elderly gait
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Gait In Elderly
During walking, more than 1000 muscles are
synchronized to move over 200 bones around
100 moveable joints.
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A normal gait pattern is essential
for maintaining independence inolder adults.”
Gait In Elderly
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Gait adaptation as seen in the elderly population may be associated with the
general decrease in muscle strength due toloss of motor neurons, muscle fibers and
aerobic capacity…Even if walking is
considered a very complex task, a healthy person walking at self selected velocity, performed this task at a minimal energy
cost.”
Gait In Elderly
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ADVANTAGES/Disadvantage
OF BIPEDAL GAIT:• Bipedal gait frees our hands, elevates our head,
and allows us to move on challenging terrain
• Disadvantage
• Very hard for CM to move in a straight line,
which would be the most efficient. (like a wheel.)
• Instead, there is an arc-shaped pattern with
lateral sway.
• Maintaining a smoother trajectory of the CM
plays a large role in determining HOW we walk.
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Elderly: Gait disorders• Most common and cannot be treated
medically or surgically.
• Treatment often relies onambulatory devices such as
canes,crutches, and walkers.
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Mature gait pattern
Development• By 11 & 15 months of age most children walk
independently
•
Mature gait pattern appears by 3yrs, through theinteraction of changes in several systems:
• Neurological (myelination)
• Biomechanical (changes in skeletal structure, including
size and mass of body parts)• Psychological (motor learning)
• Environmental (amount of handling, opportunities towalk, use of diapers)
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Young & Elderly
Gait Comparison:Gait Parameters Young(20-year) Elderly(70-year)
Stance 59 percent of gaitcycle
63 percent
Swing
Double Limb
Support
41%
18%
37%
26%
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Aging Effects on Gait•
Walk at slowerspeeds{1.0 to 1.2
meter/sec} (10-20%
decline)
• Loss of normal arm
swing
• Reduced pelvic rotation
• Decreased hip & knee
rotation
•
Increased stride width
• Decreased heel-to-
floor angle
• Decreased step length
(75-year-olds' step
length is 10% shorter
than that of 25-year-
olds
• Increased stance time,
decreased swing, and
increased double limb
support
A i ff G i
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• Increase in Sway while standing
• Anterior pelvic tilt and thoracic kyphosis
• Decreased plantar flexion and lesser heel riseduring terminal stance
• Decreased ankle PF power at push off, partlycompensated for by increased hip flexor power atpull off.
•Short steps
• Reduced postural support responses.
• Strengthening ankle plantar flexors may
maintain step length as people age.
Aging Effects on Gait
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Lumbar Spine Position• Elderly are flexed at hip joint in stance phase of
gait than younger due to increase in lumbarspine flexion and not due to pure hip flexion
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Aging Effects on Gait
• More dependent on high quality afferent
information to maintain balance, but
these sensory systems are extremelyvulnerable for age related degeneration
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Elderly Gait disorders:
Common causes• Multiple sensory deficits affecting vision,
vestibular & proprioceptive function
• Central and Peripheral nerve degeneration• Musculoskeletal degeneration
• Foot deformities Eg: callouses, bunions &
deformed nails- Incorrect proprioceptive input• Systemic illness
• Postural Hypotension
•
Excessive medication
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• Difficulty arising from chair Weakness
Arthritis
•
Instability on first standing Hypotension,Weakness
• Instability with eyes closed Proprioception
• Step height/length Parkinsonism
Frontal lobe
Fear
Elderly Gait disorders:
Common causes
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Formal Gait Evaluation
• Get up and Go Test
• Tinetti Gait and Balance Evaluation
(POMA)
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Clinical gait patterns in Elderly
Proposed
Terminology
Previous terms Lesions
Cautious Gait Elderly gait
Senile gait
Musculoskeletal,CNS and PNS
lesions.Gait Ignition
FailureGait apraxia
Magnetic aprexia
Slipping clutchphenomena
Lower half parkinsonism
Petren’s gait
Frontal lobeconnections with
brain stem
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Proposed
Terminology
Previous terms Lesions
Frontal Gaitdisorder
Marche a’ petits pas
Magnetic gait apraxia
Parkinsonian ataxiaLower half
parkinsonian
Lower body
parkinsonian
Frontal lobe andconnections
FrontalDisequilibrium
Gait apraxia
Frontal ataxia
Astasia, Abasia
Frontal lobe andconnections
Clinical gait patterns in Elderly
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ProposedTerminology
Previous terms Lesions
SubcorticalDisequilibrium
Tottering, Astasia,Abasia, ThalamicAstasia
Upper brain stem,basal Ganglia,Thalamus
Clinical gait patterns in Elderly
S b liti d i it di d i
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Sensory abnormalities producing gait disorders in
elderly
System Lesion Signs Gait
Proprioceptive 1. PeripheralNerves
Loss of positionsense, stocking-glove sensory
loss,Rhomberg’s sign
Ataxic Gait
2. Posterior
column
Loss of position
sense & othersigns of spinalcord disorder
Ataxic gait
Sensor abnormalities prod cing gait disorders in
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System Lesion Signs Gait
Vestibular 1. Peripheral
Labyrinth andvestibular
nuclei
Nystagmus,hearing deficit,Past pointing
Weavingdrunken gait
2. Central Nystagmus,
Past pointing,
cerebellar andother cranialnerves signs
Weaving/Ataxic gait
Sensory abnormalities producing gait disorders in
elderly
Sensory abnormalities producing gait disorders in
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System Lesion Signs Gait
Visual Lens, vitreous,retina, extraoccularmuscles
Altered visualacuity, diplopia,
deficient downgaze
Tentative/uncertain
gait
Sensory abnormalities producing gait disorders in
elderly
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Central dysfunction: Gait disorder in elderly Lesion Gait
Cortico spinal tracts Spastic gait, Stiff legged gait,Circumduction gait
Frontal Lobes Apraxic gait
Deep white and Gray Matter March A petits’ pas gait
Basal ganglia Parkinsonian gait
Dancing/Choreic gait
Cerebellum Ataxic
Brain stem, mid line cerebellum,Thalamus
Unable to Walk without assistance
Multiple central and peripheralsites
Senile / Cautitious gait
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Motor dysfunction: Gait disorder in elderly
Lesion Gait
Muscle Wadling gait
Distal motor neuron Slapping/ Foot drop/ high Steppagegait
Proximal motor neuron Waddling/ slapping gait
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Elderly gait disorder: Rehabilitation Aids
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Elderly gait disorder: Rehabilitation
Aids
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Elderly gait disorder: Rehabilitation
Aids
Eld l it di d R h bilit ti
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Elderly gait disorder: Rehabilitation
Aids
Eld l it di d R h bilit ti
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Elderly gait disorder: Rehabilitation
Aids
Eld l it di d R h bilit ti
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Elderly gait disorder: Rehabilitation
Aids
Elderly gait disorder: Rehabilitation
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Elderly gait disorder: Rehabilitation
Aids
Elderly gait disorder: Rehabilitation
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Elderly gait disorder: Rehabilitation
Aids
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