Brain-Based Gait

Assessment:
The Coach’s Secret
Weapon
“Gait is the most important biomarker
for neurological integrity.”
– Dr. Frederick Carrick
Posture
and Gait
Neurology
 Remember the Basics:

Motor

The Right Cortex Does 2 Things:

• Controls Voluntary Movement on the Left

Side of the Body via the Motor Cortex
• Sets the “Tone” of the Right Side of the
Body via the PMRF

Your Divided The Left Cortex Does 2 Things:

Brain • Controls Voluntary Movement on the

Right Side of the Body via the Motor
Cortex
• Sets the “Tone” of the Left Side of the
Body via the PMRF

Sensory

All Sensory Input Eventually Goes to the

Contralateral Cortex, Except Smell
 MOTOR
CONTROL
PATHWAYS
REFLEXIVE
MOTOR
CONTROL
PATHWAYS
 Hypotheses of cognitive process of posture-gait control.
A: Cognition of bodily information. Sensory signals
flowing into the central nervous system converge to the
brainstem, cerebellum, thalamus, and cerebral cortex. At
the level of cerebral cortex, signals from the visual
cortex, vestibular cortex and primary sensory cortex (S1)
is integrated and internal model of self-body, such as
body schema and verticality can be constructed at the
temporoparietal cortex including the vestibular cortex
and posteroparietal cortex. Reciprocal connection
between the temporoparietal cortex and cerebellum
may contribute to this process.
B: Transmission of the bodily information. The bodily
information is then transmitted to the supplementary
motor area (SMA) and premotor area (PM) where the
information can be utilized as materials to produce
motor programs. Similarly, the information is transferred
to hippocampus and is used to navigate further
behaviors.
C: Motor programming. The motor cortical areas closely
cooperate with the basal ganglia and cerebellum so that
appropriate motor programs are constructed.
D: Postural control by corticofugal projections to the
brainstem and spinal cord. The bodily information
generated at the vestibular cortex may be utilized for
sustention of vertical posture via cortico-vestibular and
vestibulospinal tract. Signals from the prefrontal cortex
including plans and intentions may trigger to run motor
programs in the SMA/PM, which may include those for
purposeful movements and associating postural control.
The postural control program may be utilized to
generate anticipatory postural adjustment via cortico-
reticular and reticulospinal tract. Then motor programs
are sent to the M1 so that goal-directed purposeful
skilled movements can be achieved.

Postural control by corticofugal projections to the brainstem and spinal cord. From Takakusaki, Kaoru. 2017. “Functional Neuroanatomy for
Posture and Gait Control.” Journal of Movement Disorders 10 (1): 1–17. https://doi.org/10.14802/jmd.16062.
 BASIC
• Forward Walk – Normal Speed
• Forward Walk – Slow Speed

• Forward Walk – Fast Speed

• Backward/Retro Walking

Key Gait • Sidestep Walk (Sideflow &

Crossover)

Assessments • All of the above with dual tasking

To Perform ADVANCED
• Gaze Stabilization Walks
• Semicircular Canal Position Walks
• aVOR Walks

• VOR-C Walks
• Obstacle Navigation
• Narrow Stance (Walk the Line)
 • Forward and backward walking share many
fundamental neural controls.
• However, backward walking requires:
Why Retro • Greater Overall Cortical Activation

Walking • Increased Stabilization

Assessments • Increased Muscle Activation

• Altered Kinematic Coordination
Matter • Increased Metabolic Activity
 What’s the Deal with Dual Tasking?
How to Do It
• Client Walks While Performing a Cogntive Task
• Serial 7’s (Counting Backward from 100 by 7’s)
• Every Other Month (Say January out loud. Think February. Say March out loud, etc.)
Why It’s Important
• Remember that the brain’s ability to organize simultaneous motor and cognitive activites is a key element of moving safely
through the world.
• Dual Tasking increases cortical activity and the demands on multiple systems and cortical areas including the:
• Prefrontal Cortex
• Right Inferior Frontal Cortex
• Parietal Lobe
• Z Practitioners may see EITHER gait improvements or decrements during dual tasking.
• If gait improves, the client likely needs more general cortical activation drills incorporated into their training. Think
dual tasking during motor control drills or while squatting, pressing, etc.
• If gait degrades, think fuel and activation support like targeted breathing and brain activation drills.
 • Gaze Stabilization Walks – Client performs the basic gait
assessment patterns while holding the eyes in each of the 9 gaze
stabilization positions.

• Semicircular Canal Position Walks – Client performs the basic gait

assessment patterns while statically holding the head, neck and
eyes in each vestibular canal position.

Advanced • aVOR Walks – Client performs the basic gait assessment patterns

Gait
while moving the head and neck and performing VOR gaze
stabilization.

Assessments
• VOR-C Walks – Client performs the basic gait assessment patterns
while performing VOR-C movements in each of the 8 directions.

• Obstacle Navigation – This should involve moving over, under and

around obstacles at different speeds in different directions.

• Narrow Stance (Walk the Line) – Client performs the basic gait
assessment patterns trying to walk on a 4”-6” line on the floor.
Imagine they are trying to walk on a gymnastic balance beam.
Key Findings
q Pain
q Bobblehead
q Loss of Arm Swing
q PMRF Pattern
q Cerebellar Pattern
q Poor Rhythmicity (Internal vs. External)
q Disturbed Global Stability/Balance
q Poor Proprioceptive Awareness and
Visual-Vestibular-Proprioceptive
Integration (Obstacle & Narrow Stance)
To Learn More About Our Brain-
Based Training Curriculum:
www.zhealtheducation.com
Email: info@zhealth.net
Call: +1.844.584.2822

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