Achieving Steady Gait in Older People

Introduction-

As we walk, a gait cycle is formed. One gait cycle is the time starting from one heel strike (the moment when the heels are touching the ground) of one of the legs until the heel strike on the same leg in the next cycle. There are two stages in this cycle: the stance stage and the swing stage. The stance stage is when the foot is in contact with the surface, and the swing stage is when the foot is lifted to move forward to walk. A normal gait cycle comprises 60 % stance stage and 40 % swing stage. However, a slight deviation in gait can lead to a host of different issues which are very common among elderly people. About 54 % of adults aged 85 and above are associated with an abnormal gait, and the majority of the gait disorders are connected with underlying diseases in the elderly with three or more chronic conditions like stroke, hip fractures, or cancer.

How Does Abnormal Gait Affect an Older Person?

The cause of gait disorders are usually multifactorial, and their common contributors are pain, stiffness, dizziness, numbness, weakness, and sensation of abnormal movement in the leg often caused by conditions such as degenerative joint disease, acquired multiple sclerosis (an autoimmune disease that affects the nervous system), claudication (a condition in which arteries supplying blood to the arms and legs are narrowed leading to pain), stroke, postural hypotension, impairments following orthopedic surgery.

• Because of abnormal gait, the elderly person is more prone to falls, which are the leading cause of accidental deaths and hip fractures among the elderly aged 75 years or above.

• Delayed or prolonged muscle activation is the key element of unsafe gait.

• It also implicates psychosocial problems such as depression, anxiety, and greater fear of falling.

What Are the Different Abnormal Gait Patterns?

1. Parkinson’s gait is one of the most common types caused by dopamine deficiency. It presents as a shuffling gait with difficulty in turning around. It is also known as magnetic gait because, in this condition, the person does not lift up the foot and drags it with the surface while walking. An early sign of this condition is arm swinging during walking.

2. Antalgic gait is another common type caused by pain, usually in one leg. In this condition, the patient will avoid bearing weight on that particular leg which is in pain and hence presents with short strands. The common causes include fractures, infection of the joints, osteoarthritis, etc.

3. Waddling gait is due to weakness of bilateral gluteal muscles (muscles surrounding buttocks), which will cause instability of the pelvis, and the person will devolve from one side to the other while walking. The common causes are muscular dystrophy or muscular diseases, pregnancy, etc.

4. Trendelenburg's gait is due to damage to the gluteal muscle on one side, causing instability in the pelvis. The person will drop or tilt with every step while walking. Medical mistakes are the most common cause of this condition, such as injury to the gluteal muscle while giving an intramuscular injection to the patient on that site.

How to Determine a Person With Abnormal Gait?

1. Static Balance- One leg balance for five seconds. One leg balance with eyes closed test.

2. Dynamic Balance- The ability to anticipate changes and coordinate muscle activity in response to perturbations of stability.

3. Walking Velocity- Gait speed declines at the rate of 12 to 16 % per decade after age 60. Slow or impaired walkers will have a velocity of < 0.6metre/second in comparison to fast or unimpaired walkers with a velocity of >1.0 meters/second while walking.

How to Manage Abnormal Gait in Elderly People?

The primary goals of an older person with an abnormal gait should be as follows:

• Administration of vitamin D supplements.

• Use anti-slip shoes to prevent falling.

• Use well-fitting shoes with low heels, thin and firm soles, and high fixed-collar support.

• Mobility aids.

• The intervention of impaired vision and hearing.

The caregiver or the family member of the elderly person should always consult a physician for advice on appropriate and safe exercises before starting. There are a few exercises that are explained below-

• Stepping Forward and Backward Exercise- The person should stand firmly with their feet slightly apart, take a step either forward or backward, and then return to the original position. Repeat ten times and do the same with the other leg.

• Side Stepping Exercise- First, the feet are kept together, and then one leg is extended to the side and returned to the original position. This can be repeated ten times before doing the same with the other leg.

• Forward Walking Exercise- Walk steadily forward to the end of the practice walkway.

• Side Walking Exercise- Step one foot to the side, followed by the other foot, and continue walking sideways in this phase until the end of the practice walkway.

• Backward Walking Exercise- Step backward steadily, one foot at a time to the end of the practice walkway.

Other methods include -

• To correctly assist an older person walking, the caregiver should position themself to the side and slightly in front of the person, allowing the person to use the dominant hand to hold on to the caregiver’s arm.

• Using a gait belt to assist the unsteady elderly walkers.

• Those who use walking aids like a cane should use the dominant hand to hold the cane. If the walker is too unsteady, the gait belt can also be used along with it.

• Walking on flat surfaces first after getting up and looking in the same direction to which the person is going.

• Practice maintaining a straight posture and not leaning or bending forward while walking.

• One should allow the arms to swing naturally with each step and take a normal slight stride.

• An elderly person should keep their feet as close as possible to the steps while taking the stairs.

• Using the stronger leg first while going up the stairs and the weaker leg first while going down.

Conclusion-

If a person is having difficulty walking, they should consult a doctor who will determine the cause of their problem, whether it is due to abnormal gait or due to other reasons, and will make a treatment plan according to the condition. By performing a fall assessment, taking proper history, and treating the patient’s risk factors, the problem of abnormal gait can be reduced.