Approach to the Patient with Gait Disturbance

Christopher G. Tarolli; Karlo J. Lizarraga

doi:10.1055/s-0041-1726355

Seminars in Neurology, Table of Contents

Semin Neurol 2021; 41(06): 717-730
DOI: 10.1055/s-0041-1726355

Review Article

Approach to the Patient with Gait Disturbance

Christopher G. Tarolli

¹Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Center for Health + Technology (CHeT), Department of Neurology, University of Rochester Medical Center, Rochester, New York

,

Karlo J. Lizarraga

¹Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Center for Health + Technology (CHeT), Department of Neurology, University of Rochester Medical Center, Rochester, New York

²Departamento Academico de Neurociencias, Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Peru

› Author Affiliations

Abstract

The assessment of patients presenting with disorders of gait can be a daunting task for neurologists given the broad potential localization and differential diagnosis. However, gait disorders are extremely common in outpatient neurology, and all neurologists should be comfortable with the assessment, triage, and management of patients presenting with difficulty walking. Here, we aim to present a manageable framework for neurologists to approach the assessment of patients presenting with gait dysfunction. We suggest a chief complaint-based phenomenological characterization of gait, using components of the neurological history and examination to guide testing and treatment. We present the framework to mirror the outpatient visit with the patient, highlighting (1) important features of the gait history, including the most common gait-related chief complaints and common secondary (medical) causes of gait dysfunction; (2) gait physiology and a systematic approach to the gait examination allowing appropriate characterization of gait phenomenology; (3) an algorithmic approach to ancillary testing for patients with gait dysfunction based on historical and examination features; and (4) definitive and supportive therapies for the management of patients presenting with common neurological disorders of gait.

Keywords

gait - gait analysis - postural instability - neurological gait disorders

Full Text

References

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