Normal and Pathological Gait in the Elderly

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Normal and Pathological Gait in the Elderly

• Peggy R. Trueblood, PhD, PTCalifornia State
  University, Fresno

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Part IIPATHOLOGICAL GAIT
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CNS Requirements for Locomotion

• Generate coordinated movement that provides the
  propulsion
• Provide adequate equilibrium control during the
  movement
• Allow adaptation of gait depending on goals of
  person, the environment, anticipatory control,
  and compensation for actual perturbations

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Neural Control of Gait

• Central Pattern Generators grouping of neurons
  or neural circuits that can generate coordinated,
  rhythmic movements autonomously and for
  locomotion are located in the spinal cord
• Vestibulo-Cerebellum System responsible for
  maintaining equilibrium
• Higher Brain Centers add variation in locomotor
  patterns and adaptability to task and
  environmental conditions
• Cerebellum
• Basal Ganglia
• Cerebral Cortex

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Factors Contributing to Locomotion
Higher brain centers add variation and
adaptability of locomotion
Input from brainstem and cerebellum provide
equilibrium
Cerebral Cortex
Basal Ganglia
Brainstem Nuclei
Spinal Cord
Cerebellum
Basic coordination of walking generated from
group of neurons in the spinal cord
MN
MN
Flex
Ext
AFFERENT INPUT
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• COMMON CONDITIONS CAUSING GAIT AND BALANCE
  DISORDERS

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NEUROLOGICAL CONDITIONS

• Stroke
• Parkinson disease
• Peripheral neuropathy
• Cerebellar ataxia
• Dementia

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Common Problems in Stroke Patients -
Plantarflexion and inversion at the foot -
Knee hyperextension in stance - Lacks trailing
limb - Retracted pelvis - Toe drag - Incomplete
knee ext at terminal swing
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Left Hemiplegia Secondary to Right CVA (Stroke)
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Parkinsons Disease - Decreased velocity -
Forward trunk - Shuffling with decreased
steps - Decreased ROM - Foot flat at IC -
Excessive knee flex - Lacks arms swing -
Decreased trunk mvt - Unable to control
momentum
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Parkinsons Disease
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Cerebellar ataxia - Wide base - Unsteadiness -
Irregular steps - Lateral veering - Difficulty
adjusting quickly (turning,, stopping,,
starting)
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Cerebellar Ataxia
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Alzheimers Disease
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NEUROLOGICAL DISORDERS

• Abnormal gait common characteristic
• problems vary within disorder types

Parkinsons Disease
Parkinsons Disease
Dementia
Stroke
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NEUROLOGICAL DISORDERS

• But. . . . problems vary within persons with
  disorder
• Specific Impairments seen in Neurological
  Disorders
• Weakness
• Spasticity or excessive activation of muscles in
  response to stretch
• Control problems poor timing of muscles
• Sensory disorders
• Poor adaptation

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ORTHOPEDIC CONDITIONS

• Impairments related to musculoskeletal
  limitations
• Soft tissue contractures
• Pain
• Common Orthopedic conditions that produce
  abnormal gait
• Arthritis
• Post fractures/ joint replacements

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Bilateral Knee Flexion Contractures
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CARDIOVASCULAR CONDITIONS

• Common Impairments
• Pain
• Imbalance
• Decreased velocity/stride length (poor endurance)
• Common Cardiovascular conditions that produce
  abnormal gait
• Orthostatic hypotension
• Intermittent claudication
• Chronic lower extremity edema (poor circulation)

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MAJOR CAUSES OF PATHOLOGICAL GAIT

• Joint Deformity
• Pain
• Impaired Motor Control or Spasticity
• Muscle Weakness
• Sensory System Deficits
• Central Processing Dysfunction