Why are people in front

Gait disorders in the elderly

Gait disorders include a number of factors such as slower walking speed and loss of suppleness, symmetry or synchronicity of body movements.

Elderly people require walking, getting up from a chair, turning around, and leaning against them for independent mobility. Walking speed, the time it takes to get up from a chair, and the ability to stand in tandem (stand with one foot in front of the other - a measure of balance) are independent predictors of the ability to perform instrumental activities in daily living (e.g. Shopping, traveling, cooking) and the risk of admission to a nursing home and death.

Unaided walking requires appropriate alertness and muscle strength, as well as efficient motor control to coordinate sensory input and muscle contraction.

Tips and Risks

  • Walking speed, the time it takes to get up from a chair, and the ability to stand in tandem are independent predictors of the ability to engage in instrumental activities of daily living and the risk of admission to a nursing home and death.

Normal age-related changes in gait

Some elements of the gait usually change with age, while others do not.

The Walking speed (Walking speed) remains stable until about 70 years; it then drops by about 15% per decade with normal walking and by 20% per decade with fast walking. Walking speed is a powerful predictor of mortality - as telling as the number of chronic illnesses and hospitalizations an elderly person has. After age 75, people who walk slowly die ≥ 6 years earlier than those who walk at normal speed, and ≥ 10 years earlier than those who walk quickly. Walking speed decreases because older people take shorter strides at the same speed (cadence). The most likely reason for the shortened stride length (distance from one heel to the next) is a weakness in the calf muscles, which is pushing the body forward; the strength of the calf muscles is significantly reduced in older people. However, older people seem to compensate for their decreased calf muscle strength by using their hip flexors and extensors more than young adults.

The cadence (expressed as steps / minute) does not change with age. Everyone has a preferred cadence that is related to leg length and usually represents an energy-efficient rhythm. Tall people take longer steps with a slower cadence, and short people take shorter steps with faster cadence.

The Time in a double position (i.e., the amount of time both feet are on the ground when walking around - more stable position for moving the center of gravity forward) increases with age. The percentage of time spent in double stalls ranges from 18% in young adults to ≥ 26% in healthy elderly people. Increasing the amount of time in the double stance reduces the time the swing leg has to move forward and shortens the stride length. In older people, the time spent in a double stance can even be longer if they walk on uneven or slippery surfaces, if they have problems with their balance or if they are afraid of falling. They can look like they're walking on black ice.

The Walking posture changes only slightly with aging. Older adults walk upright without bending over. However, older people walk with more anterior (downward) pelvic rotation and increased lumbar lordosis. This change in posture is usually due to a combination of weak abs, stiff hip flexors, and increased abdominal fat. Older people also walk with their legs (toes) turned to the side by about 5 °, possibly due to a failure of the internal rotation of the hip or to increase lateral stability. The freedom of the feet when walking remains unchanged with advancing age.

The Joint mobility changes easily with aging. Plantar flexion of the ankle is reduced during the late phase of ground contact (just before the rear foot takes off). The entire movement of the knee remains unchanged. Hip flexion and extension are unchanged, but hip adduction is increased. The pelvic movements are restricted in all levels.

Gait abnormalities

causes

A number of medical conditions can contribute to dysfunctional or unsteady gait. These include in particular

  • Neurological diseases

Manifestations

There are many manifestations of gait anomalies. Some support the assumption of specific causes. Video demonstrations of selected gait abnormalities are available on the NeuroLogic Exam website.

The Loss of symmetry and timing of movement between the left and right sides usually indicates a malfunction. A healthy body moves symmetrically; Stride length, cadence, trunk movements, and ankle, knee, hip, and pelvic movements are the same on the right and left sides. A regular Asymmetry occurs in unilateral neurological or musculoskeletal disorders (e.g., limping due to a sore ankle). Unpredictable or highly fluctuating gait, stride length, or step size indicate a failure in motor control of walking due to a cerebellar or frontal lobe syndrome or the use of several psychoactive drugs.

Difficulty initiating or maintaining gait can occur. When patients initiate the gait, their feet may appear to be glued to the floor, typically because patients do not put their weight on one foot to allow the other to move forward. This problem can represent an isolated gait initiation disorder, Parkinson's disease, or a frontal or subcortical disease. As soon as the gait is initiated, the steps should be continuous and with little variability in the time sequence. "Freezing", standing still, or almost standing still usually indicate a cautious gait, fear of falling, or a frontal lobe gait disorder. Shuffling is not normal (and a risk factor for tripping).

Retropulsion means walking backwards when initiating a gait or falling backwards when walking. It can occur with frontal gait disorders, parkinsonism, syphilis of the central nervous system and progressive supranuclear palsy.

A Drop foot causes toe dragging or stepping (i.e., pulling the leg up excessively so as not to catch the toe). It can be the result of anterior tibial weakness (e.g. caused by trauma to the lateral peroneal nerve at the knee or peroneal mononeuropathy, usually in connection with diabetes), a spasm of the calf muscles (gastrocnemius and soleus muscles ) or a lowering of the pelvis due to weakness of the proximal muscles on the standing side (especially the gluteus medius muscle). A low foot swing (e.g. due to reduced knee flexion) can be similar to a drop foot.

A short stride length is unspecific and may reflect a fear of falling or a neurological or musculoskeletal problem. The side with the short stride is usually the healthy side, and the short stride is usually due to a disruption of the other (problematic) leg during the stance phase. A patient with a weak or sore left leg spends less time standing on the left leg and creates less effort to move the body forward, resulting in shorter swing time for the right leg and a shorter right stride . A normal right leg has a normal single standing time, which results in a normal swing time for the abnormal left leg and a longer stride length for the left leg compared to the right.

Broad-based gait (increased step width) is determined by observing the patient's gait across a floor with 30 cm tiles. The corridor is considered broad-based if the outside of the patient's feet does not stay within the tile width. As the walking speed decreases, the step width increases slightly. Broad-based gait can be caused by cerebellar disorders or bilateral knee or hip disorders. A variable step width (rolling to one side or the other) indicates insufficient motor control, which can be attributed to frontal or subcortical gait disorders.

Circumduction (Moving the foot in an arc instead of a straight line when walking forward) occurs in patients with weak pelvic muscles or difficulty bending the knee. Spasticity of the extrinsic knee muscles is a common cause.

Festination is a progressive acceleration of steps (usually leaning forward), with patients starting to run so as not to fall. Festination can occur together with Parkinson's disease and rarely as a side effect of dopamine antagonists (conventional and atypical antipsychotics).

A Leaning of the trunk sidewaysConsistently and predictably referring to the side of the standing leg can be a strategy to reduce joint pain due to arthritis in the hip or, less commonly, the knees (antalgic gait). With hemiparetic gait, the trunk can be inclined towards the strong side. In this pattern, the patient leans to lift the pelvis on the opposite side so that the spastic leg (which cannot bend the knee) does not touch the floor during the swing phase.

Irregular and unpredictable trunk instability can be caused by cerebellar, subcortical, or basal ganglia dysfunction.

Deviations from the path are strong indicators of motor control deficits.

The Arm swing may be reduced or absent in Parkinson's disease