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gait ataxia

Etiology: 1) generally multifactorial in the elderly [4] 2) muscle weakness a) deconditioning b) neuropathy 3) sensory/balance deficit a) peripheral neuropathy b) stroke 4) limited range of motion a) arthritis b) contractures 5) impaired central processing a) dementia b) stroke, especially deep white matter & small vessel disease [3] c) normal pressure hydrocephalus d) delirium e) drugs 6) pain a) arthritis b) injury 7) spasticity a) stroke b) spinal cord lesion Epidemiology: - common in older adults [4] Clinical manifestations: - short steps, slow speed, difficulty turning, wide base suggest peripheral neuropathy [4] - weakness of hip abductors manifests as Trendelenburg gait - difficulty initiating movement, cautious gait, variable step length & stance time, difficulty moving around an object or stepping over a threshold, & difficulty maintaining a conversation while walking suggest cognitive impairment [4] Special laboratory: 1) electronystagmogram may be helpful for identifying involvement of the peripheral vestibular system 2) nerve conduction study/electromyography may be useful for evaluating a peripheral neuropathy Complications: - predictor of functional decline in older adults [4,5] - inability to walk 400 meters associated with increased mortality (see Health, Aging & Body Composition Study) Management: 1) gait training [4] 2) encourage activity 3) specific management for specific etiology

Related

gait

Specific

antalgic gait circumduction equinovarus festination foot drop foot slap freezing of gait genu recurvatum high-step gait; steppage gait magnetic gait (magnetic feet) propulsion psychogenic gait retropulsion (tendency to fall backward) scissoring Trendelenburg gait turn en bloc

General

ataxia; dyssynergia

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Sepulveda GRECC guidelines
  3. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  5. Abellan van Kan G, Rolland Y, Andrieu S et al Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging. 2009 Dec;13(10):881-9. Review. PMID: 19924348
  6. Studenski S, Perera S, Patel K Gait speed and survival in older adults. JAMA. 2011 Jan 5;305(1):50-8 PMID: 21205966
  7. Nutt JG, Horak FB, Bloem BR. Milestones in gait, balance, and falling. Mov Disord. 2011 May;26(6):1166-74 PMID: 21626560
  8. Salzman B. Gait and balance disorders in older adults. Am Fam Physician. 2010 Jul 1;82(1):61-8. PMID: 20590073