Eating disorders significantly affect older people and contribute to increased morbidity from the falls they cause.
With each passing day, these types of disorders and their consequences become more and more common as we live in increasingly long societies. for that it is important to know what the different types of gait disorder are, And what symptoms characterize them.
Gait disorders always involve a failure of balance and our locomotion system, and in general, they often affect the elderly who see how with aging their musculoskeletal system and their postural reflexes deteriorate.
To be able to understand how a gait disorder occurs, let’s first see what is the mechanism of normal walking, in general terms, Which can be divided into three phases: takeoff, advance and support.
While the knee is locked in extension, soli and the twins propel the member, lifting the heel off the groundAt the same time, the abductor muscles and the quadriceps of the contralateral limb prevent it from tilting the pelvis by keeping it fixed.
With the contralateral end supporting all the load, the reference end rises and advances. To do this, the hip and knee are gradually flexed, while the ankle and foot are extended. gradually to avoid rubbing against the ground.
It starts with the heel and immediately involves the entire sole of the foot, keeping the knee slightly bent. It is at this moment that the phase of contralateral take-off of the limb begins..
Clinical features of gait disorders
Walking disorders they may or may not have a neurological origin. Among the most common non-neurological causes are osteoarthritis of the hip and knee, orthopedic deformities and visual deficits.
The characteristics of a gait disorder can tell us the etiology. Difficulty starting to walk may be due to Parkinson’s disease or frontal subcortical disease. And when walking difficulties are associated with cognitive impairment and urinary incontinence, normotensive hydrocephalus is suspected.
On another side, the shortening of the step is quite nonspecific, but can be found in neurological, musculoskeletal or cardiorespiratory problems. When symmetry is lost in the movement between the two hemicoses, it usually means that there is a unilateral neurological or musculoskeletal disorder.
If the patient exhibits high variability in pace, length and width of stride, this usually indicates possible impairment of motor control of gait due to cerebellar, frontal syndrome or multiple sensory deficit. And in patients with a deviated gait, cerebellar and vestibular diseases are often detected.
Instability of trunk control it can be caused by changes in the cerebellum, frontal subcortical areas and basal ganglia.
On the other hand, slowing of walking usually represents degeneration of the basal ganglia and extrapyramidal dysfunction, and most likely involves early parkinsonism.
Major walking disorders
Gait disorders usually have a multifactorial etiology and, therefore, it is important to make a thorough diagnosis. A good observation of the evolution of the patient, his signs and symptoms, can guide the professional towards the origin of the predominant disorder.
Here are the main walking disorders:
For neurological problems
These types of walking disorders affect 20-50% of older people and are one of the most common causes of falls.
1. Hemiplegic walking or mowing
It is caused by hemiplegia or paresis of the lower limb, following a stroke or other brain injury. The subject should swing the leg in an outward arc (Circonduction) to ensure take-off.
In turn, there is a lateral flexion of the trunk to the healthy side and a small base of support is maintained, so there is a high risk of falls.
2. Go to “scissors”
This gait disorder is a type of bilateral circumcision; that is, the person’s legs cross while walking. The dorsiflexor muscles of the ankle are weak and the feet claw the ground. The patient takes short, laborious steps.
The most common causes are cervical spondylosis and lacunar infarction or multi-infarction dementia.
3. Parkinsonian walk the party
The typical course of Parkinson’s disease is bradykinetic, with short stages, very slow and poorly detached from the ground.. The person walks while maintaining the flexion of the hips, knees and elbows, tilting the torso forward and without swinging the arms.
There is usually a loss of balance forward as the body begins to move before the feet. As the movement progresses, the steps are usually taken more quickly and sometimes have difficulty stopping, and can easily lose balance.
4. Apraxic march
It usually appears when there are alterations to the frontal lobe and is characterized by a broad base of support, a slightly bent posture, and small, hesitant dragging steps.
The start of the process is often complicated and patients become “stuck” to the ground, To be able to oscillate and fall while making the effort to lift the foot. This gait disorder can occur in patients with Alzheimer’s disease, vascular dementia, or normotensive hydrocephalus.
5. Ataxic gait
This gait disorder usually occurs with lesions of the posterior spinal cord. There is a broad base of support and the patient is taking great strides. There is usually a loss of sense of position, so people who suffer from it do not know where their feet are and throw them forward and out.
These patients often have balance problems and change from side to side. Along with the ataxic gait, severe vitamin B12 deficiencies, spinocerebellar degeneration and cervical spondylosis also often appear.
For circulatory problems
In addition to the problems caused by immobility and disuse, there are other pathologies that cause circulatory problems and impaired walking.
1. lame walk
After a more or less large number of steps, the patient presents with numbness, tingling, cramps or pain which obliges him to stop for a moment before resuming walking.
2. For musculoskeletal problems
they exist another type of condition that causes muscle weakness and an impaired gait: Hypo and hyperthyroidism, polymyalgia rheumatica, polymyositis, osteomalacia and neuropathies; also prolonged use of drugs such as diuretics and corticosteroids.
Any loss of proximal muscle strength leads to unstable and pathetic gaits.
3. Penguin walk
In this gait disorder, there is an inclination of the trunk off the foot that increases due to weakness of the gluteus medius and the inability to stabilize the weight of the hip. these patients they have trouble getting up from low places and climbing stairs.
4. Analgesic approach
This gait disorder occurs in patients with arthritis problems with numbness and pain. The foot is usually placed flat on the ground to reduce shock. The take-off phase is avoided to reduce the transmission of forces through the damaged hip.
There is usually a decrease in the static phase of the leg affected and a decrease in the oscillation phase of the other.So the stride length is shorter on the right side and decreases the travel speed.
Fall into this type of condition
The falls in the elderly population represent a real public health problem. About 30% of people over 65 who are self-employed and independent suffer from at least one fall per year. among those over 75, the percentage rises to 35% and up to 50% among those over 85.
Fall death rates are increasing exponentially with age, in both sexes and in all racial groups.
On the other hand, falls are more frequent in women, even if over the years, the tendency is to equalize. In addition, it should be noted that the fall is a risk factor in itself to suffer further falls; for example, in a patient’s medical history file, a history of a fall is considered a predictor of hip fracture in the future.
The vast majority of falls occur indoors, unrelated to a particular time or time of year. The most common places to fall are the bathroom, kitchen and bedroom. And the activity that favors falls the most is walking. One in ten falls occurs on the stairs, the descent being more dangerous than the ascent, as well as the first and last steps.
Faced with a fall, the first thing that the professional must do is to: value the person in a global way; identify the risk factors and circumstances of the fall; early estimation of short and long term consequences; and finally try to avoid further falls.
- Palencia R. Gait disorders: diagnostic protocol. Bowl Ped 2000; 40: 97-99.
- Villar T, Taula MP, Esteban AB, Sanjoaquín AC, Fernández A. Changes in gait, instability and falls. Chapter 19. Geriatrics treatise for residents. Madrid: SEGG; 2007