Elderly Gait

8/3/2019 Elderly Gait

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Gait In Elderly

During walking, more than 1000 muscles are

synchronized to move over 200 bones around

100 moveable joints.



A normal gait pattern is essential

for maintaining independence inolder adults.”

Gait In Elderly



Gait adaptation as seen in the elderly population may be associated with the

general decrease in muscle strength due toloss of motor neurons, muscle fibers and

aerobic capacity…Even if walking is

considered a very complex task, a healthy person walking at self selected velocity, performed this task at a minimal energy

cost.”

Gait In Elderly











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 onambulatory 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 theinteraction 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 towalk, use of diapers)



Young & Elderly

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

Stance 59 percent of gaitcycle

63 percent

Swing

Double Limb

Support

41%

18%

37%

26%



Aging Effects on Gait•

Walk at slowerspeeds{1.0 to 1.2

meter/sec} (10-20%

decline)

• Loss of normal arm

swing

• Reduced pelvic rotation

• Decreased hip & knee

rotation

•

Increased stride width

• Decreased heel-to-

floor angle

• Decreased step length

(75-year-olds' step

length is 10% shorter

than that of 25-year-

olds

• Increased stance time,

decreased swing, and

increased double limb

support

A i ff G i



• Increase in Sway while standing

• Anterior pelvic tilt and thoracic kyphosis

• Decreased plantar flexion and lesser heel riseduring terminal stance

• Decreased ankle PF power at push off, partlycompensated for by increased hip flexor power atpull off.

•Short steps

• Reduced postural support responses.

• Strengthening ankle plantar flexors may

maintain step length as people age.

Aging Effects on Gait



Lumbar Spine Position• Elderly are flexed at hip joint in stance phase of

gait than younger due to increase in lumbarspine 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 extremelyvulnerable 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

Previous terms Lesions

Cautious Gait Elderly gait

Senile gait

Musculoskeletal,CNS and PNS

lesions.Gait Ignition

FailureGait apraxia

Magnetic aprexia

Slipping clutchphenomena

Lower half parkinsonism

Petren’s gait

Frontal lobeconnections with

brain stem



Proposed

Terminology


Frontal Gaitdisorder

Marche a’ petits pas

Magnetic gait apraxia

Parkinsonian ataxiaLower half

parkinsonian

Lower body

parkinsonian

Frontal lobe andconnections

FrontalDisequilibrium

Gait apraxia

Frontal ataxia

Astasia, Abasia

Frontal lobe andconnections




ProposedTerminology


SubcorticalDisequilibrium

Tottering, Astasia,Abasia, ThalamicAstasia

Upper brain stem,basal Ganglia,Thalamus


S b liti d i it di d i



Sensory abnormalities producing gait disorders in

elderly

System Lesion Signs Gait

Proprioceptive 1. PeripheralNerves

Loss of positionsense, stocking-glove sensory

loss,Rhomberg’s sign

Ataxic Gait

2. Posterior

column

Loss of position

sense & othersigns of spinalcord disorder

Ataxic gait

Sensor abnormalities prod cing gait disorders in




Vestibular 1. Peripheral

Labyrinth andvestibular

nuclei

Nystagmus,hearing deficit,Past pointing

Weavingdrunken gait

2. Central Nystagmus,

Past pointing,

cerebellar andother cranialnerves signs

Weaving/Ataxic gait


elderly





Visual Lens, vitreous,retina, extraoccularmuscles

Altered visualacuity, diplopia,

deficient downgaze

Tentative/uncertain

gait


elderly



Central dysfunction: Gait disorder in elderly Lesion Gait

Cortico spinal tracts Spastic gait, Stiff legged gait,Circumduction gait

Frontal Lobes Apraxic gait

Deep white and Gray Matter March A petits’ pas gait

Basal ganglia Parkinsonian gait

Dancing/Choreic gait

Cerebellum Ataxic

Brain stem, mid line cerebellum,Thalamus

Unable to Walk without assistance

Multiple central and peripheralsites

Senile / Cautitious gait



Motor dysfunction: Gait disorder in elderly

Lesion Gait

Muscle Wadling gait

Distal motor neuron Slapping/ Foot drop/ high Steppagegait

Proximal motor neuron Waddling/ slapping gait





Elderly gait disorder: Rehabilitation Aids



Elderly gait disorder: Rehabilitation

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Elderly Gait