Gait disturbances

GENERAL ASPECTS

Gait control involves multiple functional systems (cerebral cortex, medulla, roots, peripheral nerves and muscles; as well as the cerebellum, vestibular system, sensory system and vision) that coordinate with each other, so the cause of the disorder can be very diverse, depending on the location where the lesion occurs.

Some gait disturbances are mainly neurological and others are not, but a proper study is a priority because some of them appear as symptoms of potentially serious diseases.

CAUSES OF GAIT DISORDERS

Depending on the location of the alteration, the causes will be very diverse.

• Non-neurological causes

For example, an antalgic gait where the gait is disordered due to pain, or in the case of arthritis due to pain generated by the deformity. Also when there is an alteration of the vestibular system in the ear, which is generally accompanied by vertigo and in which patients describe that ”they go down the street as if floating and get dizzy when they move their head”. Anxiety can also sometimes cause similar symptoms. In addition, a gait characteristic of the elderly patient may be observed, walking cautiously and with fear of falling, with short strides and with minimal support they walk much better.

• Cerebral cortex pathology

It generally affects only one leg and is characterized by an increase in the tone of the leg, which does not bend at the knee and moves forward straight, ”like a stick”. The causes can be multiple: cerebral infarcts, intracranial lesions, autoimmune origin…

• Pathology of the spinal cord or nerve roots.

For example, a lumbosacral radiculopathy can cause weakness due to pain and loss of leg strength, and similarly, spinal disorders due to multiple causes (trauma, infarction, spinal stenosis, etc.) can cause gait disturbance and loss of strength.

• Alteration of the sensory system

Gait disturbances occur when the nervous system is deprived of sensory information, especially proprioceptive sensitivity, which is the one that informs us of the perception of body position in space. This alteration of proprioceptive sensitivity may be due to diseases affecting the posterior part of the medulla or due to peripheral nerve involvement. Structural causes, vitamin deficiencies, or systemic diseases such as diabetes should be ruled out. If the cause is peripheral nerve involvement, it is sometimes accompanied by a burning, sharp ”needle-like” pain sensation and lack of sensation in the soles of the feet.

• Parkinsonian syndromes

In early stages the patient shuffles somewhat, takes short steps, breaks the turn into two or three movements and goes with the head and trunk somewhat inclined, with little brachiation. In more advanced stages, there will be gait blocks, imbalance and falls. It may be due to Parkinson’s disease or, less frequently, to another group of similar diseases called parkinsonisms.

• Cerebellar alterations

It is characterized by imbalance with both open and closed eyes, widening the separation between the two legs in order to have greater stability. The causes can be multiple, from genetic, to structural or metabolic.

DIAGNOSIS

Due to the great complexity and the multiple systems involved in gait control, the initial diagnosis is based on the orientation of the disorder by a specialist according to the patient’s complaint and the examination data, who will request the relevant studies, from analytical tests to neuroimaging studies, such as a brain and/or spinal cord MRI, or neurophysiology studies, such as nerve conduction studies.

TREATMENT

Similarly, there are various treatments that will be determined according to the type of gait disorder that the patient presents.