Unsteady Gait

What is Unsteady Gait ?

It is a condition of difficult walking. Gait is not normal here and a person experiences mild limping. Sometimes, a person suffering from unsteady gait may also find it difficult to stand. The problem related to gait arise due to disorders within the central nervous system i.e. brain, peripheral nerves and spinal cord.

It is also due to problems within the muscles, inner ear, joints, and bones. Head injuries precipitate this damage to the central nervous system.

icd9 code for Unsteady Gait is – (781.2 Abnormality of Gait)

Types of Unsteady Gait

Unsteady Gait can be of various types. These include:

• Spastic gait
• Propulsive gai
• Waddling gait
• Steppage gait
• Scissors gait

1. Spastic gait

The spastic gait is the result of chronic muscle contraction of one side of the leg. The gait is stiff. Person drags the foot while walking.

2. Propulsive gait

The propulsive gait is a gait in which person attains a rigid and stooped posture. The gait is characterized by shorter steps. It is seen in case of person suffering from Parkinson’s disease. Other causes include intoxication with poisons such as Phenothiazine, Thiothixene or Manganese poisoning.

3. Scissors gait

As the name implies, the legs assumed a shape of scissors while walking. The hips and knees are flexed. Thigh and legs are crossed. There is rigidity and too much leg adduction in swinging. This gait abnormality is seen in case of upper motor neuron lesion. It is also found in spastic cerebral palsy. Other causes include

• Liver failure
• Injury to the spinal cord
• Anaemia
• Syringomyelia
• Multiple sclerosis

4. Steppage gait

Steppage gait is due to loss of dorsiflexion and is the result of injury to the deep peroneal nerve. Legs are lifted high while toes are facing downward while walking. It causes are as follow:

• Guillain-Barre syndrome
• Injury to the spinal cord
• Herniated lumbar disk
• Damage to Peroneal nerve
• Multiple sclerosis
• Polyneuropathy

5. Waddling gait

This is a characteristic duck-like gait.  The hip is not stabilized here. Therefore, on each step the hips bulge outward. It can even occur in the younger children. It is the result of weakness of the gluteus medius muscle and also found in diseases such as muscular dystrophies. Congenital hip dysplasia is also responsible for waddling gait in children.

Causes of Unsteady Gait

There are a number of causes behind unsteady gait. As a whole, the problems are classified as:

• Musculoskeletal problems characterized by impaired vigour, range of motion, and elasticity
• Damaged sensory processes including somatosensory, visual and vestibular.
• Insufficient neuromuscular reactions and responses
• Reduced cognition i.e. a person fails to adapt himself the needed posture

There are many people who suffer from problems related to gait in their lifetime. They suffer from certain diseases that precipitate problems related to the gait.  The central nervous system (CNS) is accountable for amalgamating the environmental information. It is reached to the CNS by the peripheral sensory receptors and this whole process is known as sensory process. Motor system involves the actions performed by the persons as driven by the brain.

The injury to the brain due to cancer, stroke, and certain diseases such as cerebellar ataxia, multiple sclerosis or Parkinson’s disease may lead to impairment in the ability of a person to execute those actions that are ordered by the brain. This way the abnormality in the gait arises.

Musculoskeletal problems are usually the result of damage to the bones or the nerves and they are the major contributing factor behind gait abnormalities.

Cognition impairment is an essential factor behind gait difficulties. The problems of balance may also arise here.  There is a need to evaluate the person fully and if someone has suffered from stroke or similar condition, they must be tackled properly.

Dysfunction of the Basal ganglia

The basal ganglia are the important part of the cerebral cortex and are in fact they are the 3 nuclei. They offer valuable function in the motion and gait. Due to disturbance in this area of the brain in diseases such as Huntington’s or Parkinson’s diseases, gait becomes abnormal. The posture also becomes instable.

Lesions in the Cerebellar Area

These are also one of the major causes of unsteady gait. On the basis of the area affected, gait problem may be mild to severe. Balance is also affected since cerebellar area is the major brain part that functions to provide balance. The gait seen here is ataxic gait which is similar to the gait known as intoxicated gait.

Different Other Causes Of Gait

Gaits which are unusual can take place owing to diseases in different parts of the body. There are numerous other causes of the unsteady gait such as:

• Knee or ankle arthritis
• Bone fractures
• Certain infections
• Ménière’s disease
• Anatomical and functional leg length discrepancy
• Leg injuries
• Haemophilia
• Alcohol intoxication
• Certain foot diseases
• Myositis
• Even wearing shoes that are not properly fitting

Other than these causes associated with particular gait problem has been discussed above.

Associated Symptoms of Unsteady Gait

Though gait is abnormal here but this may be associated with various other symptoms such as weakness of the legs, face, numbness of arms or legs, problems of vision and also difficulty in speaking. Body balance of such patients is also disturbed. Mainly symptoms are associated with the problems causing the gait to become abnormal.

Diagnosis

There are various ways by which your doctor may recognize your problem associated with gait abnormality. Principally your history and then physical examination help initially. Then your doctor may ask you to get certain tests including blood tests, c-ray, brain CT scan, etc. There are many other tests that your doctor may order depending on the condition you are suffering from.

Treatment for Unsteady Gait

Treatment of gait abnormality varies and depends on the cause. It is therefore necessary to detect the cause accurately. Medical as well as surgical both options are available to treat this condition. Medical therapy is based on the underlying causes such as for Parkinson’s disease drugs that are used include levo dopa and for Huntington’s disease dopamine antagonists are prescribed. For Ménière’s disease a full range of treatment options are available.

Treatments may engage the sensory, vestibular and somatosensory input manipulation. Exercises are recommended to make the muscles strong so they support a good walking. Usually the disorders related to basal ganglia are progressive so need is to understand the problem and slow down this progression. Cerebellar lesion may bring functionality and improvement to some extent.

The person should seek help from the healthcare provider so he/she may get fully evaluated and get early treatment.

Treatment For Different Types of Gait

• In case of propulsive gait, patient is asked to undergo physiotherapy. He/she is also provided walking assistance.
• For spastic gait cane, leg braces, splints and walker are advised. These patients are also advised certain exercises as well.
• If a person is suffering from scissors gait then he/she is recommended splints and leg braces. These help to keep the foot positioned normally while standing or walking. Physiotherapy is also needed for such patients.
• In case of a steppage gait, patient is advised to take enough rest because tiredness often leads to the affected person to stagger and plummet following hitting the toe. These patients are also recommended splints and leg braces.

References

http://www.healthline.com/galecontent/gait-and-balance-problems#1

http://www.neuroexam.com/neuroexam/content.php?p=38

http://www.rightdiagnosis.com/sym/unsteady_gait.htm

http://community.modernmedicine.com/_Unsteady-gait-Normal-aging-or-pathologic/blog/97416/33379.html