- General approach
| - Examination of visual acuity/hearing, cardiovascular system, joints (ankles, knees, hips)
- Assessment of psychiatric comorbidities and awareness (too much in fear of falling syndrome, too little in reckless gait)
|
- Rule out compensated disorders
| - Pain (improvement after an analgesic)
- Imbalance (eg, improvements with external support in patients with cautious gait, worsening with eye closed in vestibular/proprioceptive disorders)
- Weakness (eg, circumduction in poststroke gait)
- Lack of automaticity requiring conscious control (gait worsening during dual tasking)
|
- Assess lower limbs
| - Strength
- Coordination (dysmetria)
- Tone (spasticity, rigidity, hypotonia, myotonia, spasms, mixed)
- Involuntary movements (tremor, chorea, ballism, myoclonus, tics, dystonia)
|
- Rule out other perturbations
| - Episodic (cataplexy, hyperekplexia)
- Postural (antecollis, retrocollis, torticollis, Pisa syndrome, camptocormia, pusher syndrome*)
|
- Evaluate stepping
| - Cadence
- Step height (floor clearance)
- Step length
- Step length symmetry
- Variability
- Stance width (base of support)
|
- Evaluate arm swinging
| - Absence/reduction (symmetric versus asymmetric)
- Exaggerated (lower-body parkinsonism)
- Abnormal postures (eg, arm levitation)
|
- Recognize specific features
| - Festination
- Freezing of gait
- Effect of cues/sensory tricks/distraction maneuvers
|
- Bring it all together
| - Determine the main gait abnormality to guide the differential diagnosis (sign-based approach)
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