Difficulty with walking and balance are quite common in the general population, and can significantly impact quality of life and independence, as well as general health. These problems are most often assumed to be related to bone and joint abnormalities such as degenerative arthritis or spine difficulties, or perhaps just “slowing down with age.” However, the nervous system is often at fault creating instability and threatening one’s independence. If identified and treated, sometimes serious threats may be avoided. Specific treatments may be quite useful in stabilizing or improving many gait difficulties, however the mechanics and physiology of gait are quite complex. For this purpose, Minneapolis Clinic of Neurology offers a collaborative, multidisciplinary approach to gait analysis and intervention through our Gait Disorders Program at our Edina Office and Golden Valley Office.
Causes of Instability and Difficulty Walking:
Virtually any part of the central or peripheral nervous system, if troubled, can contribute to instability and difficulty with walking. If there is not an orthopedic cause, the nervous system is likely the culprit. For example:
1. Brain disorders are often subtle and progress slowly, with the affected individual thinking their deterioration may just be “old age.” However there are neurodegenerative disorders such as Parkinson’s, Alzheimer’s and Multiple Sclerosis which may first be manifest with trouble walking. In addition, stroke, tumors, blood clots or other intracranial disorders can affect stability and gait, as can some rare or hidden problems such as Normal Pressure Hydrocephalus or Gait Apraxia (Gait Ignition Failure) due to cerebral degeneration.
2. The cerebellum is the portion of the brain which controls coordination, and any disorder adversely impacting its function will produce an unsteady or ataxic gait.
3. The vestibular apparatus is a component of the inner ear. It senses gravity and often malfunctions. When severe difficulties are encountered, a distinct sense of spinning or vertigo, often accompanied by hearing loss or ringing in the ears, is noticeable. If there is just a minor problem, often individuals sense an imbalance without accompanying symptoms.
4. Spinal Cord disorders may emerge slowly and gradually, often escaping early detection. For example, if an individual has arthritic or disc degeneration in the cervical spine, pressure may be put upon the spinal cord creating a unique clinical picture of weakness and unsteadiness. If not rectified, serious and permanent damage can occur. There are also medical conditions, such as B12 deficiency or auto-immune inflammatory injuries, which can damage the spinal cord.
5. The peripheral nerves carry data from our skin and joint receptors to our brains and from our brains to our muscles. Nerve damage or neuropathy can cause difficulty with power, stamina and our sense of balance. This can occur in the absence of nerve pain, the more typical symptom of neuropathy. Safety is a concern with these types of disorders, particularly during the winter months with snow and ice producing unsafe footing.
6. Spinal Stenosis, a narrowing in the center of the lumbar spine, is a syndrome with symptoms not so much of back pain or sciatica, but instead a threatening loss of stamina and mobility severely limiting power and independence.
7. Muscle diseases can create weakness as seen in Myositis, Myopathies, or Myasthenia Gravis.
In many instances, more than one condition plays a role in limiting stability and walking, and thus independence. Falls and sometimes fractures are a serious result of these deteriorating conditions.
Evaluation and Treatment of Gait and Balance Disorders:
At Minneapolis Clinic of Neurology, we are concerned with maximizing safety and independence. Our Gait Disorders Program is a specialized program developed to provide a unique collaboration of neurologists, physical therapists and orthotists in the analysis and diagnosis of walking and/or balance difficulties and advanced treatment planning. Our neurologists are experts in all forms of neuropathology possibly contributing to a gait disorder. Our physical therapists have unique expertise in identifying and treating patients with neurological problems, including gait difficulties. The orthotists we work with offer inexpensive “off-the-shelf” aides, custom bracing, as well as advanced orthotic technology. Once the team completes the analysis and diagnostic components, treatment, individualized to one’s specific situation, are planned, implemented and continually reassessed for effectiveness.