Gait Disturbance : Causes, Symptoms, Diagnosis & Treatment

• General Characteristics
• Classification
• Diagnostics
• Treatment
• Conservative Therapy
• Surgery

Gait disturbance (dysbasia) is a change in the walking cycle, including a violation of the length, width, rhythm and symmetry of the step, the duration of the support and swing cycles, the position of the trunk and limbs. It is detected in lesions of the central and peripheral nervous systems: parkinsonism, strokes, neuropathies, craniocerebral injuries, demyelinating, degenerative pathologies. It is diagnosed on the basis of gait examination, neurological examination, imaging and laboratory techniques. Treatment includes drug therapy, surgery, rehabilitation measures.

general characteristics

Walking is a complex motor act that requires the coordinated work of the central brain structures, pathways, peripheral nerves, muscles of the body and limbs. The participation of nervous structures of different levels causes a variety of etiological factors of gait disorders. Many neurological and some orthopedic diseases are accompanied by the development of typical gait changes. Evaluation of the pathological gait pattern is an important part of preliminary diagnosis.

The incidence of gait disorders increases with age. In children and young people, the symptom is rarely observed, most cases are associated with traumatic injuries, infections, and purulent processes. After 4 years, the number of people suffering from this disorder begins to increase, mainly due to strokes. In the age group of 60-69 years, the prevalence reaches 15%, older than 7 years - 35%, older than 8 years - 60%, which is explained by the development of degenerative-atrophic pathologies, an increase in the proportion of complex disorders.

Classification

There are more than 2 types of gait disorders. Changes are classified taking into account the causes of development and external signs. Main options:

• Shaky (atactic). It is formed with the involvement of the cerebellum and thalamus. Due to imbalance, the patient staggers, spreads his legs wide. Staggering is detected both during walking and in a stationary position.
• Stamping. Reflects a decrease in deep sensitivity in case of damage to the pathways (more often - the posterior horns of the spinal cord). The legs are “imprinted” with effort on the surface, lowered immediately to the entire sole, walking is controlled by vision.
• Shuffling. It is detected in old age, with some neurological disorders, general weakness. The stride length is reduced, the soles do not come off or slightly come off the surface.
• Cockerel (steppage). It is observed with damage to the peroneal nerve, a number of other pathologies. During the lifting of the leg, the foot hangs down, the person strongly bends the knee so as not to cling to the floor with the toe, and throws the leg forward.
• "Duck". It is determined in patients with paresis or mechanical damage to the abductor muscles of the thigh. With a bilateral gait disorder, the patient rolls from side to side, with a unilateral lesion, the pelvis warps in the direction of the moving leg.
• Paretic. It is found in paresis of the muscles of the lower extremities. The nature of the changes is determined by the involvement of various muscle groups.
• Hemiparetic. Characteristic for hemiparesis of various etiologies. The diseased arm is pressed to the body, the diseased leg is extended and moves in a semicircle, the body deviates to the healthy side.

Along with the listed variants of gait disorders, stiffness during walking (freezing dysbasia) and propulsion are distinguished - irresistible acceleration when walking or after a small push. Both variants are found in patients with parkinsonism. Sometimes freezing dysbasia occurs after multilacunar strokes or is formed in senile patients without signs of neurological diseases.

Gait disturbance

Diagnostics

A neurologist is engaged in establishing the type and causes of gait disturbance. The examination includes the study of anamnesis, assessment of objective data, instrumental and laboratory studies. The diagnostic program provides for the following procedures:

• Objective examination . A clinical study of gait is carried out with the determination of walking characteristics (speed, rhythm, step length and width, body position, limb movements, type of contact of the foot with the surface), additional tests. A neurological examination is performed.
• visualization techniques . In some cases, echoencephalography and radiography are used as basic studies. At the stage of the final diagnosis of inflammatory, ischemic and hemorrhagic foci, MRI of the brain is the most informative. To clarify the localization, nature and prevalence of tumor processes and traumatic injuries, CT of the skull and CT of the brain are used.
• Laboratory tests . They are indicative in determining infectious processes, autoimmune pathologies, toxic lesions, neurological disorders that have developed against the background of severe somatic diseases. The list of tests may include antibody tests, biochemical tests to assess glucose levels, liver and kidney function, cerebrospinal fluid studies, PCR, ELISA, RIF.

Treatment

Conservative therapy

Pathogenetic and symptomatic therapeutic measures are required. Taking into account the cause of gait disturbance, the presence of other manifestations, patients may be prescribed antibiotics, NSAIDs, muscle relaxants and anticonvulsants. Drugs are used to improve blood circulation and nerve conduction. Non-drug methods play a significant role at all stages of treatment.

An obligatory part of therapy is considered to be physiotherapy exercises using classical techniques, mechanotherapy, special simulators. The purpose of the classes is the maximum possible restoration of the function of the limbs, the development of new motor stereotypes. Exercise therapy is complemented by massage, manual therapy, reflexology. Patients are referred for mud therapy, thermal procedures, electrical stimulation.

Surgery

In the presence of indications, patients with gait disorders perform the following operations:

• Volumetric processes : removal or aspiration of abscesses and hematomas, excision of tumors.
• Circulatory disorders : removal, occlusion and embolization of aneurysms and arteriovenous malformations, thrombolysis, reconstruction of arteries, creation of anastomoses in cerebrovascular insufficiency.
• Traumatic injuries : decompressive trepanation, removal of depressed fractures of the skull, plastic or nerve suture, vertebroplasty, corporectomy, stabilizing operations on the spine.

Some patients require orthopedic interventions to correct secondary disorders of the musculoskeletal system. It is possible to move muscles and tendons, redress contractures, arthrodesis, and other operations.