Definition
A gait disorder is a disturbance of the physiological movement sequence that makes walking difficult or impossible. It can be an expression of neurological, orthopedic or even psychological disorders. The gait disorder is based on damage to the central nervous system, peripheral nerves or the locomotor system, which consists of muscles, bones and joints.
Introduction
One speaks of a gait disorder both with reduced gait speed and with a pathologically altered gait pattern. Older people should also be able to travel one meter per second without problems. If the speed is significantly lower, a gait disorder is present.
In addition to speed, the gait pattern is also decisive. As a rule, this is fluid and harmonious. The feet have a certain distance from each other, the stride length is not too short, the foot is lifted from the ground at the right height.
Causes of a gait disorder
For a fluid gait pattern, you need not only an intact sense of balance but also a smoothly functioning musculoskeletal system. Gait disorders can therefore be roughly divided into two causes. Firstly, gait disorders are caused by problems with the sense of balance.
The following factors are important for an intact sense of balance: Above all, diseases of the inner ear such as Meniere’s disease or an inflammation severely damage the sense of balance. Diseases of the cerebellum also trigger gait disorders. Disturbances in the musculoskeletal system, such as a lack of muscular strength or limited joint function due to wear and tear, also affect the gait pattern.
Other causes of orthopaedic gait disorders include spinal canal stenoses, herniated discs or fractures. The neurological causes of gait disorders can disturb both the sense of balance and the musculoskeletal system. Typical gait disorders are Parkinson’s disease, multiple sclerosis, polyneuropathy or stroke.
Vitamin deficiency (especially vitamin B12) or alcoholism also lead to gait disorders. This also applies to special drugs – neuroleptics, antiepileptic drugs or benzodiazepines worsen the patient’s gait pattern.
- The eyes
- The organ of balance in the inner ear
- Sensitive information from the body periphery
- The cerebellum to coordinate this information
In the course of multiple sclerosis, gait disturbances may occur again and again.
The scarred inflammation in the area of the central nervous system causes various neurological symptoms in patients with multiple sclerosis. A fluid gait pattern depends on many factors. On the one hand, sensory information about the ground conditions is important, on the other hand, smooth muscle function of the lower extremity is important.
However, multiple sclerosis can lead to sensory disturbances as well as to muscle weakness and even paralysis. This affects the gait pattern. The sense of balance also plays an important role, which is controlled by the cerebellum.
Inflammatory changes in the cerebellum therefore inevitably lead to an impairment of the gait pattern. Often, the symptoms at least partially disappear after a multiple sclerosis attack. The sensitivity disorder decreases.
The mobility of the muscles improves. However, a more or less pronounced gait disorder is common in patients with a long course of the disease, since a fluid gait pattern requires very complex fine-tuning between the individual components of the central nervous system. Parkinson’s disease, hereinafter referred to as Parkinson’s disease, is a relatively common neurological disorder.
It can manifest itself with age and is caused by the death of nerve cells in the brain that regulate motor functions. A typical clinical picture is the gait disorder. The overall result is an inhibited, slowed gait pattern.
Patients with Parkinson’s disease have difficulty starting to walk. The gait disorder is characterized by the smallest triple steps, which become slightly better after a few meters. People who suffer from this clinical picture also often find it difficult to change direction when walking.
For example, if the patient is asked to turn around on the spot, he or she does so with many small steps. So-called bottleneck difficulties also belong to the gait disorder in Parkinson’s disease. This means that the gait disorder manifests itself particularly in narrow rooms or in narrow places such as a door frame.Sometimes even the smallest of elevations, such as the edge of a carpet, is enough to cause a Parkinson’s patient to stumble.
An early sign of such a gait disorder is a reduced swinging of the arms, which initially occurs on one side. The therapy consists mainly of the administration of dopamine, the messenger substance that the brain lacks. Diseases of the cervical spine can lead to problems when walking, such as a slipped disc.
The slipped disc tissue presses on the spinal cord, which causes, among other things, a gait disorder. Narrowing of the spinal canal can also cause similar symptoms. Spinal canal stenosis causes pressure to damage the spinal cord or the corresponding nerve root.
In addition, both clinical pictures are associated with massive pain, which often causes incorrect posture and thus prevents a fluid gait pattern. Disorders of the musculoskeletal system also lead to gait disorders. Tension in the shoulder and neck muscles, blockages in the first two cervical vertebrae or instability of the ligamentous apparatus can cause gait problems.
On the one hand, the sequence of movements is disturbed, on the other hand, dizziness can occur, which disturbs the sense of balance. Gait disorders due to problems with the cervical spine are therefore not uncommon. In most cases, the orthopedic specialist is the first point of contact for diagnosis and therapy.
A gait disorder can also develop due to alcohol. A distinction must be made between the gait disorder caused by an alcohol intoxication and the symptoms that a chronic alcohol abuse can cause. In a state of intoxication, the gait disorder can be explained by the direct action of alcohol in the brain, in which important centers responsible for the coordination of gait are impaired.
This alcohol-induced gait disorder is manifested by a fluctuating gait and loss of balance, and can sometimes occur at a blood alcohol level as low as 0.3 per mille. The disorder disappears after the alcohol is broken down in the body. There is also a type of gait disorder caused by chronic and excessive alcohol consumption.
It is part of the symptom complex called Wernicke’s encephalopathy, which is caused by a lack of vitamin B1 (thiamine). The affected persons suffer from a walking and also standing insecurity, walking is almost impossible. This condition persists beyond the duration of the actual alcohol intoxication.
Moderate alcohol consumption does not usually lead to this type of gait disorder. Wernicke’s encephalopathy is treated by the administration of vitamin B1 and glucose as well as alcohol withdrawal. In spinal canal stenosis (claudication intermittens), bony structures cause a narrowing of the spinal canal in the spinal column, resulting in constriction of the spinal cord and nerves.
In addition to other symptoms, this can also lead to a gait disorder. Depending on the location of the spinal canal stenosis, different symptoms occur. Often the lumbar spine is affected.
Pain caused by the incarceration restricts certain movements so that they can no longer be performed to their full extent. It is characteristic that the patient can only walk normally for a very short distance before severe pain occurs in the front and also the back of the thighs, which leads to the stopping of the walking movements. Sometimes the walking distance can be limited to less than 100m.
Typical for the symptoms are problems when walking downhill. Patients experience improvement by sitting down or by bending forward slightly, since the spinal canal is opened slightly by bending the spine and the pressure on the nerve fibers decreases. Bending backwards leads to the opposite effect.
If the cervical spine is affected, this can also lead to gait problems in spinal canal stenosis. In this case, the cause of the gait disorder is not so much pain, but rather a disturbed depth sensitivity. Information about the position of the muscles, bones and joints is no longer adequately transmitted, which leads to gait insecurity and falls. Spinal stenosis can be treated conservatively with physiotherapy, muscle training and physiotherapy. If there is no improvement in the symptoms, surgery must be considered.
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