Introduction
Many neurological disorders are often associated with abnormal gait. Various patterns of weakness, coordination loss, and proprioceptive sensory loss are responsible for producing an abnormal gait. A person's gait depends on a complex interplay of several systems such as locomotor function, balance, postural reflexes, sensory functions and sensorimotor integration, motor control, musculoskeletal apparatus, and cardiorespiratory functions. The afferent nerves from visual, vestibular, and proprioceptive systems are necessary.
Gait disorders can result in recurrent falls and injuries and greatly affect the patient's quality of life. The acute onset of gait disorder may indicate cerebrovascular or neurological diseases or side effects of drugs such as sedatives or systemic diseases. The most common causes are:
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Neurological conditions such as sensory or motor impairments.
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Orthopedic problems such as osteoarthritis and skeletal malformations.
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Medical conditions include heart failure, respiratory insufficiency, peripheral arterial occlusive disease, and obesity.
What Is a Gait Cycle?
A gait cycle can be defined as the period from one heel strike to the next heel strike of the same limb. The gait cycle consists of two phases:
Stance Phase: It begins when the heel of one leg strikes the ground and ends when the toe of the same leg lifts off. It constitutes approximately 60 percent of the gait cycle. It can be further subdivided into
Heel Contact: Initial contact.
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Foot Flat: Loading response, initial contact of the forefoot with the ground.
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Midstance: Greater trochanter in alignment with the vertical bisector of the foot.
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Heel-off: Terminal stance.
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Toe-off: Pre-swing.
Swing Phase: The swing phase represents the period between a toe off on one foot and the heel contact on the same foot. It constitutes approximately 40 percent of the gait cycle. It can be further subdivided into
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Acceleration: Initial swing.
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Mid Swing: Swinging limb overtakes the limb in stance.
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Deceleration: Terminal swing.
What Are the Factors That Can Affect Gait?
Factors that can affect gait are
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Age.
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Gender.
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Assistive devices.
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Disease status.
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Muscle weakness or paralysis.
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Asymmetry of the lower extremities.
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Injuries and malalignments.
What Are the Types of Gait?
The various types of gait are
Pyramidal Gait
Usually, upper motor neuron lesions cause a pyramidal gait. It is characterized by the upper limb being flexed while the ankle joint in the lower limb is relatively extended. This causes the toes to strike the ground while walking, and in an attempt to overcome this, the leg is swung outwards at the hip. However, the affected limb still scuffs along the ground, and the shoe on the affected side may be worn at the toes as evidence of this type of gait. In hemiplegia, the asymmetry between the affected and normal sides is obvious in walking. But, in paresis, both lower limbs swing slowly from the hips in extension and are dragged stiffly over the ground. This can often be heard and seen.
Foot Drop
Toe strike follows heel strike in a normal gait. However, if a lower motor neuron lesion is affecting the lower limb, weakness of ankle dorsiflexion occurs, disrupting this pattern. If distal weakness is severe, the foot will have to be lifted higher at the knees to allow room for the inadequately dorsiflexed foot to swing through.
Myopathic Gait
During walking, alternating transfer of the body's weight through each leg requires careful control of hip abduction by the gluteal muscles. In proximal muscle weakness, usually caused by muscle disease, the hips are not properly fixed by these muscles, and trunk movements are exaggerated, producing a rolling or waddling gait.
Ataxic Gait
An ataxic gait can occur due to lesions in the cerebellum, vestibular apparatus, or peripheral nerves. Patients with lesions of the central portion of the cerebellum walk with a characteristic broad-based gait "like a drunken sailor." Patients with acute vestibular disturbances walk similarly, but accompanying vertigo distinguishes them from those with cerebellar lesions. Less severe degrees of cerebellar ataxia can be detected by asking the patient to walk heel to toe; patients with vermis lesions cannot do this. Defects in proprioception can also cause an ataxic gait. The impairment of joint position sense makes walking unreliable, especially in poor light. The feet tend to be placed on the ground with greater emphasis, presumably in an attempt to increase proprioceptive input gait, which is often combined with foot drop caused by peripheral neuropathy. Still, it can also occur in disorders of the dorsal column in the spinal cord.
Apraxic Gait
In an Apraxic gait, the legs have normal power, no cerebellar ataxia, and no proprioception loss. As a result, the patient cannot formulate the motor act of walking. In this higher cerebral dysfunction, the feet appear stuck to the floor, and the patient cannot walk. Gait apraxia occurs in bilateral diseases such as normal pressure hydrocephalus and diffuse frontal lobe disease.
Marche à Petits Pas
This gait is characterized by small, slow steps and marked instability. This looks different from the festinant gait of Parkinson's disease in that it does not have variable pace and freezing. The usual cause is multiple small vessel cerebrovascular disease, and there are often signs of bilateral upper motor neuron disease.
Extrapyramidal Gait
Patients with Parkinson's disease and other extrapyramidal diseases have difficulty initiating walking and difficulty controlling the pace of their gait. Patients may get stuck while trying to start walking or walking through doorways. Once started, they may shuffle, have problems controlling their walking speed, and sometimes have difficulty stopping. This produces the festinant gait, initial stuttering steps that quickly increase in frequency while decreasing in length.
What Are the Diagnostic Tests to Be Carried Out?
The evaluation of gait disorders requires careful observation of gait. Also, it involves neurological and orthopedic examinations based on the patient's history, all of which will guide the physician to reach a definitive diagnosis.
What Is the Management of Gait Disorders?
Necessary steps should be taken to prevent and treat iatrogenic or medication-induced gait disorders. Drugs can be administered, such as Levodopa, to treat gait disorders in Parkinson's patients. Patients with neuromuscular conditions and frontal gait disorders, which fail to be treated by conventional methods, may benefit from the use of assistive devices, fall prevention measures, gait training, and multimodal rehabilitation. Exercise interventions like muscle strength, power, and resistance training can help improve chronic and maximum gait speed.
Conclusion
Gait is the style, manner, or pattern of walking. Walking patterns may differ from individual to individual. Gait disorders can result in recurrent falls and injuries and greatly affect the patient's quality of life. A person's gait depends on a complex interplay of several systems, such as nervous, musculoskeletal, and cardiorespiratory. Therefore, the evaluation of gait disorders requires careful observation of gait. Assistive devices, fall prevention measures, gait training, and multimodal rehabilitation have proven beneficial in managing gait disorders. Even drugs like Levodopa can be used in some cases.
