Gait In Elderly

During walking, more than 1000 muscles are synchronized to move over 200 bones around 100 moveable joints.

Gait In Elderly

A normal gait pattern is essential for maintaining independence in older adults.

Gait In Elderly
Gait adaptation as seen in the elderly population may be associated with the general decrease in muscle strength due to loss of motor neurons, muscle fibers and aerobic capacityEven if walking is considered a very complex task, a healthy person walking at self selected velocity, performed this task at a minimal energy cost.

ADVANTAGES/Disadvantage OF BIPEDAL GAIT: Bipedal gait frees our hands, elevates our head, and allows us to move on challenging terrain Disadvantage Very hard for CM to move in a straight line, which would be the most efficient. (like a wheel.) Instead, there is an arc-shaped pattern with lateral sway. Maintaining a smoother trajectory of the CM plays a large role in determining HOW we walk.

Elderly: Gait disorders

Most common and cannot be treated medically or surgically. Treatment often relies on ambulatory devices such as canes,crutches, and walkers.

Mature gait pattern Development

By 11 & 15 months of age most children walk independently Mature gait pattern appears by 3yrs, through the interaction of changes in several systems: Neurological (myelination) Biomechanical (changes in skeletal structure, including size and mass of body parts) Psychological (motor learning) Environmental (amount of handling, opportunities to walk, use of diapers)

Young & Elderly Gait Comparison:

Gait Parameters Young(20-year) Elderly(70-year)

Stance

59 percent of gait cycle 41% 18%

63 percent

Swing Double Limb Support

37% 26%

 Decreased heel-to Walk at slower floor angle speeds{1.0 to 1.2 meter/sec} (10-20% Decreased step length decline) (75-year-olds' step length is 10% shorter Loss of normal arm than that of 25-yearswing Reduced pelvic rotation olds Increased stance time, Decreased hip & knee decreased swing, and rotation increased double limb Increased stride width support

Aging Effects on Gait

Aging Effects on Gait

Increase in Sway while standing Anterior pelvic tilt and thoracic kyphosis Decreased plantar flexion and lesser heel rise during terminal stance Decreased ankle PF power at push off, partly compensated for by increased hip flexor power at pull off. Short steps Reduced postural support responses. Strengthening ankle plantar flexors may maintain step length as people age.

Lumbar Spine Position

Elderly are flexed at hip joint in stance phase of gait than younger due to increase in lumbar spine flexion and not due to pure hip flexion

Aging Effects on Gait

More dependent on high quality afferent information to maintain balance, but these sensory systems are extremely vulnerable for age related degeneration

Elderly Gait disorders: Common causes

Multiple sensory deficits affecting vision, vestibular & proprioceptive function Central and Peripheral nerve degeneration Musculoskeletal degeneration Foot deformities Eg: callouses, bunions & deformed nails- Incorrect proprioceptive input Systemic illness Postural Hypotension Excessive medication

 Difficulty arising from chair Weakness Arthritis Instability on first standing Hypotension, Weakness Instability with eyes closed Proprioception Step height/length Parkinsonism Frontal lobe Fear

Elderly Gait disorders: Common causes

Formal Gait Evaluation

Get up and Go Test Tinetti Gait and Balance Evaluation (POMA)

Clinical gait patterns in Elderly

Proposed Terminology Cautious Gait Previous terms Elderly gait Senile gait Gait apraxia Magnetic aprexia Slipping clutch phenomena Lower half parkinsonism Petrens gait Lesions Musculoskeletal, CNS and PNS lesions. Frontal lobe connections with brain stem

Gait Ignition Failure

Clinical gait patterns in Elderly

Proposed Terminology Frontal Gait disorder Previous terms Marche a petits pas Magnetic gait apraxia Parkinsonian ataxia Lower half parkinsonian Lower body parkinsonian Gait apraxia Frontal ataxia Astasia, Abasia Lesions Frontal lobe and connections

Frontal Disequilibrium

Frontal lobe and connections

Clinical gait patterns in Elderly

Proposed Terminology Subcortical Disequilibrium Previous terms Lesions

Tottering, Astasia, Upper brain stem, Abasia, Thalamic basal Ganglia, Astasia Thalamus

Sensory abnormalities producing gait disorders in elderly

System Lesion Signs Gait Proprioceptive 1. Peripheral Loss of position Ataxic Gait Nerves sense, stockingglove sensory loss, Rhombergs sign 2. Posterior Loss of position Ataxic gait column sense & other signs of spinal cord disorder

Sensory abnormalities producing gait disorders in elderly

System Vestibular Lesion Signs Gait 1. Peripheral Nystagmus, Weaving Labyrinth and hearing deficit, drunken gait vestibular Past pointing nuclei 2. Central Nystagmus, Weaving Past pointing, /Ataxic gait cerebellar and other cranial nerves signs

Sensory abnormalities producing gait disorders in elderly

System Lesion Signs Gait Visual Lens, vitreous, Altered visual Tentative/ retina, extra acuity, diplopia, uncertain occular deficient downgaze gait muscles

Central dysfunction: Gait disorder in elderly

Lesion
Cortico spinal tracts Frontal Lobes Deep white and Gray Matter Basal ganglia Cerebellum

Gait
Spastic gait, Stiff legged gait, Circumduction gait Apraxic gait March A petits pas gait Parkinsonian gait Dancing/Choreic gait Ataxic

Brain stem, mid line cerebellum, Unable to Walk without assistance Thalamus Multiple central and peripheral sites Senile / Cautitious gait

Motor dysfunction: Gait disorder in elderly

Lesion
Muscle Distal motor neuron Proximal motor neuron

Gait
Wadling gait Slapping/ Foot drop/ high Steppage gait Waddling/ slapping gait

Elderly gait disorder: Rehabilitation Aids

Elderly gait disorder: Rehabilitation Aids

Elderly gait disorder: Rehabilitation Aids

Elderly gait disorder: Rehabilitation Aids

Elderly gait disorder: Rehabilitation Aids

Elderly gait disorder: Rehabilitation Aids

Elderly gait disorder: Rehabilitation Aids

Elderly gait disorder: Rehabilitation Aids