Gait disorder: Description
Since walking is generally intuitive, most people do not think about the complex processes in the nervous system and musculature that are actually necessary for a normal gait. Particularly important for an undisturbed gait are the equilibrium organ, one’s own (unconscious) perception of movement, information through the eyes and the precise control of the musculature. A disturbance in any of these areas can lead to a gait disorder.
There are many causes of gait disorders. Basically, however, most gait disorders can be traced back to two main causes: A disturbance of the sense of balance or a disturbance of the musculoskeletal system.
Impaired sense of balance
For a person to be able to stand upright and walk at all, he or she needs an intact sense of balance. If this is missing, walking disorders and falls occur.
If one of these three systems fails, the two remaining systems can often still compensate, so that the sense of balance is only slightly disturbed. However, if two of the systems are affected, balance disorders inevitably occur. What all these processes have in common is that they usually take place unconsciously and one only becomes aware of their existence as soon as they no longer function as usual.
- Vestibular system: The vestibular organ is located in the inner ear. It registers rotations, as well as acceleration and deceleration of the body. Each person has a balance organ in the right and left inner ear. For a normal sense of balance, it is important that the organs of balance on both sides are intact. If one of them fails, conflicting information occurs. This can greatly disturb the sense of balance and cause dizziness.
Disorder of the musculoskeletal system
In order for a person to walk normally, he depends not only on his sense of balance but also on a functioning musculoskeletal system. This means that his muscle strength is sufficient and that his mobility is not restricted by normal joint function. If muscle strength is too low, normal movement is only possible to a limited extent.
Very often, a joint is damaged by wear and tear or by chronic inflammation, as a result of which it can no longer be moved normally. In gait disorders, problems with muscles and joints in the foot, leg and hip are of particular importance.
Overview of common causes of gait disorders
Neurological reasons for gait disorder
This category primarily includes diseases of the brain and nervous system in which gait dysfunction can occur:
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Parkinson’s disease |
A small-stepped, forward-bent gait is typical of Parkinson’s disease. |
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Multiple sclerosis |
In multiple sclerosis, balance disorders are most common, resulting in an unsteady gait. |
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Inner ear damage |
Damage to one of the two organs of equilibrium in the inner ear, for example due to medication, inflammation or diseases such as Meniere’s disease, leads to balance disorders and dizziness. |
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Vitamin deficiency |
For example, a deficiency of vitamin B12 can cause funicular myelosis, in which gait disturbances occur in addition to sensory disturbances in the arms and legs. |
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Drug side effects |
Especially drugs that affect the brain, such as neuroleptics, antiepileptics and benzodiazepines can be the cause of gait disorder. |
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Brain tumor/ |
Depending on the location of the tumor, sensory and/or motor functions are impaired. |
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Inflammatory diseases |
For example, in cases of Lyme disease in the central nervous system (neuroborreliosis), disturbances of movements such as gait disturbances are possible. |
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Dilatation of the cerebral ventricles due to increased cerebrospinal fluid pressure |
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Chronic alcohol consumption leads to brain damage (Wernicke-Korsakow syndrome). |
Orthopedic reasons for gait disorder
This category primarily includes diseases of the musculoskeletal system in which a gait disorder can occur:
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Wear and tear of the joints (arthrosis) |
Osteoarthritis can severely limit the mobility of a joint, leading to gait problems – especially when knees, hips or ankles are affected. |
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Rheumatic diseases |
Diseases of the so-called rheumatic type can make a normal gait impossible due to joint destruction and chronic pain. |
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Muscle weakness |
Especially inherited diseases with muscle weakness (muscular dystrophy, myotonic muscular dystrophy, etc.) are responsible for gait disorders. |
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A herniated disc (disc prolapse) often means severe pain for the affected person, who can also develop gait disorders as a result. |
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Not an orthopedic disease in the strict sense: Circulatory disorders cause pain in the legs, which means that those affected can only walk short distances. |
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Spasticity of the muscles |
An increase in muscle tension (muscle tone) can result from damage to the brain and make normal walking difficult. |
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Injuries |
For example, a fracture of the neck of the femur is a very common cause of gait impairment in older age. |
In addition to the physical reasons for a gait disorder mentioned so far, mental problems can also be responsible for a disturbed gait. The underlying mental disorders are very diverse. Psychogenic gait disorder became known through research work on war returnees after the First World War.
However, psychogenic gait disorder does not only occur in the context of PTSD. The psychological causes can be very different. However, they all have in common that they are primarily not caused by a malfunction of the nervous system or the musculoskeletal system, but are in fact primarily psychological in nature.
Gait disorders: When should you see a doctor?
Gait disorders: What does the doctor do?
In the case of a gait disorder, it depends on the suspected cause which doctor is the right contact. If the gait disorder is more likely to be neurological due to damage to the nervous system (nerve tracts, brain, spinal cord), a specialist in neurology can help you.
Medical history (anamnesis)
At the beginning of the visit to the doctor, there is a detailed discussion between the patient and the doctor, through which important information about the cause of the gait disorder can be obtained. Your doctor will ask you various questions. For example:
- How long have you had the gait disorder?
- Did the gait disorder appear suddenly, or did it come on gradually?
- Is the gait disorder always present, or do the symptoms change?
- In what situations does the gait disorder occur?
- Are you taking any medications? If yes, which ones?
- Do you have any previous illnesses (for example, heart attack, stroke, orthopedic diseases)?
- Apart from gait disorders, do you have any other complaints such as dizziness or sensory disturbances in your arms or legs?
Physical examination
In addition, the “timed up and go test” (time taken to stand up and walk) is also used. In this test, you are asked to stand up from a chair, walk three meters and sit back down on the chair. The doctor measures the time it takes them to do this. Usually, it takes no more than 20 seconds to do this exercise. If it takes longer than 30 seconds, it is considered abnormal and therefore a gait disorder is likely.
If closing your eyes causes you to have problems with balance and sway, this indicates a disturbance of the information conduction in the spinal cord, which leads to a balance disorder (“spinal ataxia”). If they already have problems with this exercise with their eyes open and closing their eyes has no effect on the stability of your posture, this is more indicative of damage to the cerebellum.
After the exercise, it is determined how far it has rotated its position by pedaling in one direction. A rotation of more than 45 degrees in relation to the starting position is conspicuous and indicates damage to the cerebellum or the organ of balance. In addition to assessing gait and balance, the physician also performs a general neurological examination. In doing so, he assesses reflexes, muscle strength and sensitivity.
Further examinations
- Computed tomography (CT) or magnetic resonance imaging (MRI)
- Measurement of nerve conduction velocity with electroneurography (ENG)
- Examination of blood and/or cerebrospinal fluid (CSF)
- Measurement of brain waves (electroencephalography, EEG)
- Measurement of nerve-muscle conduction (electromyography, EMG)
- Eye test, hearing test
Therapies
Particularly in the case of orthopedic causes, surgical intervention is occasionally necessary. In many cases, supportive therapy measures such as physiotherapy (physical therapy) and physical treatment methods (such as exercise baths, massages, heat applications, etc.) are useful for gait disorders in order to strengthen muscle strength and improve movement coordination.
Gait disorders: What you can do yourself
As part of the treatment of a gait disorder, one learns some gait exercises in physiotherapy. These should be performed regularly at home. Even if progress is literally slow and “step by step”. By strengthening and mobilizing still existing reserves, defects in the nervous system can often be compensated.
In the case of an existing gait disorder, alcohol should be avoided completely if necessary, since alcohol damages the brain and nerve pathways. Polyneuropathy due to diabetes mellitus (diabetes) is one of the frequent causes of gait disturbance. If diabetes is detected and treated in time by a doctor, severe consequences such as gait disorder are often avoidable.
Important for gait disorders: Fall prevention
If a person with gait disorder has already fallen or a fall could occur at any time, preventive measures should be taken in any case to minimize the risk of falling and the possible consequences of a fall.