Gait and Balance Assessment

Abstract

Gait and balance deficits are commonly experienced by individuals with a variety of neurologic disorders. These deficits can be particularly frustrating because they often profoundly impact a person's quality of life. The author applies information about gait and balance based on the neurologic examination and summarizes important relationships among common impairment measures of gait and balance deficits. She also provides an interpretation of these relationships to assist the clinician in how to identify and manage gait and balance deficits.

Keywords

gait - balance - strength - weakness - sensation - vibration - somatosensation - proprioception - ataxia - foot drop - rehabilitation

• References

• 1 Prosperini L, Kouleridou A, Petsas N , et al. The relationship between infratentorial lesions, balance deficit and accidental falls in multiple sclerosis. J Neurol Sci 2011; 304 (1–2) 55-60
• 2 Zwibel HL. Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis. Adv Ther 2009; 26 (12) 1043-1057
• 3 Heesen C, Böhm J, Reich C, Kasper J, Goebel M, Gold SM. Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler 2008; 14 (7) 988-991
• 4 Pike J, Jones E, Rajagopalan K, Piercy J, Anderson P. Social and economic burden of walking and mobility problems in multiple sclerosis. BMC Neurol 2012; 12: 94
• 5 Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil 2006; 87 (9) 1274-1279 , quiz 1287
• 6 Nilsagård Y, Lundholm C, Denison E, Gunnarsson LG. Predicting accidental falls in people with multiple sclerosis — a longitudinal study. Clin Rehabil 2009; 23 (3) 259-269
• 7 Coote S, Hogan N, Franklin S. Falls in people with multiple sclerosis who use a walking aid: prevalence, factors, and effect of strength and balance interventions. Arch Phys Med Rehabil 2013; 94 (4) 616-621
• 8 Fritz NE, Marasigan RE, Calabresi PA, Newsome SD, Zackowski KM. The impact of dynamic balance measures on walking performance in multiple sclerosis. Neurorehabil Neural Repair 2015; 29 (1) 62-69
• 9 Keller JL, Wang JI, Kang JY , et al. Strength: a relevant link to functional performance in the neurodegenerative disease of adrenomyeloneuropathy. Neurorehabil Neural Repair 2012; 26 (9) 1080-1088
• 10 Newsome SD, Wang JI, Kang JY, Calabresi PA, Zackowski KM. Quantitative measures detect sensory and motor impairments in multiple sclerosis. J Neurol Sci 2011; 305 (1–2) 103-111
• 11 Oh J, Zackowski K, Chen M , et al. Multiparametric MRI correlates of sensorimotor function in the spinal cord in multiple sclerosis. Mult Scler 2013; 19 (4) 427-435
• 12 Zackowski KM, Wang JI, McGready J, Calabresi PA, Newsome SD. Quantitative sensory and motor measures detect change overtime and correlate with walking speed in individuals with multiple sclerosis. Mult Scler Relat Disord 2015; 4 (1) 67-74
• 13 Zackowski KM, Smith SA, Reich DS , et al. Sensorimotor dysfunction in multiple sclerosis and column-specific magnetization transfer-imaging abnormalities in the spinal cord. Brain 2009; 132 (Pt 5) 1200-1209
• 14 Shiee N, Bazin P-L, Zackowski KM , et al. Revisiting brain atrophy and its relationship to disability in multiple sclerosis. PLoS ONE 2012; 7 (5) e37049
• 15 Benedetti MG, Piperno R, Simoncini L, Bonato P, Tonini A, Giannini S. Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler 1999; 5 (5) 363-368
• 16 Gianfrancesco MA, Triche EW, Fawcett JA, Labas MP, Patterson TS, Lo AC. Speed- and cane-related alterations in gait parameters in individuals with multiple sclerosis. Gait Posture 2011; 33 (1) 140-142
• 17 Remelius JG, Jones SL, House JD , et al. Gait impairments in persons with multiple sclerosis across preferred and fixed walking speeds. Arch Phys Med Rehabil 2012; 93 (9) 1637-1642
• 18 Sosnoff JJ, Socie MJ, Boes MK, Sandroff BM, Motl RW. Does a waist-worn ActiGraph accelerometer quantify community ambulation in persons with multiple sclerosis?. J Rehabil Res Dev 2012; 49 (9) 1405-1410
• 19 Huisinga JM, Schmid KK, Filipi ML, Stergiou N. Gait mechanics are different between healthy controls and patients with multiple sclerosis. J Appl Biomech 2013; 29 (3) 303-311
• 20 Dubin A. Gait: the role of the ankle and foot in walking. Med Clin North Am 2014; 98 (2) 205-211
• 21 Stanaway FF, Gnjidic D, Blyth FM , et al. How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. BMJ 2011; 343: d7679
• 22 Keller JL, Fritz N, Chiang CC , et al. Adapted resistance training improves strength in eight weeks in individuals with multiple sclerosis. J Vis Exp 2016; 29 (107) e53449
• 23 Pearson M, Dieberg G, Smart N. Exercise as a therapy for improvement of walking ability in adults with multiple sclerosis: a meta-analysis. Arch Phys Med Rehabil 2015; 96 (7) 1339-1348.e7
• 24 Zackowski KM, Dubey P, Raymond GV, Mori S, Bastian AJ, Moser HW. Sensorimotor function and axonal integrity in adrenomyeloneuropathy. Arch Neurol 2006; 63 (1) 74-80
• 25 Eils E, Behrens S, Mers O, Thorwesten L, Völker K, Rosenbaum D. Reduced plantar sensation causes a cautious walking pattern. Gait Posture 2004; 20 (1) 54-60
• 26 Jankovic J. Gait disorders. Neurol Clin 2015; 33 (1) 249-268
• 27 Morton SM, Bastian AJ. Relative contributions of balance and voluntary leg-coordination deficits to cerebellar gait ataxia. J Neurophysiol 2003; 89 (4) 1844-1856
• 28 Keller JL, Bastian AJ. A home balance exercise program improves walking in people with cerebellar ataxia. Neurorehabil Neural Repair 2014; 28 (8) 770-778
• 29 Hemmett L, Holmes J, Barnes M, Russell N. What drives quality of life in multiple sclerosis?. QJM 2004; 97 (10) 671-676
• 30 Daley ML, Swank RL. Quantitative posturography: use in multiple sclerosis. IEEE Trans Biomed Eng 1981; 28 (9) 668-671
• 31 Rougier P, Faucher M, Cantalloube S, Lamotte D, Vinti M, Thoumie P. How proprioceptive impairments affect quiet standing in patients with multiple sclerosis. Somatosens Mot Res 2007; 24 (1–2) 41-51
• 32 Cameron MH, Horak FB, Herndon RR, Bourdette D. Imbalance in multiple sclerosis: a result of slowed spinal somatosensory conduction. Somatosens Mot Res 2008; 25 (2) 113-122
• 33 Gor-García-Fogeda MD, Cano de la Cuerda R, Carratalá Tejada M, Alguacil-Diego IM, Molina-Rueda F. Observational gait assessments in people with neurological disorders: a systematic review. Arch Phys Med Rehabil 2016; 97 (1) 131-140
• 34 Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34 (2) 119-126
• 35 Prosperini L, Petsas N, Raz E , et al. Balance deficit with opened or closed eyes reveals involvement of different structures of the central nervous system in multiple sclerosis. Mult Scler 2014; 20 (1) 81-90
• 36 Fling BW, Dutta GG, Horak F. Functional connectivity underlying postural motor adaptation in people with multiple sclerosis. NeuroImage: Clinical 2015; 8: 281-289
• 37 Kasser SL, Jacobs JV, Ford M, Tourville TW. Effects of balance-specific exercises on balance, physical activity and quality of life in adults with multiple sclerosis: a pilot investigation. Disabil Rehabil 2015; 37 (24) 2238-2249
• 38 Azimzadeh E, Hosseini MA, Nourozi K, Davidson PM. Effect of Tai Chi Chuan on balance in women with multiple sclerosis. Complement Ther Clin Pract 2015; 21 (1) 57-60
• 39 Burschka JM, Keune PM, Oy UH, Oschmann P, Kuhn P. Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression. BMC Neurol 2014; 14: 165
• 40 Duncan RP, Earhart GM. Randomized controlled trial of community-based dancing to modify disease progression in Parkinson disease. Neurorehabil Neural Repair 2012; 26 (2) 132-143
• 41 Mandelbaum R, Triche EW, Fasoli SE, Lo AC. A pilot study: examining the effects and tolerability of structured dance intervention for individuals with multiple sclerosis. Disabil Rehabil 2016; 38 (3) 218-222
• 42 Therrien AS, Wolpert DM, Bastian AJ. Effective reinforcement learning following cerebellar damage requires a balance between exploration and motor noise. Brain 2016; 139 (Pt 1): 101-114
• 43 Lang CE, Lohse KR, Birkenmeier RL. Dose and timing in neurorehabilitation: prescribing motor therapy after stroke. Curr Opin Neurol 2015; 28 (6) 549-555