Gait ImbalanceDr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Because gait and balance disorders are associated with a greater number of falls in the adult population, many assume that gait imbalance is a natural consequence of aging. Yet, changes in gait are multifactorial at best and are related to past and present health conditions, an individual’s environment and psychological health.
To better understand, gait is the way an individual walks or steps. It may be described as a stride, pace or tread and encompasses the individual’s posture and body positioning. Thus, each individual has a distinctive manner of walking. Without question, this makes it difficult to classify a “normal gait,” and effective orthopedic and sports therapy is best determined through a multidisciplinary approach.
When it comes to gait velocity, stride length and stance width, research reports a 10-20% reduction with age, more time spent with both feet on the ground (double support phase) and more time in the bent posture. In addition, there is less force as individuals “push off” to begin walking. While age is clearly a factor, changes in gait may also be the result of an underlying condition. It may also be from the person adapting to changing sensory signals to create a safer pattern of walking. In other cases, gait may include a shuffling pattern that is slow and broad-based. Sometimes referred to as “senile gait disorder,” research suggests that this interruption in gait movement is related to heart disease, dementia and institutionalization.
A number of other risk factors and conditions, including psychiatric conditions, cardiovascular conditions and infectious and metabolic diseases are believed to correlate with gait imbalance:
- Sleep disorders
- Substance abuse
- Heart arrhythmia
- Congestive heart failure
- Coronary artery disease
- Orthostatic hypotension
- Peripheral artery disease
- Thromboembolic disease
- Hyper and hypothyroidism
- Tertiary syphilis
- Vitamin B12 deficiency
Musculoskeletal disorders, neurologic disorders and sensory abnormalities may also contribute to gait imbalance, including:
- Cervical spondylosis
- Lumbar spinal stenosis
- Muscle atrophy
- Cerebellar dysfunction
- Multiple sclerosis
- Parkinson’s disease
- Vestibular disorders
- Hearing impairment
- Peripheral neuropathy
- Visual impairment
Rehabilitation for Gait Imbalance
While a wide variety of conditions and disorders contribute to gait imbalance, physiatrists are adept at bridging multiple disciplines in order to determine the root cause of an individual’s imbalance. Physiatrists understand how conditions and body systems affect the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. They are able to propose and manage rehabilitation that incorporates gait training, balance and coordination, flexibility, neuromuscular reeducation and bracing/splinting. They also bring an awareness of body mechanics, posture and positioning.
Often consulting with other medical professionals including physical and occupational therapists, clinicians and interventionists, physiatrists customize treatment with the whole body in mind, not one area or symptom. Rehabilitation strategies to improve an individual’s gait may involve performing simple activities such as balancing on one leg, stepping in place and lifting and placing the heel on the ground. While this brings awareness to a person’s gait, it also provides pertinent diagnostic information to the therapist and physiatrist that is used as a framework for therapy.
Continued physical rehabilitation may include balance activities to stabilize walking, using inactive muscle groups to strengthen the gait. It may also include bracing or splinting to provide stability and help individuals move. In addition, weight-bearing activities, eye-hand coordination activities, upper extremity movements and stretching that involve crossing the patient’s midline. Also, using sound to bring attention to a weaker muscle group may be used. Other activities focus on helping patients modify body movements, while generating an awareness of body position, speed, force, accuracy and amplitude.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
Contact us today to schedule your appointment.