[Gait and gait disturbance].
Disequilibrium and gait disturbance are the most common causes of falls, which are becoming a serious social problem for the increasing geriatric population. Gait disturbance is caused not only by neurological diseases but also by joint and skeletal system abnormalities, and these abnormalities have to be taken into account before evaluating neurological conditions. The final common pathway for gait is formed by primary motor and premotor cortices, corticospinal tracts, anterior horn cells, α-motor nerves, neuromuscular junction, and muscles. The multiple other systems are involved in the control this pathway include the supplementary motor area, basal ganglia, cerebellum, brainstem nuclei such as the pedunculopontine nucleus and locus caeruleus; and feedback receptive systems such as the somatosensory, vestibular, visual (including the visual motion area), and auditory systems. Gait disturbance due to neurological diseases is classified into several types according to the characteristics of each condition: spastic gait, paralytic gait, ataxic gait, parkinsonian gait, dystonic gait, involuntary movements, combined form, and psychogenic gait disturbance. Ataxic gait is caused by lesions that involve the cerebellum, vestibular system, or proprioceptive system. Involuntary movements that interfere with gait include action tremor, chorea, myoclonus, ballism, and dyskinesia. Psychogenic gait disturbance is not uncommon and must be considered when the features of gait disturbance are incongruous with respect to its conventional forms and/or when the features and degree of gait disturbance vary over time. In such cases the family background or the patient's social environment is usually suggestive of psychogenic disorders. Correct judgment regarding the classification as well as the cause of gait disturbance is of utmost importance for choosing the most appropriate treatment for gait disturbance in order to prevent falls.
Takeda General Hospital, Kyoto, Japan.
Hiroshi
H
Shibasaki
D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000145:classification / Q000209:etiology; D006801:Humans; D011602:Psychophysiologic Disorders / Q000150:complications