusion. The psychomotor disadaptation syndrome requires multidisciplinary management including medical, physiotherapeutic and psychological approaches. PROSPECTS AND PROJECTS: In the next years we have to determine the frequency of psychomotor disadaptation syndrome and its physiopathology needs to be further explored.

Aged↗
PubMed2000

[Focus on current research: improving the mobility of paraplegic patients].

Since the first paraplegic centre was established in 1945, life expectancy and life quality of paraplegics have considerably improved. However, endeavours to enhance the mobility of these patients have been less successful. The most promising approach, functional electric stimulation of paralysed muscles, is poorly accepted by patients at present because of technical problems. This study describes current approaches which may help to improve patients' mobility. A central motor lesion is perceived by the patient as a movement disorder of the legs, e.g. a gait disorder. Neurological investigation indicates, on the basis of exaggerated tendon reflexes and increased resistance of the non-activated leg muscles to stretching, that spastic paresis underlies the movement disorder. This combination of symptoms and clinical (physical) signs suggests that the exaggerated tendon tap reflexes are responsible for muscle hypertonia and the latter causes the movement disorder. However, electromyography during movement shows that the exaggerated short latency reflexes are associated with loss or attenuation of the functionally essential polysynaptic spinal reflexes. In the event of impaired supraspinal control there is loss of monosynaptic stretch reflex inhibition combined with reduced facilitation of polysynaptic spinal reflexes. Development of tension in tonically active calf muscles in patients with spastic paresis during gait occurs independently of spinal reflex activity. From electrophysiological and histological observations it can be assumed that transformation of motor units resulting in simple and less well adapted regulation of muscle tone allows movements such as gait. The reduction of muscle tone obtained with antispastic drugs is usually associated with paresis and may therefore hamper locomotion. Locomotor training represents a new attempt to improve the mobility of patients with incomplete paraplegia. It includes activation of neuronal circuits within the spinal cord below the level of the lesion. In incomplete paraplegics a coordinated leg muscle activation pattern and corresponding leg movements can be triggered and trained in patients standing on a treadmill with partial weight support. Improvement of training of the spinal cord locomotor centre can be expected from triggering of spinal cord reflexes and regeneration of spinal tract fibres, which is expected to be possible in the near future.

Humans↗
PubMed2001

[Gait disorders in Parkinson disease. Neuroanatomic and physiologic organization of gait].

GAIT IS A VOLUNTARY, AUTOMATIC AND REFLEX RHYTHMIC ACTIVITY: It is generated by a central pattern generator identified from animal models. This spinal gait generator (SGG) is controlled by various parts of the central nervous system: the descending tracts and locomotor regions of the brainstem, the cerebellum, the basal ganglia, the motor and parietal cortex and the hippocampus. Kinesthetic inputs which project to the SGG and the cerebellum, play an important role in the production of postural reflex responses; vestibular and visual inputs mainly control balance. GAIT MAINLY DEPENDS ON THE RELATIONSHIP BETWEEN POSTURE BALANCE AND MOVEMENT: As concerns posture each segment is under the control of both peripheral and central nervous systems and is used as a system of reference to organize movements of adjacent segments. Balance is maintained by sensory inputs which provide corrective mechanisms: anticipatory postural responses, reflex postural responses and voluntary responses. DIFFERENT DESCRIPTIVE PARAMETERS MAY BE PROPOSED: Analysis of kinematic (displacement, speed and acceleration of segments) and kinetic parameters during the four successive stages of gait (posture, initiation, rhythmic gait and return to the initial posture) provides an understanding of neurological gait disorders. In particular the relationship between the center of pressure and the center of gravity is used to analyze infraclinical gait abnormalities. NEW AND SOPHISTICATED INVESTIGATIONS METHODS ARE AVAILABLE: The optoelectronic system provides a tridimensional analysis of movement and can be combined with forceplate and electromyographic recordings. These methods constitute an interesting contribution to the clinical analysis of gait. CLASSIFICATION: This is established according to clinical data and the positionment of the lesion among the structures of the nervous system. The physiopathological approach is then specified taking into account the lesions of the muscular, skeletal and nervous structures.

Brain↗
PubMed2005

[Proximal tibial osteotomy for osteoarthritis of the knee with varus deformity].

OBJECTIVE: Correction of the axial malalignment to slow down wear and tear of the medial compartment of the knee in instances of medial compartment osteoarthritis with varus deformity. Return to nearly normal weight-bearing ability of the knee. INDICATIONS: Patients up to a biologic age of 65 years with medial compartment osteoarthritis with varus malalignment. CONTRAINDICATIONS: Morbid obesity, circulatory disturbances, gait disorders neurologic in origin, osteoarthritis of all three compartments. SURGICAL TECHNIQUE: 1st step: oblique fibular osteotomy between proximal and middle third without internal fixation. 2nd step: anterolateral approach to the proximal tibia from distal-lateral to medial-proximal and resection of a bony wedge leaving the medial cortex intact. Internal fixation with a six-hole semitubular plate using a tensioner for compression of the fragments. RESULTS: In 113 patients 121 valgus realignment tibial osteotomies for medial compartment osteoarthritis were performed by three surgeons. Minimal postoperative follow-up period 10 years. 86% of the osteotomies required no further treatment even after 10 years, a total knee replacement was done in only three patients between the 7th and 10th postoperative year.

Female↗
PubMed2005

Patient-cooperative strategies for robot-aided treadmill training: first experimental results.

Task-oriented repetitive movements can improve motor performance in patients with neurological or orthopaedic lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate, and document neurological and orthopedic rehabilitation. This paper deals with the application of "patient-cooperative" techniques to robot-aided gait rehabilitation of neurological disorders. We define patient-cooperative to mean that, during movement, the technical system takes into account the patient's intention and voluntary efforts rather than imposing any predefined movements or inflexible strategies. It is hypothesized that such cooperative robotic approaches can improve the therapeutic outcome compared to classical rehabilitation strategies. New cooperative strategies are presented that detect the patient's voluntary efforts. First, this enables the patient increased freedom of movement by a certain amount of robot compliance. Second, the robot behavior adapts to the existing voluntary motor abilities. And third, the robotic system displays and improves the patient contribution by visual biofeedback. Initial experimental results are presented to evaluate the basic principle and technical function of proposed approaches. Further improvements of the technical design and additional clinical testing is required to prove whether the therapeutic outcome can be enhanced by such cooperative strategies.

Exercise Test↗
PubMed2006

Pitfalls in paediatric gait disturbances: painless bone diseases.

INTRODUCTION: We describe three boys who were referred for neurological work-up of a tottering gait and in whom we diagnosed bone diseases, namely, Camurati-Engelmann disease, cartilaginous exostoses and a stress fracture as the underlying causes for the gait-disturbances. CONCLUSION: "Non-neurologic disorders" must be considered even if pain is not a leading symptom in gait disturbances.

Adolescent↗
PubMed2002

Gait analysis of patients with neurogenic intermittent claudication.

STUDY DESIGN: The gait of patients with neurogenic intermittent claudication was analyzed before and after surgery using a ground reaction force plate. OBJECTIVES: To analyze the gait characteristics of patients with neurogenic intermittent claudication, to evaluate quantitatively their gait improvement after surgical treatment, and to examine the differences in gait characteristics and postoperative improvement among different types of neuropathy. SUMMARY OF BACKGROUND DATA: A number of reports have been published on the pathophysiology or treatment of neurogenic intermittent claudication. However, almost no detailed reports exist on the gait abnormalities associated with this condition. METHODS: The subjects were 60 lumbar canal stenosis patients with intermittent claudication who underwent surgery at the authors' hospital. A ground reaction force plate was used for the analysis, and factors related to time and distance (speed, stride, interval, and pitch) were analyzed, as well as factors related to the style of walking (symmetry, reappearance, smoothness, sway, rhythm, and impact). RESULTS: Before surgery, there were abnormalities of various factors related to the style of walking soon after the patients began to walk. Gait analysis also showed that the pattern of gait abnormality and its improvement after surgery varied depending on the type of neuropathy. CONCLUSIONS: Gait analysis permits objective and quantitative evaluation of the gait characteristics of patients with lumbar canal stenosis and is useful for evaluating responses to surgical treatment in these patients.

Aged↗
PubMed2007

Gait abnormalities in psychogenic movement disorders.

An abnormal gait is not uncommon in patients with medically unexplained neurological symptoms, including those with other psychogenic movement disorders (PMDs). Previous studies have not evaluated the gait characteristics of patients with a variety of PMDs and there are no reports comparing PMDs with and without gait disturbances. We were interested in determining how those with and without additional involvement of gait differed and how PMD patients differed from those with a pure psychogenic gait disorder (PGD) in the absence of another PMD. We investigated gait features in a large series of patients with PMD (n = 279), dividing them into two groups (Group I with a normal gait and Group II with an abnormal gait). Group I included those with PMD with a normal gait and no change in the PMD while walking (I-1), and those with a change in PMD while walking, but not affecting gait (I-2). Group II was divided into those with PMD with additional abnormal gait (II-1) and those with pure psychogenic gait disorder without other abnormal movements (II-2). Excessive slowing of movement was more common in PMD patients with an abnormal gait (Group II) compared to those without (Group I). Slowness of gait was the most common feature in patients with PMD combined with a PGD (II-1) and buckling of the knee pattern was the most common type of pure PGD (II-2), followed by astasia-abasia.

Adolescent↗
PubMed2003

[Unusual causes of gait disorders].

Gait disorder is a common complaint in general practice, in particular in the elderly, and more than one cause frequently interact to produce various abnormalities of gait, including neurological, orthopedic, rhumatologic or ophthalmologic conditions, among others. The most frequent etiologies of gait impairment include sensory deficits, cervical myelopathy, vascular encephalopathy, parkinsonism and normal pressure hydrocephalus. In a particular individual, several of them may contribute to alter gait and, as a general rule, the treatment of these well-established conditions is generally considered difficult. Besides them, a number of rare and underrecognized neurological conditions may also produce a gait disorder as their initial, main or exclusive feature, including dopa-responsive dystonia, stiff-person syndrome, orthostatic tremor, primary progressive freezing gait and cursive epilepsy. In this review article, the clinical, therapeutic and other characteristics of these conditions are revisited and a typical illustrative case is reported for each. Since most of these conditions are responsive to specific treatments, we believe that a better knowledge of these unusual forms of gait disorder may allow general practitioners to identify them more accurately, to assess them and to improve therapeutic strategies.

Adult↗
PubMed2001

Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease.

OBJECTIVES: Comparative gait analyses in neurological diseases interfering with locomotion are of particular interest, as many hypokinetic gait disorders have the same main features. The aim of the present study was (1) to compare the gait disturbance in normal pressure hydrocephalus and Parkinson's disease; (2) to evaluate which variables of the disturbed gait pattern respond to specific treatment in both diseases; and (3) to assess the responsiveness to visual and acoustic cues for gait improvement. METHODS: In study 1 gait analysis was carried out on 11 patients with normal pressure hydrocephalus, 10 patients with Parkinson's disease, and 12 age matched healthy control subjects, on a walkway and on a treadmill. In study 2, patients with normal pressure hydrocephalus were reinvestigated after removal of 30 ml CSF, and patients with Parkinson's disease after administration of 150 mg levodopa. In part 3 visual cues were provided as stripes fixed on the walkway and acoustic cues as beats of a metronome. RESULTS: The gait disorder in both diseases shared the feature of a reduced gait velocity, due to a diminished and highly variable stride length. Specific features of the gait disturbance in normal pressure hydrocephalus were a broad based gait pattern with outward rotated feet and a diminished height of the steps. After treatment in both diseases, the speed increased, due to an enlarged stride length, now presenting a lower variability. All other gait variables remained unaffected. External cues only mildly improved gait in normal pressure hydrocephalus, whereas they were highly effective in raising the stride length and cadence in Parkinson's disease. CONCLUSION: The gait pattern in normal pressure hydrocephalus is clearly distinguishable from the gait of Parkinson's disease. As well as the basal ganglia output connections, other pathways and structures most likely in the frontal lobes are responsible for the gait pattern and especially the disturbed dynamic equilibrium in normal pressure hydrocephalus. Hypokinesia and its responsiveness to external cues in both diseases are assumed to be an expression of a disturbed motor planning.

Aged↗