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For the elderly gait speed, chair rise time, and the ability to perform
tandem stance are independent predictors of their ability to perform
instrumental activities of daily living eg , the ability to shop, travel, and
cook.

Gait speed, chair rise time, and balance are also predictors of the risk of
medical care and death.

Walking without assistance requires the effective coordination of adequate

sensation, musculoskeletal and motor control, and attention.

m      
 




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 remains stable until about age 70; it then declines about 15%
per decade for usual gait and 20% per decade for maximal gait.

 


 
 is shorter in the elderly.

 
 increases with age to > 26% in healthy elderly persons.

 



i. osteoporosis with kyphosis

ii. increase in lumbar lordosis
iii. 5° greater "toe outµ






i. nkle plantar flexion is reduced during the toe off

ii. Maximal ankle dorsiflexion is not reduced
iii. The overall motion of the knee is unchanged.
iv. Hip motion is unchanged in the sagittal plane but in the frontal plane
shows greater adduction.
v. Pelvic motion is reduced in the frontal and transverse planes, and
transverse plane rotation is reduced.


 
 

~n normal, the movement of the body is usually symmetrical. Step length,

cadence, torso movement, and ankle, knee, hip, and pelvis motion are
equal on the right and left sides.

÷ ¬   





 
 


 
i. Producing regular asymmetry with unilateral neurologic or
musculoskeletal disorders.
ii. Symmetric short step length usually indicates a bilateral problem.
iii. Unpredictable or highly variable gait cadence, step lengths, and
stride widths indicate breakdown of motor control of gait due to a
cerebellar or frontal lobe syndrome.
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Pain, weakness, and numbness with walking that improves when sitting
down may be caused by spinal stenosis.

÷ 













Represent isolated gait initiation failure, evidence of Parkinson·s disease, or

evidence of frontal or subcortical disease.

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Due to high-level sensorimotor disorder may progress to other

abnormalities, including stiff posture with short steps, retropulsion in
stance, weak or poor corrective responses to perturbations of balance when
walking, and a highly variable and unstable gait pattern.

Normal-pressure hydrocephalus should be considered if cognitive deficits

and urinary incontinence are present in combination with high-level
sensorimotor gait disorders.
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÷  

    

     
       
   

  
 
 
  
    
 
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i. Psychogenic
ii. Neurological
iii. Musculoskeletal
÷ ~  

 
  


 

 can be caused by
i. Serebellar, subcortical, and basal ganglia dysfunction.
ii. Knee arthritis (antalgic gait).
iii. Hemiparesis
÷  


    are strong indicators of motor control deficits.
Wide stride width can be caused by cerebellar disease, if the width is
consistent. Variable stride width suggests poor motor control, which
may be due to frontal or subcortical gait disorders.






Diagnosis is best approached in four parts:

÷ History
÷ {bserve gait with and without an assistive device (if safe)
÷ ssess all components of gait & observe gait again with a knowledge
of the patient's gait components

 performance-oriented assessment tool may be helpful, as many other

tests.




   



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i. Measurement of stride length

ii. Measurement of gait kinetics
iii. Balance is impaired if the patient is unable to perform tandem stance
or single leg stance for >= 5 seconds.
iv. Proximal muscle strength is tested by having the patient get out of a
chair without using his arms.
v. Gait velocity is measured using a stopwatch. Gait velocity in healthy
elderly persons ranges from 1.5 to 1.1 meters/second.
 vi. Sadence is measured as steps/minute. Sadence varies with leg
length.
vii. Step length, the easiest way to measure or calculate the patient's foot
length; normal step length is three foot lengths. The following
equation calculates average step length in centimeters: 10 × velocity ×
time to take 10 steps. n equivalent calculation is 0.16 × velocity ×
cadence (steps/minute).
viii. Step height
ix. symmetry or variability of gait rhythm

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i. High levels of physical activity help maintain mobility, even in

patients with disease.  regular walking program of 30 minutes/day
is the best single activity for maintaining mobility. The patient should
be instructed to increase gait speed and duration over 4 months.
ii. Stretching
iii. Resistance training
iv. Balance exercises
v. Joint range of motion
vi. Develop muscle power and motor control.
vii. The positive psychological effects are difficult to measure but are
probably just as important.
viii. Training of assistive devices use by therapists.

References:
i. The merck manual of geriatrics, ch. 21,  

 
.
ii. Thieme journal abstract 2006.
iii. Sudarsky & Lewis Massachusetts Medical Society Publication the
New England Journal of Medicine year: 1990.
iv. Journal of neurology, Springerlink 3 September 1990
v. Moe r. Lim et al Journal of the merican cademy of {rthopedic
Surgeon 2006.
vi. http://www.wrongdiagnosis.com/sym/walking_symptoms.htm
vii. http://knol.google.com/k/gait-disorders-in-the-elderly#
viii. http://www.geriatricsreviewsyllabus.org/gait6_m.htm
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!

 

    

rticle abstract:

Many elderly people have problems with gait, or the manner of walking
that contribute to the incidence of falling. The mechanical, anatomical and
physiological factors of normal gait are reviewed.

The effects of aging on gait include the increase of sway while standing,
slowed responses of postural support for balance, and change in the
capacity to integrate sensory information.

Studies have shown that people over the age of 65 use shorter, broader-
based strides to compensate for the change in balance and walk more
slowly.

There are two general causes of gait disorders: those that affect the muscles
and skeleton, such as myelopathy (diseases of the muscles), degenerative
arthritis of the spine, spinal cord compression (causing bony protrusions of
the spine), and vitamin b12 deficiency; and neurologic abnormalities, such
as parkinson's disease, sequelae from stroke, cerebellar degeneration,
disorders of sensory afferent systems, and encephalopathy (abnormalities
of the structure or function of the tissues of the brain) due to the toxicity of
medications or adverse effects of medications on the body's metabolism.

 number of other factors can also occasionally cause gait disorders. The
evaluation of patients with gait disorders should include a history of the
patient, a physical examination concentrating on musculoskeletal, visual,
and neurologic abnormalities, observation of the patient's gait, assessment
of balance, and other testing when appropriate, such as ct scanning or
magnetic resonance imaging.

The type of treatment depends on the cause of the gait disorder.

pproximately one of four gait disorders is treatable, and physical therapy
with gait training is recommended for all patients.

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Distinguishing between the normal gait of the elderly and pathologic gaits
is often difficult.

Pathologic gaits with neurologic causes include:

i. frontal gait
ii. spastic hemiparetic gait
iii. parkinsonian gait
iv. taxic gait

Pathologic gaits with combined neurologic and musculoskeletal causes

include:

i. myelopathic gait
ii. stooped gait of lumbar spinal stenosis
iii. steppage gait

Pathologic gaits with musculoskeletal causes include:

i. antalgic gait
ii. coxalgic gait
iii. trendelenburg gait
iv. knee hyperextension gait

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~nfrared computerized stroboscopic photometry was used to measure the

kinematic profile of walking of 20 young adults and 20 neurologically
healthy elderly people. Sompared with the young adults, the elderly
exhibited 17²20% reductions in the velocity of gait and length of stride. The
elderly also exhibited comparable reductions in the maximum toe-floor
clearance, arm swing, and rotations of the hips and knees, but these
alterations in gait were attributable to the reduction in stride length, which
may have non-neurological causes.



 +

 

3 September 1990)