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PubMed2001

Age-related changes in lower trunk coordination and energy transfer during gait.

The effects of aging on lower trunk (trunk-low-back joint-pelvis) coordination and energy transfer during locomotion has received little attention; consequently, there are scant biomechanical data available for comparison with patient populations whose upper body movements may be impaired by orthopaedic or neurologic disorders. To address this problem, we analyzed gait data from a cross-sectional sample of healthy adults (n = 93) between 20 and 90 yr old (n = 44 elderly, >50 yr old; n = 49 young, <50 yr old). Gait characteristics of elders were mostly typical: gait speed of elders (1.13 +/- 0.20 m/s) was significantly (P = 0.007) lower than gait speed of young subjects (1.20 +/- 0.18 m/s). Although elders had less low-back (trunk relative to pelvis) range of motion (ROM; P = 0.013) during gait than young subjects, no age-related differences were detected in absolute trunk and pelvis ROM or peak pitch angles during gait. Despite similar upper body postures, there was a strong association between age and pelvis-trunk angular velocity phase angle (r = 0.48, P < 0.001) with zero phase occurring at approximately 55 yr of age; young subjects lead with the pelvis while elderly subjects lead with the trunk. Age related changes in gait speed and low-back ROM were unable to explain the above findings. The trunk-leading strategy used by elders resulted in a sense reversal of the low-back joint power curve and increased (P = 0.013) the mechanical energy expenditure required for eccentric control of the lower trunk musculature during stance phase of gait. These data suggest an age-related change in the control of lower trunk movements during gait that preserves upper body posture and walking speed but requires a leading trunk and higher mechanical energy demands of lower trunk musculature-two factors that may reduce the ability to recover from dynamic instabilities. The behavioral and motor control aspects of these findings may be important for understanding locomotor impairment compensations in aging humans and in quantifying falls risk.

Abdominal Muscles↗
PubMed2004

Personal gait satisfaction after displaced intraarticular calcaneal fractures: a 2-8 year followup.

BACKGROUND: Patients' satisfaction with gait after calcaneal fracture has rarely been studied. The objective of this paper was to determine how patient demographics, fracture type and treatment affected gait satisfaction after displaced intraarticular calcaneal fractures. The design of the study is a prospective randomized trial performed in four Level I trauma centers. METHODS: Three hundred and nineteen patients with 351 radiographically proven displaced intraarticular calcaneal fractures (DIACF) were randomly assigned to open reduction and internal fixation (ORIF), or nonoperative treatment. A 2- to 8-year follow-up was obtained, with patients completing SF-36 and a validated visual analogue scale to assess personal gait satisfaction. The final joint positions were confirmed using plain radiographs and CT scans for both treatment arms. Examination using a one-way analysis-of-variance was performed to determine if statistical differences existed in personal gait satisfaction between the treatment arms. RESULTS: Personal gait satisfaction scores were not significantly different between those DIACF treated with ORIF and those treated nonoperatively at 2- to 8-year follow-up. In patients treated with ORIF, improved personal gait scores were reported in those who were younger than 30 years of age, were non-WCB, had jobs requiring a moderate work-load before injury, and had Bohler angles restored to above 0 degrees. Factors not found to be significant in gait satisfaction included unilateral or bilateral calcaneal fractures, quality of initial reduction, and sex of the patient. CONCLUSIONS: Subcategories determined that younger patients who were self-employed and treated operatively had improved gait scores. Treatment (operative or nonoperative) of calcaneal fractures did not affect gait satisfaction according to patient outcome scores.

Adult↗
PubMed2000

Relationship between timed 'up and go' and gait time in an elderly orthopaedic rehabilitation population.

OBJECTIVE: To analyse the relationship between the timed 'up and go' (TUG) and gait time in an elderly orthopaedic population, in order to determine whether additional useful information is obtained by measuring both. DESIGN: Observational study. SETTING: Jewish Rehabilitation Hospital, Laval, Quebec. SUBJECTS: Seventy-nine consecutive inpatients in the orthopaedic programme with a primary admitting diagnosis of either total hip replacement (THR), total knee replacement (TKR), or hip fracture repair. OUTCOME MEASURES: Timed 'up and go' and time to walk 10 metres. RESULTS: The admission correlation between gait time and TUG was r= 0.745. The correlation at discharge (r= 0.816) was higher than that seen on admission. The relationship between gait time and TUG was linear both at admission and discharge. The correlation between gait time and TUG was strong for patients with TKR at admission (r= 0.868) and discharge (r= 0.878), and for patients with THR, both at admission (r= 0.809) and discharge (r= 0.879). However, the correlation on admission was weaker for patients with hip fracture (r= 0.497). For slow walkers (people with a gait speed below 0.5 m/s) on admission, the correlation was moderate (r= 0.649). However, for those with gait speeds faster than or equal to 0.5 m/s, the correlation was weaker (r= 0.484). This discrepancy was no longer evident on discharge. Likewise, for patients with a fast TUG score (< 30 seconds) on admission, there was virtually no relationship between TUG and gait time (r= 0.084), although a good correlation was present for those with 'up and go' times longer than 30 seconds (r = 0.634). As with gait speed, this difference disappeared by discharge. CONCLUSIONS: The relationship between gait time and TUG in an elderly orthopaedic rehabilitation population is good, and its strength varies by specific diagnosis, mobility, and time point in the course of therapy. The two measures are not redundant in this population.

Aged↗
PubMed2006

Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study.

OBJECTIVE: Freezing of gait is a frequently disabling symptom in Parkinson's disease, poorly responding to dopaminergic treatment. We investigated the short-term effectiveness of a rehabilitation protocol in parkinsonian patients with freezing of gait. DESIGN: Prospective, uncontrolled pilot study with open label design. SETTING: Outpatient service for rehabilitation of neurological disorders. SUBJECTS: Twelve patients (8 male, 4 female; aged 59-78 years; Hoehn-Yahr stage: 2-3; mean disease duration: 14.2 +/- SD 4.1 years). INTERVENTIONS: Patients attended three (45 min) sessions every week, over a six-week period, of physical therapy focused to improve balance, postural control and walking, and to learn new strategies for overcoming freezing of gait. MAIN OUTCOME MEASURES: Patients were evaluated before (T0), at the end (T1), and one month after (T2) rehabilitation by means of clinical rating scales (Unified Parkinson Disease Rating Scale--Motor Section; Freezing of Gait Questionnaire; Parkinson Disease Quality of Life Score) and gait parameters (number of strides, stride length and velocity) during a standardized walking test. RESULTS: The scores of Freezing of Gait Questionnaire and of Parkinson Disease Quality of Life Questionnaire (but not of the Unified Parkinson Disease Rating Scale--Motor Section) were significantly improved after treatment (T1). Gait parameters were significantly improved at T1 and T2. CONCLUSIONS: We showed the potential short-term efficacy of a rehabilitative approach to freezing of gait in Parkinson's disease. The positive outcome was documented by clinical rating scales and objective gait evaluation. The rapid reversibility of the clinical benefit suggests that further studies are needed to better define the optimal frequency and duration of treatment.

Aged↗
PubMed2003

Knock knee and the gait of six-year-old children.

AIM: Knock knee (genu valgum) interferes with the locomotive and supporting function of the lower limb. In static conditions the load-bearing axis of the valgus limb is displaced laterally in relation to the middle of the joint, causing the knee joint, the ankle joint, and the foot as a whole to be weighted in the wrong way. The purpose of this work is to examine the influence of knock knee on gait kinematics. METHODS: The gait of twenty-two 6-year-old children of both sexes in whom knock knee had been medically diagnosed was compared with the gait of 33 children of the same age whose knee joints conformed to the norm in formation and position. Gait was recorded separately for the sagittal and the frontal planes, using a video-computer system. RESULTS: The results of the examination indicated statistically significant differences in the gait of the two groups of children. These differences related mainly to the time features of gait and to data on the angles in the knee and ankle joints. Although the results obtained for other features of gait did not reveal statistical differences, these did indicate that the children with knock knee walked more slowly and with a lower cadence. CONCLUSION: The results indicate that knock knee in 6-year-old children has an adverse impact on the mechanics of the lower limb joints in gait and causes a deterioration in gait quality. Thus knock knee in children should not be treated merely as a superficial defect but should be subject to therapy and, more importantly, taken into account when introducing children to early sports training.

Biomechanical Phenomena↗
PubMed2004

Gait velocity in senior people. An easy test for detecting mobility impairment in community elderly.

BACKGROUND: Functional assessment is an important part of the evaluation of elderly patients. Mobility problems detected by functional tests predict the development of more severe disability and injurious events such as falls and hip fractures. Several tests to evaluate mobility have been described, but most of them are difficult to perform by a primary care physicians or take much time in the ambulatory setting. PURPOSE: To evaluate different mobility test to detect mobility impairment in community senior people. Select an easier test to perform on the ambulatory ward by a GP with the hypothesis that gait velocity could be an easier test to detect early mobility impairment. METHODS: A cohort of 100 elderly subjects of 75 year and older were selected from our database and contacted by phone. The subjects were appointed and assessed by three geriatricians from January to May 2000. The measures including MMSE, Yesavage Test, ADL (Barhtel) and IADL (Lawton), the Get Up and Go test, the POMA, one leg balance test and the Gait Velocity (GV). A gait velocity of 0.8 m/s or lower was defined as a pathological gait velocity (PGV). RESULTS: 95 subjects, mean age 79.63 (+/- 4) ranged form 75 to 95. Women in 71.3%. The ADLs were normal on 85% of the patients and the MMSE was normal on 78%. There was a significant association between pathological gait velocity (<0.8m/sec) and impairment on Get up and Go (OR 2.20; 95% CI 1.44-3.34), incapacity to perform the one leg balance test (OR 2.20; 95%CI: 1.43 - 4.71) and abnormal POMA test (OR 4.60; 95 %CI 1.5-14.7). Only 15% of the subjects with normal gait velocity reported recurrent falls in the previous 6 months while 35% of subjects with pathological gait velocity did. (OR 0.32 CI95% 010-099 p < 0.044). CONCLUSION: The pathological gait velocity (<0.8m/sec) correlates with a pathologic performance of Get Up and Go test and POMA and with the incapacity to perform the One Leg Balance test. Also correlate with previous repeated falls in the last 6 (p <0.04). The gait velocity could be a test easy to perform, no time consuming, and an operative tool to apply in the ambulatory care to detect elderly patients with mobility impairment.

Accidental Falls↗
PubMed2005

Gait characteristics in patients with type 2 diabetes; improvement after administration of rosiglitazone.

BACKGROUND: Gait is impaired in people with type 2 diabetes. An insulin sensitizer, rosiglitazone(RSG) has promise to reverse some of the circulatory impairments seen in diabetes. The hypothesis to be tested was if RSG would improve gait in patients with diabetes. MATERIAL/METHODS: Gait in 30 controls and 25 subjects with Type 2 diabetes was examined (10 subjects with diabetes were placed on rosiglitazone (4 mg/day) for 6 months, a PPAR-gamma ligand known to improve peripheral circulation, to asses any improvements in gait). Gait was analyzed by video, shoe sensors, accelerometers and electromyogram of the medial gastrocnemius and tibialis anterior muscles during the initiation of gait, steady state gait and turns. RESULTS: Subjects with diabetes had almost double the movement at the knee in both the flexion-extension and lateral directions than did control subjects. For example, for flexion-extension at the knee during constant velocity gait in a linear path, subjects with diabetes averaged a force of 1.91+/-0.29 g whereas control subjects only averaged 1.26+/-0.27 g, these differences were significant (p<0.01). Subjects with diabetes also showed greater muscle use (the average use of the tibiallis anterior muscle was 26.5+/-6.9% of total muscle activity for control subjects whereas subjects with diabetes averaged 59.6+/-14.9%). CONCLUSIONS: These differences were reversed after 6 months administration of rosiglitazone. The results seem to imply that much of the impairment in gait is associated with cardiovascular insufficiency to the nervous system and/or muscle.

Adult↗
PubMed2005

Gait abnormalities in older people--comparison of inter-professional assessment.

Gait abnormalities are common in older people but relatively under-diagnosed. We investigated the prevalence of gait abnormalities among patients presenting to a geriatric medicine day hospital, classified them according to whether they were lower, middle or higher level gait disorders and compared inter-professional (physician and physiotherapist) assessments for this classification. Prospective independent assessment by a physician and a senior physiotherapist of 50 consecutive patients presenting to a day hospital. Presence of a gait abnormality was determined and then classified. Levels of agreement were determined between the two professions. There was 98% agreement that a gait abnormality existed in 43 people. In classifying the gait abnormality there was complete agreement in over two-thirds of cases (67.4%). There was further agreement of higher level gait disorders (but disagreement in the sub-classification) in 11.6% of cases. Given the high prevalence of gait abnormality presenting to the day hospital, screening for gait and balance disorders should be of paramount importance. While levels of agreement between the two professions were high, disagreement existed in approximately one-third of cases. Agreement among professionals essential for appropriate tailoring of treatment and intervention.

Aged↗
PubMed1991

[Evaluating gait disorders in geriatrics].

Gait disorders in the elderly are a major cause of falls and accidents. They also interfere badly with the quality of life and the psychosocial well-being. The prevalence of these disorders is very high: 15% of the persons over 65 years and about 25% of those over 75 years suffer from gait disorders. The cause of gait disorders can be a specific disease, but in the elderly, multiple causes are much more frequent. In the elderly, the analysis of gait disorders consists not only of a diagnostic work-up, but also of a comprehensive geriatric and functional gait assessment. A minimal gait assessment includes a special clinical examination, an instrumental analysis of gait speed and a functional assessment of gait and balance by standard tests. In this article the relevant methods of a practical gait assessment are presented and some basic aspects of treatments are discussed.

Accidental Falls↗
PubMed1995

Validation of the NINCDS-ADRDA criteria regarding gait in the clinical diagnosis of Alzheimer disease. A clinicopathologic study.

The NINCDS-ADRDA criteria for the clinical diagnosis of probable Alzheimer disease (AD) state that "gait disturbances at the onset or very early in the course of the illness make the diagnosis of Alzheimer disease uncertain or unlikely," yet there have been few studies documenting the validity of the statement. We therefore reviewed all cases of pure autopsy-proven AD in the Ramsey Brain Bank to determine how frequently an abnormal gait was noted at time of presentation. Any reported gait disturbance was considered an abnormal gait. Only cases for which medical records were available documenting the patient's presentation for dementia were included. Cases were excluded if any other pathology was present that may have contributed to the patient's dementia or to a gait disorder, if neuroleptic medication had been used, or if there was a preexisting gait disorder. Clinical dementia severity at time of presentation was graded as mild, moderate, or severe per DSM-IIIR criteria. Of the 95 cases that met study criteria, none of the 36 patients with mild dementia were reported to have had an abnormal gait. Sixteen percent of the patients with moderate and 32% with severe dementia had gait abnormalities reported. This study confirms the statement regarding gait in the NINCDS-ADRDA criteria.

Age of Onset↗
PubMedDate not supplied

Comparison of a stiff and a spring-type ankle-foot orthosis to improve gait in spastic hemiplegic children.

The effect of two different types of functional ankle-foot orthosis on the gait of patients with spastic hemiplegia was studied. A gap was cut into the conventional stiff orthosis to allow a limited dorsiflexion of 10-15 degrees, while plantarflexion was blocked (spring type). This gap was bridged by an aluminum bar to stiffen the orthosis for the experiment. Fourteen patients of different ages (6.5-20.1 years) walked barefoot and with the orthosis, once springy and once stiff. Kinetics and kinematics were analyzed. Gait was significantly improved into normal pattern by using any type of ankle-foot orthosis. While walking barefoot with a toe-heel-toe gait, the physiological heel-toe gait was restored with any type of orthosis. The spring type of orthosis was significantly superior to the stiff orthosis. This was most clearly expressed in the general parameters of gait-like cadence, velocity, and step length. Kinetic data gave a significant improvement by using any ankle-foot orthosis. Whereas break force was similar with both types, push-off was further improved with the spring type. Kinematics revealed little statistical difference between the two types, although gait was more dynamic and physiological with the spring type of orthosis. Any functional ankle-foot orthosis ameliorates the gait pattern in patients with spastic hemiplegia, but a spring type of orthosis renders the gait more dynamic and best corrects the pathology of gait.

Adolescent↗
PubMed2005

Gait disturbances in patients with schizophrenia and adaptation to treadmill walking.

This study evaluated the gait patterns of schizophrenic patients at free gait and at three fixed velocities on a treadmill. The effects of illness and antipsychotic treatment on gait parameters and on adaptation to treadmill walking were compared. Gait parameters of 14 drug-naive schizophrenic patients, 14 patients treated with conventional antipsychotics, 14 patients treated with olanzapine, as well as 14 matched controls were assessed on a walkway and on a treadmill at three different velocities (very slow, intermediately slow, and comfortable) using an ultrasonic movement analysis system. At free gait, all patients showed a significantly decreased gait velocity, predominantly due to a shorter stride length, when compared to the controls, with the most striking difference observed between the patients treated with conventional neuroleptics and the controls (ANOVA, P < or = 0.001). Cadence (steps per second) did not differ between the investigated groups. When gait was evaluated on the treadmill, differences in stride length and cadence were significant only at the very slow treadmill velocity (ANOVA, P < or = 0.05). In all patient groups, mean stride length was decreased and cadence compensationally increased. Significant differences between the patient groups were no longer detectable. With increasing treadmill velocities, gait parameters of all patient groups normalized. The results show that, like in patients with Parkinson's Disease, impaired gait parameters can also be normalized in schizophrenic patients by external stimulation via treadmill walking.

Adaptation, Physiological↗
PubMed2005

Gait variability: methods, modeling and meaning.

The study of gait variability, the stride-to-stride fluctuations in walking, offers a complementary way of quantifying locomotion and its changes with aging and disease as well as a means of monitoring the effects of therapeutic interventions and rehabilitation. Previous work has suggested that measures of gait variability may be more closely related to falls, a serious consequence of many gait disorders, than are measures based on the mean values of other walking parameters. The Current JNER series presents nine reports on the results of recent investigations into gait variability. One novel method for collecting unconstrained, ambulatory data is reviewed, and a primer on analysis methods is presented along with a heuristic approach to summarizing variability measures. In addition, the first studies of gait variability in animal models of neurodegenerative disease are described, as is a mathematical model of human walking that characterizes certain complex (multifractal) features of the motor control's pattern generator. Another investigation demonstrates that, whereas both healthy older controls and patients with a higher-level gait disorder walk more slowly in reduced lighting, only the latter's stride variability increases. Studies of the effects of dual tasks suggest that the regulation of the stride-to-stride fluctuations in stride width and stride time may be influenced by attention loading and may require cognitive input. Finally, a report of gait variability in over 500 subjects, probably the largest study of this kind, suggests how step width variability may relate to fall risk. Together, these studies provide new insights into the factors that regulate the stride-to-stride fluctuations in walking and pave the way for expanded research into the control of gait and the practical application of measures of gait variability in the clinical setting.

Journal Article↗
PubMed2005

Managing variability in the summary and comparison of gait data.

Variability in quantitative gait data arises from many potential sources, including natural temporal dynamics of neuromotor control, pathologies of the neurological or musculoskeletal systems, the effects of aging, as well as variations in the external environment, assistive devices, instrumentation or data collection methodologies. In light of this variability, unidimensional, cycle-based gait variables such as stride period should be viewed as random variables and prototypical single-cycle kinematic or kinetic curves ought to be considered as random functions of time. Within this framework, we exemplify some practical solutions to a number of commonly encountered analytical challenges in dealing with gait variability. On the topic of univariate gait variables, robust estimation is proposed as a means of coping with contaminated gait data, and the summary of non-normally distributed gait data is demonstrated by way of empirical examples. On the summary of gait curves, we discuss methods to manage undesirable phase variation and non-robust spread estimates. To overcome the limitations of conventional comparisons among curve landmarks or parameters, we propose as a viable alternative, the combination of curve registration, robust estimation, and formal statistical testing of curves as coherent units. On the basis of these discussions, we provide heuristic guidelines for the summary of gait variables and the comparison of gait curves.

Journal Article↗
PubMed2007

Neurological gait disorders in elderly people: clinical approach and classification.

Gait disorders are common and often devastating companions of ageing, leading to reductions in quality of life and increased mortality. Here, we present a clinically oriented approach to neurological gait disorders in the elderly population. We also draw attention to several exciting scientific developments in this specialty. Our first focus is on the complex and typically multifactorial pathophysiology underlying geriatric gait disorders. An important new insight is the recognition of gait as a complex higher order form of motor behaviour, with prominent and varied effects of mental processes. Another relevant message is that gait disorders are not an unpreventable consequence of ageing, but implicate the presence of underlying diseases that warrant specific diagnostic tests. We next discuss the core clinical features of common geriatric gait disorders and review some bedside tests to assess gait and balance. We conclude by proposing a practical three-step approach to categorise gait disorders and we present a simplified classification system based on clinical signs and symptoms.

Aging↗
PubMed2004

A comparison of gait characteristics between older women with and without peripheral neuropathy in standard and challenging environments.

OBJECTIVES: To compare gait patterns in older women with and without peripheral neuropathy (PN) in standard (smooth surface, normal lighting) and challenging environments (CE) (irregular surface, low lighting). DESIGN: Observational, controlled study of 24 subjects. SETTING: Biomechanical research laboratory. PARTICIPANTS: Twenty-four older women, 12 with PN and 12 without PN (mean age +/- standard deviation =67.1 +/- 7.9 and 70.2 +/- 4.3, respectively). MEASUREMENTS: Gait parameters and, in the 12 PN subjects, neuropathy severity. RESULTS: The CE was associated with increases in step width, step-width variability, step-width range, step width-to-step length ratio, step time and step-time variability, and decreases in step length and speed. The PN subjects demonstrated a greater step width-to-step length ratio and step time and shorter step length and slower speed than the control subjects. In adapting to the CE, the PN subjects demonstrated greater increases in step width-to-step length ratio and step-time variability and a greater decrease in step length than did the control subjects. In the standard environment, only one gait parameter correlated with PN severity, whereas in the CE, four gait parameters did so. CONCLUSION: The subjects demonstrated a gait that was slower, less efficient, and more variable temporally and in the frontal plane in the CE. Control and PN subjects demonstrated similar variability in medial-lateral step placement in the CE but at the cost of speed and efficiency for the PN subjects. Because the CE magnified gait differences between the two groups of subjects and caused gait changes in the PN subjects that correlated with PN severity, the CE may offer improved resolution for detecting gait abnormalities.

Accidental Falls↗
PubMed2002

The natural history of the syndrome of primary progressive freezing gait.

BACKGROUND: Primary progressive freezing gait disorder is considered to be a distinct clinical entity that manifests predominantly as a progressive freezing gait disorder without accompanying abnormalities. However, confusion remains about its clinical presentation, natural history, and classification. OBJECTIVE: To examine the natural history, clinical and brain imaging characteristics, and response to dopaminergic medications of primary progressive freezing gait (PPFG) disorder. DESIGN/METHODS: Review of medical records, videotape examinations, and computed tomographic and magnetic resonance imaging of the brain and results of neurological evaluations, including the Unified Parkinson's Disease Rating Scale, in patients with PPFG. RESULTS: Thirty patients (16 male) were diagnosed as having PPFG (mean age at onset, 72.2 years; mean duration of disease, 5 years). Gait disorder was the initial complaint in 27 patients. Freezing gait was the initial manifestation in 18 and was present within the first year in 27. Natural history included 25 patients falling within 3 years of onset, 20 experiencing retropulsion within 4 years, and 16 requiring wheelchairs by 5 years. On neurological examination, bradykinesia was present in 29 patients, muscle rigidity in 15, and postural tremor in 11. Other features included speech abnormalities in 10, hyperreflexia without clonus in 17, and dementia in 8. Extraocular movement abnormalities and dysphagia were rare. All 30 patients were treated with levodopa with minimal effect. Eighteen were treated with a dopamine agonist with no notable effect. Of the 23 patients with magnetic resonance imaging scans, results were normal in 9 and included minor nonspecific changes in 14. The computed tomographic scans obtained in 12 patients showed similar results. One patient underwent fluorine F ((18)F) labeled deoxyglucose positron emission tomography, which showed mild reduction in medial frontal glucose metabolism. CONCLUSIONS: Primary progressive freezing gait appears to be a clinically distinct progressive neurological disorder that primarily affects gait, initially resulting in freezing and later in postural instability. A wheelchair-bound state often develops within 5 years. It is accompanied by other parkinsonian features, particularly bradykinesia, but is unresponsive to dopaminergic medications. It progresses in a fairly stereotyped manner. Primary progressive freezing gait disorder should be a unifying term for this disorder that has gone by many names in the literature and should be classified as a Parkinson-plus disorder.

Aged↗
PubMed2005

Prevalence of gait disorders in hospitalized neurological patients.

The prevalence of gait disorders among neurological inpatients is unknown, although disturbed gait is a common symptom. Gait disorders often lead to loss of independence with restraints for the patients and caregivers and costs for the health system. We designed a prospective study and investigated all patients admitted to a neurological hospital during a 100-day period for the presence of a gait disorder. Clinical investigation and several disease-specific rating scales were carried out for 493 patients. In 60% of the patients, a disturbance of gait was diagnosed. Most frequent diagnoses were stroke (21%), Parkinson's disease (17%), and polyneuropathy (7%). Within these diagnoses, the rate of patients with disturbed gait was high in Parkinson's disease (93%), subcortical arteriosclerotic encephalopathy (85%), and motor neuron disease (83%). Advanced age, dementia, alcohol abuse, and treatment with antiepileptics, neuroleptics, benzodiazepines, and chemotherapeutics were identified as risk factors for a gait disorder. A decline of cognitive function was accompanied by a reduction of walking speed. According to these results, gait disorders are among the most frequent symptoms in neurology.

Adult↗