Gait Disorders: Evaluation and Management PDF

Preface

The ability to walk safely, easily, and in an aesthetically pleasing manner is a skill learned early and highly prized. Although it is typically taken for granted, gait is key to mobility and functional independence and at the core of our ability to carry out many activities of daily living. In older adults and patients with neurological deficits, ease and safety in walking may become compromised, and gait is often viewed as abnormal, i.e., as a disorder. While not an inevitable part of aging, gait disorders are common among older adults and in patients with neurological disease. By some estimates, as much as 20% of non-institutionalized older adults admit to walking difficulties or require the assistance of another person or special equipment to walk. Left untreated, gait disorders may contribute to reduced physical activity, impaired mental health, falls, fear of falling, frailty, nursing home admission, and loss of independence.

Fortunately, when a gait disorder appears, a diagnostic andmanagement strategy can be developed that may limit the extent of the disorder and its functional impact. When properly managed, the risk of falling, for example, can often be reduced. A major goal of this book is to provide clinicians, therapists and others treating gait disorders with an understanding of the mechanisms underlying gait disorders and how to best manage these disorders. To a large extent, the content in this book is self-contained and assumes minimal pre-requisite understanding of motor control and gait. As such, it should also prove helpful to patients and their caregivers who want to better understand and manage their own gait disorders as well as to students and investigators in a variety of disciplines who would like to learn more about this field.

The book is divided into three major sections. Section I serves as the foundation. Here, experts in the field summarize the motor control, physiology and biomechanics of walking; review the current understanding of how and why gait and balance often change with aging and neurological disease; and describe gait disorders that are common in older adults and in patients with neurological disease. Section II examines clinical tools available for the evaluation of gait disorders and falls and provides a detailed, practical plan for the evaluation and assessment of gait disorders and fall risk. In Section III, experts describe the current state-of-the-art of management of gait disorders in general and offer a guide to the management of certain specific problems that commonly affect gait in older adults, in patients with foot and ankle disorders, hip fracture and replacement, and neurological disease.

Describing a wide range of assessment tools, diagnostic evaluation strategics, and clinical approaches to gait, this reference:

• introduces as new classification scheme to encompass the full range of mobility capacity in all older adults

• reviews the physiology and biomechanics of gait and common gait disorders

• covers cognitive and behavioral influences on gait and falling

• details clinical and evidence-based methods for gait disorder and fall analysis, as well as techniques for gait optimization in patients with neurological disorders, foot and ankle disorders, and post-hip surgery,

• presents a state-of-the-art strategy for multidimensional fall risk assessment and fall reduction

• features a detailed review of exercise strategies including Tai Chi to improve balance and gait

People of all ages may have gait disorders. While there is much overlap in the evaluation and management of gait disorders in the young and the old, there are also unique differences. In many young adults, a single cause of a gait disturbance can often be pinpointed. Older adults often have multiple deficits that may contribute to or exacerbate the gait disorder. Many older adults often have multiple conditions that affect their gait, further complicating evaluation and management. In this book, we place a special focus on the gait disorders of older adults and in patients with common neurological diseases, but note of course, that much of the presentation may be applicable to other populations as well.

Gait is influenced by many factors and can be studied from multiple perspectives. One key to successful evaluation and management of gait disorders is appreciation of this diversity and the interaction among a variety of apparently disparate factors. Neurologists, geriatricians, neuropsychologists, biomechanists, physiatrists, neuroscientists, and physical therapists are actively involved in the study and treatment of gait disorders among older adults. Reflecting this wide spectrum, we note that experts from numerous and varied disciplines have contributed to this book. We hope that this product will produce a synergistic effect and prove useful to students, clinicians, patients and investigators, who may be interested in improving their understanding and treatment of a multi-factorial problem common to many older adults and patients with neurological disease.