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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Gait disturbance Resident Survival Guide Microchapters}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Gait disturbance resident survival guide#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Gait disturbance resident survival guide#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Gait disturbance resident survival guide#Diagnosis|Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Gait disturbance resident survival guide#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Gait disturbance resident survival guide#Do's|Do's]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Gait disturbance resident survival guide#Don'ts|Don'ts]]
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{{CMG}}; {{AE}}[[User:MoisesRomo|Moises Romo M.D.]]
 
'''''Synonyms and Keywords:''' gait disturbance management, gait disturbance workup, gait disturbance approach, approach to disequilibrium, approach to imbalance''''' <br />'''
==Overview==
==Overview==
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
[[Disequilibrium|'''Gait disturbance''']] refers to an impaired [[sense]] or absence of [[Balance disorder|balance]] or [[equilibrioception]] that primarily occurs during standing or walking. [[Disequilibrium|'''Gait disturbance''']] usually occurs without any cephalic sensations like [[headache]], [[nausea]], and [[vomiting]]. It may also causes [[dizziness]], but it is typically a more complex category with more continuous [[symptoms]] in comparison to the other [[causes]] of [[dizziness]], like [[presyncope]] and [[vertigo]].
 
==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.


*[[Life threatening cause 1]]
*[[Intoxication|Intoxications]]
*[[Life threatening cause 2]]
*[[Head trauma]]
*[[Life threatening cause 3]]
*[[Carbon monoxide poisoning]]


===Common Causes===
===Common Causes===


*[[Common cause 1]]
*[[Osteoarthritis]]
*[[Common cause 2]]
*[[Pelvic girdle pain]]
*[[Common cause 3]]
*[[Ataxia]]
*[[Common cause 4]]
 
*[[Common cause 5]]
*[[Hip dysplasia]]
*[[Polio]]
*[[Multiple sclerosis]]
 
*[[Cerebellar lesion|Cerebellar lesions]]
*[[Cerebellum|Cerebellar]] [[degeneration]]
 
*[[Parkinson's disease]]


==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines. {{familytree/start |summary=PE diagnosis Algorithm.}} {{familytree | | | | A01 | | | A01= }} {{familytree | | | | |!| | | | }} {{familytree | | | | B01 | | | B01= }} {{familytree | | |,|-|^|-|.| | }}{{familytree | | C01 | | C02 | C01= | C02= }} {{familytree/end}}
Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality|Gait disturbance]] according to the American Academy of Neurology guidelines:<ref name="pmid24132835">{{cite journal |vauthors=Giladi N, Horak FB, Hausdorff JM |title=Classification of gait disturbances: distinguishing between continuous and episodic changes |journal=Mov Disord |volume=28 |issue=11 |pages=1469–73 |date=September 2013 |pmid=24132835 |pmc=3859887 |doi=10.1002/mds.25672 |url=}}</ref> <br><br>
 
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | A01= [[Gait]] disturbance }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | |}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | B01 | | | B01= When? }}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|.| | | }}
{{Family tree | | | | | | | | | | | | | | | | | | B01 | | | | | | | | B02 | | | | B03 | | B01= Always with [[Movement disorder|movement]] (may vary in severity) | B02= Intermittently during [[Movement disorder|movement]] (may vary in severity and frequency)| B03= Continuous and intermittent disturbances are present at least once }}
{{Family tree | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |!| | | | | |!| | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | B01 | | | | | | | | B02 | | | | B03 | | B01= Continuous | B02= Episodic| B03= Mixed }}
{{Family tree | | | | | | | | | | | | | | | | | | |!| | | | | | | | | |!| | | | | | }}
{{Family tree | | | | | | | | | | | | | | | | | | |!| | | | | |,|-|-|-|+|-|-|-|.| | | }}
{{Family tree | | | | | | | | | | | | | | | | | | |!| | | | | B01 | | B02 | | B03 | | B01= Transient inability to create effective stepping? | B02= Unintentional increase in [[speed]], usually with small steps? | B03= Transient [[imbalance]]? }}
{{Family tree | | | | | | | | | | | | | | | | | | |!| | | | | |!| | | |!| | | |!| | }}
{{Family tree | | | | | | | | | | | | | | | | | | |!| | | | | B01 | | B02 | | B03 | | B01= Freezing | B02= Festination | B03= [[Disequilibrium]] }}
{{Family tree | | | | | | | | | | | | | | | | | | |!| | }}
{{Family tree | | |,|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|.| | }}
{{Family tree | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | | B07 | | B08 | | B09 | | B01= [[Disequilibrium]] and hypermetria of stance and [[gait]]? | B02= Associated with [[Postural instability|increased postural tone]]? | B03= Slow or small steps and/or slow or [[Postural instability|small postural]]? | B04= Involuntary [[Movement disorder|movements]]? | B05= Associated with [[muscle weakness]] or [[paralysis]]? | B06= Static or [[axial]] postural deformities? | B07= Secondary to [[musculoskeletal]] or central [[pain]]? | B08= Present at a higher level? | B09= Difficult to classify the continuous nature of the [[gait]] disturbance? }}
{{Family tree | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }}
{{Family tree | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | | B07 | | B08 | | B09 | | B01= [[Ataxic]] | B02= [[Spastic]] | B03= [[Bradykinesia|Bradykinetic]]/[[Hypokinesia|hypokinetic]] | B04= [[Dyskinesia|Dyskinetic]]/[[Chorea|Choreic]]/[[Dystonia|Dystonic]] |B05= [[Paresis|Paretic]] | B06=Trunkal disturbance | B07= Antalgic | B08=Frontal disturbance | B09=Undetermined }}
{{Family tree/end}}<br>
 
==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines. {{familytree/start |summary=PE diagnosis Algorithm.}} {{familytree | | | | | | | | A01 |A01= }} {{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }} {{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }} {{familytree | | | |!| | | | | | | | | |!| }} {{familytree | | | C01 | | | | | | | | |!| |C01= }} {{familytree | |,|-|^|.| | | | | | | | |!| }} {{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }} {{familytree | |!| | | | | | | | | |,|-|^|.| }} {{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }} {{familytree | | | | | | | | | | |!| | | | |!| }} {{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}{{familytree/end}}
Treat the underlying [[Causes|cause]].
 
*To view the specific [[treatment]] of [[Ataxia]] [[Ataxia medical therapy|click here]].
*To view the specific [[treatment]] of [[Multiple sclerosis]] [[Multiple sclerosis medical therapy|click here]].
*To view the specific [[treatment]] of [[Polio]] [[Polio medical therapy|click here]].
*To view the specific [[treatment]] of [[Osteoarthritis]] [[Osteoarthritis|click here]].
*To view the specific [[treatment]] of [[Hip dysplasia]] [[Hip dysplasia|click here]].
 
==Do's==
==Do's==


*The content in this section is in bullet points.
*Perform a top-down [[visual]] orientation evaluation to assess [[symmetry]], [[quantity]], and quality of [[arm]] swing; [[pelvic]] rotation; [[knee]] motion; pelvic tilt; and lateral trunk shift.<ref name="Deppen2007">{{cite journal|last1=Deppen|first1=R|title=From the CORE to the Floor—Interrelationships|year=2007|pages=145–173|doi=10.1016/B978-044306642-9.50013-7}}</ref>
*Perform a bottom-up orientation evaluation to assess [[ankle]], [[Subtalar joint|subtalar]], midfoot, and [[hallux]] [[Motion (physics)|motion]] [[symmetry]], [[quantity]], and quality.<ref name="Deppen2007" />
*Perform a thorough evaluation of [[gait]], measuring [[gait]] on a level surface, change in [[gait]] speed, [[gait]] with horizontal head turns, [[gait]] with vertical head turns, [[gait]] with pivot turn, step over obstacle, [[gait]] with narrow base of support, [[gait]] with [[eyes]] closed, ambulating backwards, and steps.<ref name="urlFunctional Gait Assessment - Physiopedia">{{cite web |url=https://www.physio-pedia.com/Functional_Gait_Assessment#cite_note-Rehab-2 |title=Functional Gait Assessment - Physiopedia |format= |work= |accessdate=}}</ref><ref name="urlRehabilitation Measures | Shirley Ryan AbilityLab">{{cite web |url=https://www.sralab.org/rehabilitation-measures?ID=893 |title=Rehabilitation Measures &#124; Shirley Ryan AbilityLab |format= |work= |accessdate=}}</ref>
*Be aware of the patients' surroundings and be always aware for possible [[Falling (accident)|falls]].<ref>{{cite journal|year=2013|doi=10.1016/C2009-0-64011-3}}</ref>
*Three-dimensional analysis systems may be used as a tool as it is currently the gold standard for measuring [[Spatiotemporal Epidemiological Modeler|spatiotemporal]] variables and joint kinematics.<ref>{{cite journal|year=2019|doi=10.1016/C2016-0-03480-0}}</ref>
*Innovative pressure measurement technology may provide unique insight on mechanical dysfunctions and [[gait]] abnormalities.<ref name="urlGait Analysis Systems | Tekscan">{{cite web |url=https://www.tekscan.com/gait-analysis-systems?utm_source=google&utm_medium=cpc&utm_term=gait+analysis&utm_content=eta4&utm_campaign=medical&gclid=Cj0KCQjwreT8BRDTARIsAJLI0KJcw66kGRfB_G1kvNywAVn5-qi5wv0IYFD9Yb9sMUm0xLcNIiF-ORAaAraREALw_wcB |title=Gait Analysis Systems &#124; Tekscan |format= |work= |accessdate=}}</ref>


==Don'ts==
==Don'ts==


*The content in this section is in bullet points.
*Do not delay [[brain]] [[imaging]] when [[Traumatic brain injury|TBI]] is suspected.
*Do not perform [[walking]] tests in patients with severe acute [[Gait abnormality|gait disturbance]].


==References==
==References==
{{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}}
{{Reflist|2}}  
[[Category:Primary care]]
[[Category:Neurology]]
[[Category:Up-To-Date]]

Latest revision as of 19:43, 15 January 2021

Gait disturbance Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.

Synonyms and Keywords: gait disturbance management, gait disturbance workup, gait disturbance approach, approach to disequilibrium, approach to imbalance

Overview

Gait disturbance refers to an impaired sense or absence of balance or equilibrioception that primarily occurs during standing or walking. Gait disturbance usually occurs without any cephalic sensations like headache, nausea, and vomiting. It may also causes dizziness, but it is typically a more complex category with more continuous symptoms in comparison to the other causes of dizziness, like presyncope and vertigo.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Gait disturbance according to the American Academy of Neurology guidelines:[1]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gait disturbance
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
When?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Always with movement (may vary in severity)
 
 
 
 
 
 
 
Intermittently during movement (may vary in severity and frequency)
 
 
 
Continuous and intermittent disturbances are present at least once
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Continuous
 
 
 
 
 
 
 
Episodic
 
 
 
Mixed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Transient inability to create effective stepping?
 
Unintentional increase in speed, usually with small steps?
 
Transient imbalance?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Freezing
 
Festination
 
Disequilibrium
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Disequilibrium and hypermetria of stance and gait?
 
Associated with increased postural tone?
 
Slow or small steps and/or slow or small postural?
 
Involuntary movements?
 
Associated with muscle weakness or paralysis?
 
Static or axial postural deformities?
 
Secondary to musculoskeletal or central pain?
 
Present at a higher level?
 
Difficult to classify the continuous nature of the gait disturbance?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ataxic
 
Spastic
 
Bradykinetic/hypokinetic
 
Dyskinetic/Choreic/Dystonic
 
 Paretic
 
Trunkal disturbance
 
 Antalgic
 
Frontal disturbance
 
Undetermined
 


Treatment

Treat the underlying cause.

Do's

  • Perform a top-down visual orientation evaluation to assess symmetry, quantity, and quality of arm swing; pelvic rotation; knee motion; pelvic tilt; and lateral trunk shift.[2]
  • Perform a bottom-up orientation evaluation to assess ankle, subtalar, midfoot, and hallux motion symmetry, quantity, and quality.[2]
  • Perform a thorough evaluation of gait, measuring gait on a level surface, change in gait speed, gait with horizontal head turns, gait with vertical head turns, gait with pivot turn, step over obstacle, gait with narrow base of support, gait with eyes closed, ambulating backwards, and steps.[3][4]
  • Be aware of the patients' surroundings and be always aware for possible falls.[5]
  • Three-dimensional analysis systems may be used as a tool as it is currently the gold standard for measuring spatiotemporal variables and joint kinematics.[6]
  • Innovative pressure measurement technology may provide unique insight on mechanical dysfunctions and gait abnormalities.[7]

Don'ts

References

  1. ↑ Giladi N, Horak FB, Hausdorff JM (September 2013). "Classification of gait disturbances: distinguishing between continuous and episodic changes". Mov Disord. 28 (11): 1469–73. doi:10.1002/mds.25672. PMC 3859887. PMID 24132835.
  2. ↑ 2.0 2.1 Deppen, R (2007). "From the CORE to the Floor—Interrelationships": 145–173. doi:10.1016/B978-044306642-9.50013-7.
  3. ↑ "Functional Gait Assessment - Physiopedia".
  4. ↑ "Rehabilitation Measures | Shirley Ryan AbilityLab".
  5. ↑ . 2013. doi:10.1016/C2009-0-64011-3. Missing or empty |title= (help)
  6. ↑ . 2019. doi:10.1016/C2016-0-03480-0. Missing or empty |title= (help)
  7. ↑ "Gait Analysis Systems | Tekscan".
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