Disorders of gait and balance are among the most disabling disorders, particularly affecting the elderly (54). In this article, the author discusses the various causes of gait disorders and how to evaluate and treat them.
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• Slowness of gait is a normal consequence of aging, which can be accelerated in the setting of Parkinson disease or other parkinsonian disorders.
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• Lower-body parkinsonism usually indicates the presence of vascular etiology, usually a multi-infarct state.
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• Most gait disorders in the elderly are of multifactorial origin, including prior strokes, orthopedic or arthritic problems, peripheral neuropathy, and a fear of falling.
Historical note and terminology
Gait is the act and manner of walking. Normal human walking is a learned motor skill that can be performed automatically and without conscious effort. It is also a complex phenomenon that requires action, interaction, and integration of many different parts of the musculoskeletal and nervous systems (17; 22; 23; 90; 148). Fossil evidence indicates that humans have used the bipedal form of locomotion for more than 1 million years (86). Bipedal gait, along with language and speech, are the abilities that differentiate humans from their ancestors. Normal gait is critical to an individual's quality of life. Therefore, disorders of gait are a source of considerable handicap and distress. Although particularly common among the elderly, gait disorders can affect people of any age. However, because of reduced reserves to support balance and gait, the elderly are more prone to gait disturbances and falls (134).
Gait disturbances must have been recognized and treated throughout history, but cases with primary gait disturbance have been documented in the literature only in the last hundred years. Bruns was the first to use the term "frontal ataxia" to describe severe disequilibrium due to mass lesions in the frontal lobe (14). Petrén reported patients with start hesitation, freezing, and turning pauses and termed the condition "trepidant abasia" (99). Von Malaise described the gait pattern marché á petit pas in patients with frontal lobe disorders (141). Critchley noted gait abnormalities associated with cerebrovascular disease. In their review, Nutt and colleagues summarized some of the historical perspectives in gait disorders (91). Newer classification of gait disorders has been proposed (Tables 1 and 2) (56).