Gait and Balance

History of falls, walking aids

Balance

  • Patient to sit in a chair with back straight against the back of the chair
  • Keep arms folded while standing
    • Sit without leaning or sliding (trunkal instability)
    • Arise from chair in single movement without using arms
    • Sit down in a smooth motion without falling

Stance

  • Patient to place feet together without any support
    • Stand for > 30sec
    • Stand without loss of balance with eyes closed (Romberg’s Test)
    • Turn head to both sides and look up without losing balance
    • Maintain balance when nudged gently (nudge 3 times on the sternum)
    • Stand on one leg
    • Reach up to get an object and down to get an object without loss of balance



 

Gait

    • Patient to walk across room, turn and walk back as quickly as possible
    • Initiate gait immediately (if no, dopamine deficiency/ substantia nigra lesion)
    • Maintain normal step height, clearing the floor with their feet (maximum of 5 cm)
    • 5 cm → high stepping
    • Maintain a step length between stance toe and swinging heel that is length of foot
    • Step symmetry and continuity (raises heel of one foot as other foot touches down)
      • Maintain a straight path and normal truncal stability (no swaying back, knee flexion or arm abduction)
      • Observed from behind: normal walk stance with feet almost touching
    • Stop without difficulty
    • Turn without discontinuity of steps

Pathological gaits

  • Parkinsonian
    • Shuffling gait
    • Lack of arm swingin
    • Difficulty initiating/stopping.
  • Foot drop
    • Compensate with high-stepping.
  • Spastic hemiparesis
    • Leg is extended, foot is plantarflexed
  • Sensory ataxia
    • Wide, unsteady gait that is worse with eyes closed.
  • Cerebellar ataxia
    • Unsteady, wide based gai
    • Difficulty with turns, veers towards side of lesion
  • Antalgic
    • Painful, short contralateral step

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