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Chapter 48 - Gait and Balance Disorders

from Section 4: - Dyscoordinative and Otherwise Inappropriate Motor Behaviors

Published online by Cambridge University Press:  07 January 2025

By
Fabian Büchele
Edited by
Erik Ch. Wolters  and
Christian R. Baumann
Erik Ch. Wolters
Affiliation:
Universität Zürich
Christian R. Baumann
Affiliation:
Universität Zürich
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Summary

Gait and balance are fundamental human abilities. When assessing a patient, a certain phenomenologic gait pattern is identified based on characteristic signs that we relate to anatomic systems (topo-diagnosis). According to their functional complexity, these systems can be categorized into lower-level systems (bones, muscles, nerves); intermediate-level systems (basal ganglia, cerebellum, sensory systems); and higher-level systems (cortex–basal ganglia loops). In a second step, we relate this to an underlying etiology, giving rise to a two-axis diagnosis. Gait examination can show direct stepping disturbances as well as indirect, i.e., compensatory changes mainly related to dysbalance (e.g., broad-based gait). The most common disorders include the “ataxias,” related to disturbances of the cerebellum or the sensory systems; basal ganglia gait disorders with parkinsonian or hyperkinetic phenomenology; and higher-level gait disorders, related to disturbances within the cortex–basal ganglia loops, which lead to inappropriate selection and organization of gait and balance programs, resulting in impaired stepping (with freezing of gait) and balance.

Keywords

Gait and balance disordershigher-level gait disorderNPHnormal pressure hydrocephalusfreezing of gaitpostural instability
Type
Chapter
Information
International Compendium of Movement Disorders , pp. 600 - 616
Publisher: Cambridge University Press
Print publication year: 2025

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