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March 14, 2022Neuro Rehabilitation For Walking And Gait Issues
Is Walking As Easy As It Looks?
Walking, we do it every day. It’s actually a very complex task that requires many systems to work together. Walking requires the co-ordination of vision, sensation, cardio vascular, musculoskeletal and nervous systems. It also includes balance, and high level brain processing systems. As we age our walking abilities can change and this can have an impact on quality of life, and independence.
As a physiotherapist, there are certain elements we observe during your gait or walking pattern. Gait has 2 distinct phases, each leg takes a turn at stance phase (where we are standing on one leg) and a swing phase (the leg is free and swinging though). Stance phase can be further broken down into the basic elements of heel strike, mid stance, and toe-off.
What To Look At On A Walking Pattern?
When I look at a patient’s walking pattern I am not only looking at time spent in swing and stance phase but I am also looking at specific elements: gait width, step length, and stride length. Gait width is the distance between the center of each heel, noting if it is equal distance, narrow, wide, or crossing over.
Step length is the distance between steps (e.g. center of Left back heel to center of Right front heel), and stride length (e.g. Right heel to Right heel). I am examining if the step length or stride is shorter, longer, asymmetrical or uneven.
I also examine the way the foot contacts the ground until it pushes off. Overall, I am looking to see if the gait pattern is upright (shoulders in line with hips), with freely swinging limbs, and it appears flowing or rhythmical.
What Can Cause Walking or Gait Issues?
There are many reasons walking impairments occur. People can have medical conditions (e.g. vascular disease), orthopedic issues (e.g. hip and knee osteoarthritis) and neurological conditions that affect how they walk.
The people I treat have different neurological impairments which mean they all have different types of gait. Each condition does share some common abnormal elements. I most often treat patients with Multiple Sclerosis (MS) and Parkinson’s, and these are just some of the things that I observe in the clinic.
Parkinson’s disease often present with a characteristic stooped posture, slow movements, with short step lengths or maybe even shuffling gait. There may also be issues with freezing, and difficulty initiating a step; this can also show up when approaching an object or narrow space (e.g. Doorframe). There may also be a resting tremor, and difficulty changing position, or turning.
MS patients can demonstrate changes to their nervous system which can result in muscle weakness, and spasticity or muscle tone in the lower extremities. This can be seen and heard as a foot drop or slap, and limited muscle power to lift their hip and knee when swinging the leg through.
The increased leg spasticity or muscle tone may also make the legs appear as a stiff or locked. This may even result in a leg that swings around (circumducted) in order to clear the ground. Walking faster typically makes this worse.
Rarely, I may also see people with ataxic gait. Ataxia is degenerative, neurological condition that can impact co-ordination, speech, fine motor skills, and gait. Ataxic gait demonstrates a wobbly, wide base, with high stepping or stomping, and lack of co-ordination (Pirker & Katzenschlager, 2017).
There is an increased reliance on vision to keep steady, making it is easy to see how this could be an issue for late night washroom breaks.
Are Seniors More At Risk With Gait Or Walking Difficulties?
Last but not least are the more senior or elderly population. The senior population may demonstrate a cautious gait pattern. This may appear cautious, slow, anxious, with a wide base, and slightly stooped posture. This may be a linked to age related body changes and a fear of falling (Pirker & Katzenschlager, 2017).
These are just some of the conditions and gait patterns I might see in the clinic. Walking is an amazing skill when you really stop and think about all the systems that have to co-ordinate to make it look easy and flowing. Next time you see someone walking differently, be kind, there could be many reasons for it.
References
Pirker, W., & Katzenschlager, R. (2017). Gait disorders in adults and the elderly: A clinical guide. Wiener klinische Wochenschrift, 129(3-4), 81–95. https://doi.org/10.1007/s00508-016-1096-4
