Contributed by Nir Giladi, MD
Director, Movement Disorder Unit
MD Unit, Department of Neurology
Tel Aviv, Israel
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Gait disorders are a common and significant cause of reduced quality of life and independence. Falls are one of the most important consequences of gait disorders, but slow and insecure gait and ‘fear of falling’ also have great clinical significance.
Gait disorders can be classified according to the system responsible for the abnormal locomotion, according to the underlying disease associated with the abnormal gait or by its phenomenology. Parkinsonian gait disturbances may also be sub-classified as continuous (appearing whenever the patient walks) and episodic (lasting seconds).
Most gait disorders can be diagnosed and classified after obtaining a good history and a detailed physical and neurological exam. Detailed assessment with ambulatory gait monitoring devices or in a sophisticated gait laboratory are justified prior to surgery, to help document or identify impairments, subtle changes over time and therapeutic effects, and research.
Increased attention has recently been given to the cognitive aspects of gait. These also should be assessed as part of the routine evaluation of gait disturbances. Fall risk assessment is an essential part of the evaluation of a patient with gait disturbance including internal and external risk factors.
Treatment of gait disturbances should include an active intervention to decrease fall risk as well as medical, surgical and physical interventions which usually are given simultaneously.