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For the elderly gait speed, chair rise time, and the ability to perform
tandem stance are independent predictors of their ability to perform
instrumental activities of daily living eg , the ability to shop, travel, and
cook.
Gait speed, chair rise time, and balance are also predictors of the risk of
medical care and death.
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remains stable until about age 70; it then declines about 15%
per decade for usual gait and 20% per decade for maximal gait.
is shorter in the elderly.
increases with age to > 26% in healthy elderly persons.
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i. Producing regular asymmetry with unilateral neurologic or
musculoskeletal disorders.
ii. Symmetric short step length usually indicates a bilateral problem.
iii. Unpredictable or highly variable gait cadence, step lengths, and
stride widths indicate breakdown of motor control of gait due to a
cerebellar or frontal lobe syndrome.
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Pain, weakness, and numbness with walking that improves when sitting
down may be caused by spinal stenosis.
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÷ History
÷ {bserve gait with and without an assistive device (if safe)
÷ ssess all components of gait & observe gait again with a knowledge
of the patient's gait components
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References:
i. The merck manual of geriatrics, ch. 21,
.
ii. Thieme journal abstract 2006.
iii. Sudarsky & Lewis Massachusetts Medical Society Publication the
New England Journal of Medicine year: 1990.
iv. Journal of neurology, Springerlink 3 September 1990
v. Moe r. Lim et al Journal of the merican cademy of {rthopedic
Surgeon 2006.
vi. http://www.wrongdiagnosis.com/sym/walking_symptoms.htm
vii. http://knol.google.com/k/gait-disorders-in-the-elderly#
viii. http://www.geriatricsreviewsyllabus.org/gait6_m.htm
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rticle abstract:
Many elderly people have problems with gait, or the manner of walking
that contribute to the incidence of falling. The mechanical, anatomical and
physiological factors of normal gait are reviewed.
The effects of aging on gait include the increase of sway while standing,
slowed responses of postural support for balance, and change in the
capacity to integrate sensory information.
Studies have shown that people over the age of 65 use shorter, broader-
based strides to compensate for the change in balance and walk more
slowly.
There are two general causes of gait disorders: those that affect the muscles
and skeleton, such as myelopathy (diseases of the muscles), degenerative
arthritis of the spine, spinal cord compression (causing bony protrusions of
the spine), and vitamin b12 deficiency; and neurologic abnormalities, such
as parkinson's disease, sequelae from stroke, cerebellar degeneration,
disorders of sensory afferent systems, and encephalopathy (abnormalities
of the structure or function of the tissues of the brain) due to the toxicity of
medications or adverse effects of medications on the body's metabolism.
number of other factors can also occasionally cause gait disorders. The
evaluation of patients with gait disorders should include a history of the
patient, a physical examination concentrating on musculoskeletal, visual,
and neurologic abnormalities, observation of the patient's gait, assessment
of balance, and other testing when appropriate, such as ct scanning or
magnetic resonance imaging.
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Distinguishing between the normal gait of the elderly and pathologic gaits
is often difficult.
i. frontal gait
ii. spastic hemiparetic gait
iii. parkinsonian gait
iv. taxic gait
i. myelopathic gait
ii. stooped gait of lumbar spinal stenosis
iii. steppage gait
i. antalgic gait
ii. coxalgic gait
iii. trendelenburg gait
iv. knee hyperextension gait
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3 September 1990)