Normal and Pathological
Gait in the Elderly
Peggy R. Trueblood, PhD, PT
California State University, Fresno
Part II
PATHOLOGICAL GAIT
CNS Requirements for
Locomotion
 Generate
coordinated movement that
provides the propulsion
 Provide adequate equilibrium control
during the movement
 Allow adaptation of gait depending on
goals of person, the environment,
anticipatory control, and compensation
for actual perturbations
Neural Control of Gait



Central Pattern Generators – grouping of neurons or
neural circuits that can generate coordinated,
rhythmic movements autonomously and for
locomotion are located in the spinal cord
Vestibulo-Cerebellum System responsible for
maintaining equilibrium
Higher Brain Centers add variation in locomotor
patterns and adaptability to task and environmental
conditions
• Cerebellum
• Basal Ganglia
• Cerebral Cortex
Factors Contributing to
Locomotion
Higher brain centers add
Input from brainstem and
cerebellum provide
equilibrium
variation and adaptability of
locomotion
Basal
Ganglia
Cerebral
Cortex
Brainstem Nuclei
Spinal
Cord
Cerebellum
MN
Flex
MN
Basic coordination of
walking generated from
group of neurons in the
spinal cord
Ext
AFFERENT INPUT
COMMON CONDITIONS CAUSING
GAIT AND BALANCE DISORDERS
NEUROLOGICAL
CONDITIONS
 Stroke
 Parkinson
disease
 Peripheral neuropathy
 Cerebellar ataxia
 Dementia
Common Problems in
Stroke Patients:
- Plantarflexion and
inversion at the foot
- Knee hyperextension in
stance
- Lacks trailing limb
- Retracted pelvis
- Toe drag
- Incomplete knee ext
at terminal swing
Left Hemiplegia Secondary to
Right CVA (Stroke)
Parkinson’s Disease:
- Decreased velocity
- Forward trunk
- Shuffling with
decreased steps
- Decreased ROM
- Foot flat at IC
- Excessive knee flex
- Lacks arms swing
- Decreased trunk mvt
- Unable to control
momentum
Parkinson’s Disease
Cerebellar ataxia:
- Wide base
- Unsteadiness
- Irregular steps
- Lateral veering
- Difficulty adjusting
quickly (turning,,
stopping,, starting)
Cerebellar Ataxia
Alzheimer’s Disease
NEUROLOGICAL DISORDERS

Abnormal gait common characteristic
• problems vary within disorder types
Parkinson’s
Disease
Stroke
Parkinson’s
Disease
Dementia
NEUROLOGICAL
DISORDERS

But. . . . problems vary within persons with
disorder
Specific Impairments seen in Neurological Disorders
• Weakness
• Spasticity or excessive activation of muscles in
response to stretch
• Control problems; poor timing of muscles
• Sensory disorders
• Poor adaptation
ORTHOPEDIC CONDITIONS
 Impairments
related to
musculoskeletal limitations
• Soft tissue contractures
• Pain
 Common
Orthopedic conditions that
produce abnormal gait
• Arthritis
• Post fractures/ joint replacements
Bilateral Knee Flexion
Contractures
CARDIOVASCULAR
CONDITIONS
 Common
Impairments
• Pain
• Imbalance
• Decreased velocity/stride length (poor
endurance)
 Common
Cardiovascular conditions
that produce abnormal gait
• Orthostatic hypotension
• Intermittent claudication
• Chronic lower extremity edema (poor
circulation)
MAJOR CAUSES OF
PATHOLOGICAL GAIT
 Joint
Deformity
 Pain
 Impaired
Motor Control or Spasticity
 Muscle Weakness
 Sensory System Deficits
 Central Processing Dysfunction