Normal and Pathological Gait in the Elderly

1. Normal and Pathological Gait in the Elderly Peggy R. Trueblood, PhD, PTCalifornia State University, Fresno

2. Part IIPATHOLOGICAL GAIT

3. CNS Requirements for Locomotion • Generate coordinated movement that provides the propulsion • Provide adequate equilibrium control during the movement • Allow adaptation of gait depending on goals of person, the environment, anticipatory control, and compensation for actual perturbations

4. Neural Control of Gait • Central Pattern Generators – grouping of neurons or neural circuits that can generate coordinated, rhythmic movements autonomously and for locomotion are located in the spinal cord • Vestibulo-Cerebellum System responsible for maintaining equilibrium • Higher Brain Centers add variation in locomotor patterns and adaptability to task and environmental conditions • Cerebellum • Basal Ganglia • Cerebral Cortex

5. Factors Contributing to Locomotion Higher brain centers add variation and adaptability of locomotion Input from brainstem and cerebellum provide equilibrium Cerebral Cortex Basal Ganglia Brainstem Nuclei Spinal Cord Cerebellum Basic coordination of walking generated from group of neurons in the spinal cord MN MN Flex Ext AFFERENT INPUT

6. COMMON CONDITIONS CAUSING GAIT AND BALANCE DISORDERS

7. NEUROLOGICAL CONDITIONS • Stroke • Parkinson disease • Peripheral neuropathy • Cerebellar ataxia • Dementia

8. Common Problems in Stroke Patients: - Plantarflexion and inversion at the foot - Knee hyperextension in stance - Lacks trailing limb - Retracted pelvis - Toe drag - Incomplete knee ext at terminal swing

9. Left Hemiplegia Secondary to Right CVA (Stroke)

10. Parkinson’s Disease: - Decreased velocity - Forward trunk - Shuffling with decreased steps - Decreased ROM - Foot flat at IC - Excessive knee flex - Lacks arms swing - Decreased trunk mvt - Unable to control momentum

11. Parkinson’s Disease

12. Cerebellar ataxia: - Wide base - Unsteadiness - Irregular steps - Lateral veering - Difficulty adjusting quickly (turning,, stopping,, starting)

13. Cerebellar Ataxia

14. Alzheimer’s Disease

15. NEUROLOGICAL DISORDERS • Abnormal gait common characteristic • problems vary within disorder types Parkinson’s Disease Parkinson’s Disease Dementia Stroke

16. NEUROLOGICAL DISORDERS But. . . . problems vary within persons with disorder • Specific Impairments seen in Neurological Disorders • Weakness • Spasticity or excessive activation of muscles in response to stretch • Control problems; poor timing of muscles • Sensory disorders • Poor adaptation

17. ORTHOPEDIC CONDITIONS • Impairments related to musculoskeletal limitations • Soft tissue contractures • Pain • Common Orthopedic conditions that produce abnormal gait • Arthritis • Post fractures/ joint replacements

18. Bilateral Knee Flexion Contractures

19. CARDIOVASCULAR CONDITIONS • Common Impairments • Pain • Imbalance • Decreased velocity/stride length (poor endurance) • Common Cardiovascular conditions that produce abnormal gait • Orthostatic hypotension • Intermittent claudication • Chronic lower extremity edema (poor circulation)

20. MAJOR CAUSES OF PATHOLOGICAL GAIT • Joint Deformity • Pain • Impaired Motor Control or Spasticity • Muscle Weakness • Sensory System Deficits • Central Processing Dysfunction