This article provides insight and reviews useful tools for the clinical assessment, understanding, and management of neurologic gait disorders.
In recent years, our understanding of the physiology of human walking has steadily increased. The recognition of gait as a complex, “higher-order” form of motor behavior with prominent influence of mental processes has been an important new insight, and the clinical implications of gait disorders are increasingly being recognized. Better classification schemes, the redefinition of established entities (eg, senile gait), and new insights from research on degenerative disorders primarily affecting gait (eg, primary progressive freezing of gait) have become available.
Gait disorders are directly correlated with poor quality of life and increased mortality. Because gait is very sensitive to any insult to the nervous system, its assessment should be carried out carefully in routine clinical practice.
Disorders of locomotion are easily discernible to the naked eye. However, when examining gait, clinicians should bear in mind that the clinical phenotype is the net result of changes induced by the disease itself plus any compensations adopted by the patient to improve stability. This review presents a clinically oriented approach to gait disorders based on the dominant phenomenology and underlying pathophysiology, which are tightly connected. The authors conclude by proposing a practical management approach.
Supplemental Digital Content is available in the text.
Address correspondence to Dr Alfonso Fasano, Movement Disorders Centre, Toronto Western Hospital, 399 Bathurst St, 7 Mc412, Toronto, ON Canada M5T 2S8, firstname.lastname@example.org.
Relationship Disclosure: Dr Fasano serves as a speaker for Abbott Laboratories, Chiesi, Medtronic, Inc, and UCB, and receives research support from Afar and Medtronic, Inc. Dr. Bloem serves as a consultant for Boehringer Ingelheim and GlaxoSmithKline and receives research grants from Abbott Laboratories, GlaxoSmithKline, and Medtronic, Inc.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Fasano and Bloem discuss the unlabeled use of donepezil and methylphenidate as cognitive enhancers and stimulation of the pedunculopontine nucleus as a surgical indication for the treatment of gait and postural disorders.
Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and iPad versions of this article; the URLs are provided in the print version. Video legends begin on page 1379.