Neurology-Online

Gait disorder

definition

A gait disorder is a disruption of the physiological sequence of movements that makes walking difficult or impossible. It can be an expression of neurological, orthopedic or psychological disorders.

The gait disorder is based on damage to the central nervous system, peripheral nerves or the musculoskeletal system, which consists of muscles, bones and joints.

introduction

One speaks of a gait disorder both with reduced gait speed and with a pathologically altered gait pattern. Older people should also be able to travel a meter per second without any problems. If the speed is significantly lower, there is a gait disorder.

In addition to the speed, the gait pattern is also decisive. As a rule this is fluid and harmonious. The feet are a certain distance apart, the stride length is not too short, the foot is lifted off the ground at the correct height.

Causes of a gait disorder

For a smooth gait you need an intact sense of balance as well as a smoothly functioning musculoskeletal system. Gait disorders can therefore be roughly divided into two causes.

On the one hand, gait disorders are triggered by problems with the sense of balance. The following factors are important for an intact sense of balance:

the eyes
the organ of equilibrium in the inner ear
sensitive information from the body periphery
the cerebellum to coordinate this information

In particular, diseases of the inner ear such as Menière's disease or inflammation have a massive impact on the sense of balance. Diseases of the cerebellum also trigger gait disorders. Disorders in the musculoskeletal system such as a lack of muscle strength and restricted joint function due to signs of wear and tear also affect the gait pattern.

Other causes of an orthopedically induced gait disorder are spinal canal stenoses, herniated discs or fractures. The neurological causes of a gait disorder can disturb both the sense of balance and the musculoskeletal system.

Gait disorders are typical in Parkinson's disease, multiple sclerosis, polyneuropathy or stroke. Vitamin deficiency (especially vitamin B12) or alcoholism lead to gait disorders. This also applies to special drugs - neuroleptics, antiepileptics or benzodiazepines worsen the patient's gait.

Gait disorder in multiple sclerosis

In the case of multiple sclerosis, gait disorders can occur over and over again.Due to the scarred inflammation in the area of the central nervous system, various neurological symptoms occur in patients with multiple sclerosis.

A fluid gait depends on many factors. On the one hand, sensory information about the nature of the ground is important, and on the other hand, smooth muscle function of the lower extremities. However, multiple sclerosis can lead to sensory disorders as well as muscle weaknesses and even paralysis. This affects the gait pattern.

The sense of balance also plays an important role; this is controlled by the cerebellum. Inflammatory changes in the cerebellum therefore inevitably lead to an impairment of the gait pattern.

The symptoms often resolve at least partially after a multiple sclerosis attack. The sensitivity disturbance decreases. The mobility of the muscles improves. A more or less pronounced gait disorder is common in patients with a long course of the disease, since a very complex fine-tuning between the individual components of the central nervous system is required for a fluid gait pattern.

If you are interested in other symptoms of this condition then read our next topic: Symptoms of multiple sclerosis

Gait disorder in Parkinson's disease

Parkinson's disease, hereinafter referred to as Parkinson's, is a relatively common neurological disorder. It can manifest in old age and is caused by the death of nerve cells in the brain that regulate motor skills. A typical clinical picture is a gait disorder. Overall, the result is an inhibited, slowed gait pattern. Parkinson's patients have difficulty starting to walk. The gait disorder is characterized by the smallest triple steps that get a little better after a few meters. People who suffer from this disease often find it difficult to change direction when walking. If the patient is e.g. When asked to turn around on the spot, he does so with many small steps. So-called bottleneck difficulties are also part of Parkinson's gait disorder. This means that the gait disturbance is particularly evident in narrow spaces or in narrow spaces such as a door frame.

Sometimes even the smallest bumps, such as the edge of a carpet, are enough to trip a Parkinson's patient. An early sign of such a gait disorder describes a reduced swinging of the arms, which initially occurs on one side. The therapy consists primarily of the administration of dopamine, the messenger substance that the brain lacks.

Read more on this topic at: Symptoms of Parkinson's Disease

Gait disorder due to diseases of the cervical spine

Diseases of the cervical spine can lead to problems walking, such as a herniated disc. The slipped intervertebral disc tissue presses on the spinal cord, which among other things causes a gait disorder.

A narrow spinal canal can cause similar symptoms. Spinal stenosis damages the spinal cord or the corresponding nerve root from pressure. In addition, both clinical pictures are associated with massive pain, which often causes poor posture and thus prevents a fluid gait.

Disorders of the musculoskeletal system also lead to gait disorders. Tension in the shoulder and neck muscles, blockages in the first two cervical vertebrae or instability of the ligamentous apparatus can cause a gait disorder. On the one hand, the sequence of movements is disturbed, on the other hand, it can cause dizziness, which disturbs the sense of balance.

Gait disorders due to problems with the cervical spine are therefore not uncommon. The orthopedic specialist is usually the first point of contact for diagnosis and therapy.

Read more about the symptoms of cervical disorders under: Symptoms of a cervical spine syndrome

Gait disorder from alcohol

A gait disorder can also develop from alcohol. A distinction must be made between the gait disturbance caused by alcohol intoxication and the symptoms that chronic alcohol abuse can cause. In the intoxicated state, the gait disorder can be explained by the direct effect of alcohol in the brain, in which important centers responsible for the coordination of the gait are impaired. This gait disorder caused by alcohol manifests itself in a staggering gait and loss of balance; it can sometimes occur at a blood alcohol level of 0.3 per mille. The disorder disappears after the alcohol is broken down in the body.

There is also a type of gait disorder caused by chronic and excessive alcohol consumption. It is part of the symptom complex called Wernicke encephalopathy and is caused by a deficiency in vitamin B1 (Thiamine) is caused. The affected people suffer from unsteadiness to walk and stand, and walking is almost impossible. This state persists beyond the duration of the actual alcohol intoxication. With moderate alcohol consumption, no gait disturbance of this kind develops. Wernicke encephalopathy is treated by administering vitamin B1 and glucose and with alcohol withdrawal.

Read more on this topic at: Consequences of alcohol

Gait disorder in spinal stenosis

In spinal stenosis (Claudicatio intermittens) Bony structures cause the spinal canal in the spinal column to narrow and thus pinch the spinal cord and nerves. In addition to other symptoms, this can also lead to a gait disorder. Depending on the location of the spinal stenosis, various symptoms occur.

The lumbar spine is often affected. Pain caused by the entrapment restricts certain movements so that they can no longer be fully performed. It is characteristic that the patient can only walk a very short distance normally before severe pain occurs in the front and back of the thighs, which lead to the walking movements stopping. Sometimes the walking distance can be limited to less than 100m. Problems when walking downhill are typical of the symptoms.

The patient experiences an improvement by sitting down or by bending forward slightly, since the spinal canal is opened slightly by the flexion of the spine and thus the pressure on the nerve fibers is reduced. Bending backwards has the opposite effect.

If the cervical spine is affected, it can also lead to gait disorders in spinal canal stenosis. The cause of the gait disorder is not so much pain, but rather a disturbed deep sensitivity. Information about the position of muscles, bones and joints is no longer adequately transmitted, which leads to unsteady gait and falls. Spinal canal stenosis can be treated conservatively with physiotherapy, muscle training and physiotherapy. If there is no improvement in the symptoms, surgery must be considered.

You can find out more about this at: Symptoms of spinal stenosis

Gait disorder in toddlers

The development of a gait disorder occurs in children or toddlers No rarity. Often they appear in the course of development and also disappear again, e.g. at a Coxa antetorta the case is. It affects around 15% of children. Here the legs are rotated a little inwards. This gait disorder almost always regresses. In some cases, however, there is a cause that needs treatment.

Most of the causes in the child / toddler are orthopedic in nature. The gait disorders are often accompanied by Hip- or Knee pain. An innate, undiscovered one Hip dysplasia leads to movement-dependent pain and a typical limping or waddling gait in toddlers. Also a Perthes disease, which affects the femoral head in the child, causes a limping, painful gait disorder. In older children, a newly occurring gait disorder can be an expression of a detachment of the Femoral head epiphysis (Epiphysiolysis capitis femoris) be. In addition, a gait disorder in children or toddlers can be caused by congenital misalignments of the feet, legs or hips. Every gait disorder in the child or toddler should be recognized and treated quickly in order to avoid permanent damage from constant incorrect stress and thus promote normal development.

Gait disorder in old age

A gait disorder often manifests itself for the first time in old age. In addition to making it difficult to walk, the increased risk of falling is a particular problem, as the bones become more susceptible to fractures with age. This form of gait disorder can have various causes. Neurological diseases as a stroke, which leads to paralysis, or a Parkinson's disease can often be the trigger for the appearance of the disease. In addition, injuries from Spinal cord e.g. thought to be due to a fracture of a vertebral body or brain tumor.

However, the most common causes of gait disorder in old age are orthopedic Nature in which bones and muscles are damaged. This includes the arthrosis, a degeneration of joints caused by wear and tear, especially in the hip or knee. The joints can no longer be loaded without restriction and thus hinder the gait pattern. Also rheumatic Conditional restrictions can lead to a gait disorder. Frequent clinical symptoms are limping, shuffling or dragging of a leg. Weakened muscles are often the reason for a gait disorder. Depending on the cause, the underlying disease must be treated and the gait pattern through professional physiotherapy be stabilized

Accompanying symptoms with a gait disorder

Gait disorders are often accompanied by other symptoms. If there is an orthopedic cause of a gait disorder such as a slipped disc or spinal canal stenosis, pain often also plays a major role. Also numbness or abnormal sensations (Tingling paresthesia) and muscle paralysis are conceivable. This is also the case with neurological symptoms.

If the gait disorder occurs in patients with multiple sclerosis, sensory disorders and muscle paralysis are common. This also applies to gait disorders in the context of a stroke. For patients with Parkinson's disease, tremor (Muscle tremors) a typical accompanying symptom.

In patients who suffer from a gait disorder due to a chronic increase in intracranial pressure, the accompanying symptoms are dementia (mostly reversible) and urinary incontinence. If an inner ear disease is responsible for the gait disorder, this is usually associated with hearing loss.

In summary, it can be said that gait disorders often have accompanying symptoms. These can provide a good indication of the cause of the gait disorder.

What is an atactic gait disorder?

In an atactic gait disorder, there is a disruption in the process and coordination of muscle movements. This is shown by a correspondingly changed gait pattern. The patients usually walk with their legs apart and appear very insecure. To outsiders, this often seems like a drunk walk.

The most common cause of atactic gait disorder is a disease of the cerebellum. The cerebellum has a central function when it comes to balance but also the planning of motion sequences. Therefore, proper cerebellar function is essential for a fluid gait.

Tumors or circulatory disorders in the cerebellum are therefore noticeable, among other things, through an atactic gait disorder. Even with a pathological expansion of the CSF spaces in the brain (Hydrocephalus) an atactic gait disorder can occur.

This is similar to the gait of a Parkinson's patient. Those affected only take small steps. If the disease is more pronounced, it may be that walking without support is hardly possible.

What is a phobic gait disorder?

With a phobic gait disorder, an unfounded, exaggerated fear of running is in the foreground. Phobias are therefore one of the anxiety disorders. Affected people try to avoid the fear-inducing situation. Often just the thought of it is enough to trigger fear. Those affected are therefore very reluctant to move. Some run like on ice.

The chronic fear reaction can lead to secondary muscle tension, which, especially when it occurs in the cervical spine, can also lead to dizziness and balance disorders.

Exercises for a gait disorder

One of the pillars of improvement and therapy for a gait disorder is physiotherapy or physiotherapy, in which the muscles are built up with various exercises or a bad posture is counteracted. Exercises are particularly useful for orthopedic problems, but certain exercises also play an important role after a stroke, e.g. to improve the gait pattern again. Depending on the cause and extent of the gait disturbance, certain exercises come into consideration that must be professionally instructed and consistently performed by the patient.

With lighter Spinal stenosis does the Strengthening the back muscles Sense to improve posture and thus take pressure off your nerves.

In old age are worth doing exercises for stabilization of the Leg- and Hip muscles especially. In addition, exercises to improve coordination and sense of balance can be used, which can significantly reduce gait disturbance and the risk of falling.

For children Exercises to improve posture and the position of the joints are also a good measure, as many posture problems can still be solved in toddler age. It is important to know that all exercises are only effective if they are properly and careful are executed. It is therefore worth taking the help of a physiotherapist to learn the training procedures together so that they can be carried out at home at a later point in time.

Of course, every type of physiotherapy has its limits. If the gait disorder does not improve even after a few weeks, further therapeutic measures must be considered. A clear diagnosis should also be made beforehand by a doctor in order not to unnecessarily delay the start of an adequate therapy in the case of serious illnesses. Often, however, exercises are a tried and tested means with which to remedy mild forms of gait disorder, especially in poor posture and muscle weakness.

Such is the prognosis of a gait disorder

The prognosis of a gait disorder depends on its cause. There are causes for gait disorders that can be treated well, then the gait disorder usually improves quickly.

This is the case, for example, with (normal pressure) hydrocephalus. After the removal of nerve fluid, the internal cerebrospinal fluid spaces in the brain are relieved and the gait disorder suddenly improves.

Even untreated Parkinson's disease can improve with drug therapy. Ultimately, Parkinson's disease, but also multiple sclerosis, are chronically progressive diseases that cannot be cured. The resulting gait disorder therefore has a poorer prognosis.