Gait training

GAIT DYSFUNCTIONS

Gait dysfunctions are changes in your normal walking pattern, often related to a disease or abnormality in different areas of the body. Gait dysfunctions are among the most common causes of falls in older adults, accounting for approximately 17% of falls. This guide will help you better understand how gait dysfunctions are categorized, and how treatment by a physical therapist can help you regain a healthy gait. Physical therapists are experts at identifying the root causes of gait dysfunctions, and designing treatments that restore gait.

What are Gait Dysfunctions?

Gait dysfunctions make the pattern of how you walk (ie, your gait) appear “abnormal." Most changes in gait are related to underlying medical conditions. Gait dysfunctions can be related to disorders involving the inner ear; nervous system disorders such as Parkinson's disease; muscle diseases such as muscular dystrophy; and musculoskeletal abnormalities such as fractures. In many cases, treatment of the underlying medical condition will help normalize the gait pattern.

Common classifications of gait dysfunction include:

  • Antalgic. This type of gait dysfunction is often caused by bearing weight on a painful leg. It can be related to arthritis or a traumatic injury, and is what many people refer to as a "limp." People with this dysfunction take slow and short steps, and quickly try to shift their weight off of the sore leg, ankle, or foot, and back onto the unaffected leg.
  • Cerebellar Ataxia. This gait dysfunction is often seen in individuals who have a condition of the cerebellum (a region of the brain), drug or alcohol intoxication, multiple sclerosis, or have experienced a stroke. The affected individual will have a wide-based stance (feet wide apart), and display inconsistent and erratic foot placement.
  • Parkinsonian. This type of gait dysfunction is often related to Parkinson’s disease and is characterized by short, shuffled steps.
  • Steppage. This dysfunction occurs in people with "foot drop" (an inability to lift the ankle), which is related to conditions, such as lumbar radiculopathy and neuropathy. Because the ankle will "slap" off of the ground, the individual will often lift the leg higher at the knee and hip, to clear the foot when taking a step./li>
  • Vestibular Ataxia. This pattern is often related to vertigo, Meniere’s disease (an inner-ear condition), and labyrinthitis (a type of inner-ear disorder in 1 ear). It causes people to walk unsteadily, often falling toward 1 side. 
  • Waddling. This pattern often arises from muscular dystrophy and myopathy, and causes individuals to walk on their toes, while swaying side-to-side.

Note: These are only a few of the many possible gait dysfunctions. If you suspect you are walking differently, call your physical therapist for a gait assessment.

How Is It Diagnosed?

There are many different strategies and tools that can help a physical therapist diagnose a gait dysfunction. While other health care professionals are educated in the screening for potential conditions related to the gait abnormality, a physical therapist is the expert in diagnosing the actual type of gait dysfunction. Your physical therapist will ask you questions, such as:

  • When did you notice you were walking differently?
  • Is the problem getting better or worse?
  • Has it resulted in a fall or any additional problems?
  • Are you in pain while you walk?
  • Have there been any recent changes in your medical history, including changes in medications?

Your physical therapist will also conduct certain tests to learn more about your condition. Your assessment may include:

  • Observation. Your physical therapist will ask you to walk back and forth, to observe any abnormalities in your gait pattern. 
  • Gait speed measurements. Your physical therapist will time your walking speed. Studies have shown that complications like falling are related to how fast you walk.
  • Balance tests. Your physical therapist may also assess your balance to determine your risk of falling.
  • Strength and range-of-motion measurements. These tests can help determine whether the dysfunction is due to musculoskeletal limitations. A physical therapist may utilize tools, such as a goniometer to measure your joint motion, or dynamometer to measure your strength. 
  • Reflex and sensation screenings. These measurements will help your physical therapist determine whether a neurological (brain or nervous system) condition is present.

How Can a Physical Therapist Help?

Physical therapists play a vital role in helping individuals improve their gait. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals. Your physical therapist will design an individualized program to treat your specific condition.

The treatment strategy may include:

Pre-Gait Training. Your physical therapist may begin your treatment by having you perform activities and exercises that will help you understand how to improve your gait, without taking a single step. These exercises may include simple activities, such as having you stand and lift your leg in place, to more complex strategies like stepping in place and initiating contact with your heel to the ground, prior to other portions of the foot. 

Gait Training. Your physical therapist will help you focus on retraining the way you walk. Because the underlying condition may be vestibular, neurological, or muscular, variations in the training exist. Your physical therapist will design the safest and best training for your specific condition.

Balance and Coordination Training. Your physical therapist may prescribe balance activities for you to perform to help stabilize your walking pattern.

Neuromuscular Reeducation. Your physical therapist may employ neuromuscular reeducation techniques to activate any inactive muscle groups that may be affecting your gait.

Bracing or Splinting. If the gait dysfunction is due to significant weakness or paralysis of a ligament, your physical therapist may teach you how to use adaptive equipment, like a brace or splint, to help you move.

APTA'S HEALTH CENTER FOR CAREGIVERS

Although they make up 29% of the U.S. population, caregivers are an often overlooked, but vital, part of someone’s health care team.  They spend an average of 20 hours a week providing care for a chronically ill, disabled, or aged family member or friend during a given year. The demanding role often means that the caregiver themself is often in need of assistance.

Physical therapists often work with caregivers and see the toll it can take, which can ultimately turn the caregiver into a patient in need of care as well.  Visit the APTA website for more resources to help caregivers in their role, and tips on how to maintain health and happiness for themselves.

Did you know that caregivers for individuals with Alzheimer's, on average, require 46% more doctor's visits than their non-caregiver counterparts? Or that they require over 70% more prescription drugs? 

 

Physical therapists, who are experts in restoring and improving motion, recommend that elderly adults who use canes and walkers as walking aids be properly assessed and fitted by a physical therapist to avoid fall-related injuries.

With emergency rooms experiencing 47,000 fall-related visits annually from senior citizens due to improper use and fit of walking aids*, assessment by a physical therapist can help reduce the number of these dangerous incidents by ensuring appropriateness and proper fit of the walking device.

Tips for Using Walkers and Canes:

  • The walker or cane should be about the height of your wrists when your arms are at your sides.
  • When using a walker, your arms should be slightly bent when holding on, but you shouldn't have to bend forward at the waist to reach it.
  • Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.

Physical therapists also advise against borrowing walking aids from friends and family. This often leads to improper fit and misuse, and can result in further injury. Your physical therapist can also evaluate your walking aid and determine if it is in proper working condition.