Older gait disorders

Published At: 21 January 2020 , 03:49 PM

Gait disorders cover several problems, including slowing down the speed of movement and loss of smoothness, symmetry, or synchronism of body movement. For older people, regular walking, getting up from a chair, turns and bends are necessary to maintain the ability to move independently. Movement speed, time of getting up from a chair and the ability to take a tandem position (standing position, one leg in front of the other — a measure of balance) are independent predictors of the ability to perform motor activity in everyday life (for example, shopping or traveling, cooking) and avoid the risk of being placed in nursing home and delay the onset of death.

Walking without assistance requires adequate attention and muscle strength, plus effective motion control to coordinate sensory signals and muscle contraction.

Normal age-related gait changes

Some of the components that make up the gait change with age, some not.

Walking speed remains stable until about 70 years old; then it decreases by about 15% at ten years for a normal gait and 20% at ten years for a quick walk. Walking speed is the most truthful prognostic parameter of the lifespan - as accurate as of the number of chronic diseases and hospitalizations in an older adult. Those who stroll at the age of 75 die on average six years earlier than those who walk at a reasonable speed and ten years more first than those who walk fast. Walking speed becomes slower, as the elderly have reduced stride length while maintaining the same pace (stride frequency). The most likely cause of the reduction in stride length (distance from heel to heel) is the weakness of the calf muscle, which pushes the body forward; in the elderly, the strength of the calf muscle significantly reduced. However, older people seem to

The step frequency (determining the number of steps in 1 min) does not change with age. Each person has a preferred step frequency, related to the length of the legs, and, as a rule, represents the most energy-efficient rhythm. The step of tall people is longer at a slower step frequency; taller people take shorter steps at a faster step frequency.

With age, the duration of the second position of the legs increases (i.e., the time both legs are on the ground while walking is a more stable position for moving the body's center of gravity forward). The percentage of double-time position increases from 18% at a young age to 26% in healthy elderly. Increased time in a double area reduces leg advancement time and shortens stride length. An even more significant increase in the range of the dual view of the legs in the elderly observed either when they walk on an uneven or slippery surface, or if they suffer from imbalances, or when they are afraid to fall. They look like they are walking on wet ice.

The walking posture changes slightly with aging. Older people walk straight without leaning forward. However, some go with higher anterior (descending) pelvic rotation and an increase in lumbar lordosis. Such a modified posture, as a rule, appears due to a combination of weak abdominal muscles, flexors of tight abdominal muscles, and an increase in fat in the abdominal cavity. The legs of the elderly, as a rule, are turned sideways by about 5 ° so that the fingers stick out, because the internal femoral rotation has weakened, and it is necessary to maintain lateral stability. The clearance of the feet (feet) when walking with a measured step with age remains unchanged.

Combined articular mobility varies slightly. Plantar flexion of the ankle weakens precisely in the late stage of completion of the maneuver, i.e., a little earlier than the back leg rises. The general movement of the knee does not change. Flexion and extension of the thigh remain unchanged, but the adduction of the hips increases. Pelvic movements reduced in all planes.

Pathological gait changes

Causes

Several diseases can contribute to the occurrence of insufficiently functional or even unsafe gait for the patient. This includes in particular:

  • Neurological disorders
  • Musculoskeletal disorders 

Neurological complications include various types of dementiacerebellar disorders, as well as sensory and motor neuropathies.

Manifestations

There are many manifestations of gait disturbance. Some deviations suggest related causes.

Loss of symmetry of movement and coordination in time between the left and right sides of the body, as a rule, indicates a disorder. In the absence of disturbances, the body moves symmetrically; stride length, stride frequency, shape, ankle, knee, hip, and pelvis movement are uniform on both sides. Unilateral asymmetry usually develops either with a neurological disease or with a disease of the musculoskeletal system (for example, lameness caused by pain in the knee). The unpredictability of extreme variability of the gait rhythm, stride length, or width of the leg transfer indicates impaired regulation of gait motility due to cerebellar syndrome, frontal lobe syndrome, or repeated use of psychotropic drugs.

Difficulties with starting or maintaining a walk may develop. At the start of walking, patients' legs can "stick to the floor," because they shift their weight onto one leg to allow the other leg to move forward. This problem may be a separate flaw - the disunity of the gait may be a manifestation of Parkinson's disease, or maybe due to violations in the frontal lobes or subcortical parts of the brain. From the moment you start walking, the steps should be continuous, with slight fluctuations in the duration. Braking, stopping, or almost stopping, as a sign of careful walking, suggests a fear of falling or gait syndrome of lesion of the frontal lobe. Bullied legs are a risk factor for tripping and are standard in itself.

Retrospulsion means an irresistible movement of the patient back at the beginning of walking or falling back during walking. It can occur with frontal gait disorder, parkinsonism, CNS syphilis, the presence of progressive foci of paralysis.

A sagging foot causes a dragging of the toes or a step-by-step gait (i.e., exaggeratedly raised legs so as not to stumble). It can be secondary due to weakness of the anterior tibial nerve (for example, caused by trauma to the tibial nerve in the lateral aspect of the knee or fibular mononeuropathy, usually associated with diabetes), spasm of the calf muscles (calf and soleus), or lowering of the pelvis due to muscle weakness, which provides proximal extraneous position (in particular, gluteus maximus). A low leg amplitude (for example, due to a reduction in knee flexion) may resemble a shaggy foot.

The length of a short step is not specific and can be a manifestation of a fear of falling, a neurological problem, or a problem of the musculoskeletal system. A side with a short stride length is usually the excellent side, and a quick step, as a rule, appears due to problems of the opposite (problem) leg. For example, a patient with a weak or painful left leg spends less time in a single position on the left leg and produces less energy to propel the body forward, resulting in shorter walking time for the right leg and a more concise right step. A first right leg has an average length of a single position, resulting in a regular walking time for the left leg, and the step length of the left leg becomes longer than the right.

Sweeping gait (increased stride width) is detected by observing the patient's gait on the floor, laid out with a 30 cm tile. A gait considered to be widespread if the outer edges of the legs extend beyond the width of the pipe. With decreasing speed, the step width increases slightly. Sweeping gait can be caused by cerebellar insufficiency or bilateral disease of the knee or hip joints. A variable step width (spreading legs to one or the other side) indicates a low level of motor control, which is due to a decrease in subcortical regulation.

Circumduction (moving the foot in an arc rather than in a straight line when walking forward) occurs in patients with weakness of the pelvic floor muscles or difficulty bending the knee. A common cause is a spasticity in the extensor muscles of the knee.

Bending the body forward can occur with kyphosis, Parkinson's disease, or Parkinson-like disorders associated with dementia (especially with vascular dementia and dementia with diffuse Levy bodies).

The mincing gait is manifested by an accelerating increase in steps (usually with a forward bend), because of which patients can go on a run to prevent a fall forward. A mincing gait can occur in Parkinson's disease or, less commonly, as a manifestation of undesirable consequences from taking medications that are dopamine-blockers (typical and atypical antipsychotics).

The deviation of the body towards the affected leg is predictable because of the desire to reduce pain in the arthrosis-affected hip or knee joints ("painless" gait). With hemiparetic pace, the body can lean on the strong side. In this position, to free up space for movement due to the impossibility of bending the knee, the patient turns to raise the pelvis in the opposite direction.

Uneven and unpredictable instability of the body position can be caused by dysfunction of the cerebellum, subcortical, or basal ganglia.

Deviations from the path of movement are an indicator of the lack of control of motor control.

The amplitude of hand swings may be reduced or completely absent in Parkinson's disease and vascular dementia. Disorders of the magnitude of the arm movement can also occur due to the adverse effects of dopamine blockers (typical and atypical antipsychotics).