Common Neurological Problems affecting Gait and Balance

Common Neurological Problems Affecting Gait and Balance

Stroke

Every year, 731,000 Americans suffer from strokes, the majority of which are ischemic and 66% of which cause long-term neurological abnormalities that affect balance and movement. Hemiplegia, hemiparesis, and paraparesis are all possible outcomes of a stroke, and they all cause a loss of muscle strength and frequently proprioceptive input on the side that is affected. The affected leg in hemiplegia is frequently rigid, slightly stretched at the knee and hip, and the foot is plantar flexed. The afflicted arm is frequently kept in an elbow flexion position. Gait and balance are influenced by all of this.

Parkinson's Disease

The significant nigra and locus rules' and pigmented neurons' ability to synthesize dopamine is disrupted in this condition. Parkinson's disease is characterized by a wide range of physical abnormalities, cognitive failure, and depressive symptoms. Parkinson's disease is caused by a lack of dopamine, which serves as a neurotransmitter in the striatum and other related brain areas.

Tremor, rigidity of the muscles, and dyskinesia are the three main signs of Parkinson's disease. The blink rate slows down, the facial expression stays the same, the voice can get monotonous and soft, and the conversation is hurried. Drooling is typical and a difficulty swallowing may be seen. Patients with parkinsonism typically experience dementia and depression.

Peripheral Neuropathies

Peripheral neuropathy is a major consequence of numerous typical issues that affect older people. The nerve cell body (neuron), the axon, and the myelin coating covering the axon make up the peripheral nervous system. Neuropathies, axonopathies, and myelopathies are terms used to describe diseases affecting these parts.

Patients with neuropathies frequently report sensory abnormalities, proprioceptive impairments, frequent limb stiffness, decreased clearance, and a propensity for circumduction. Gait and balance difficulties are brought on by these physiological changes in older adults.

Degenerative Changes in Spinal Cord

Desiccation and disc fragmentation of the intervertebral disc are the first signs of cervical spondylosis, the most common cause of cord compression in the elderly. The annulus' elasticity declines, and the height of the disk also decreases. Around the disk, osteopathic spurs may form, and the hypophyseal joints may deteriorate concurrently, shrinking the neural foramen. The modifications all affect the function of the lower extremities by reducing spinal cord and nerve root mobility.

Management of Gait and Balance Disorder

A team of physical therapists, occupational therapists, pharmacists, doctors, nurses, and family members should be assembled to manage gait irregularities and falls. A safe, energy-efficient walking pattern as well as functional mobility improvement, strength and endurance improvement, deformity prevention, and appropriate pharmacologic intervention are among the treatment's objectives. To accomplish the goal, assistive devices and medications that reduce spasticity can be used.

Assistive Devices

Using the right orthotic device can help with a variety of gait abnormalities. The plastic-molded ankle-foot orthosis is one of the most frequently used orthoses.

• Ambulatory Assistive Devices

  • Patients with gait and balance issues are frequently administered ambulatory aided devices or gait aids. Canes, crutches, and walkers broaden the base of support, which improves stability.

Instruction to Patients

• Correct Height and Fit
  • When a patient is standing straight and with their arms at their sides, the height of their cane or walker should be at the level of their wrist crease.
• Proper Use
  • A cane should be held across from a weak or sore lower extremity and pushed forward in tandem with the opposite leg. When using a cane or walker, the posture should be straight with no lateral or front slant.
• Medications
  • Stroke-related spasticity can also be treated with a number of oral medicines. These consist of tizanidine, dantrolene sodium, and baclofen. Tizanidine, the most recent oral spasticity medication, has been found to be effective in treating both spinal and cerebral forms of spasticity.

Fall/Injury

Falls are the predominant etiology of accidental deaths in those over the age of 65 and the largest cause of injury-related visits to emergency rooms in the United States. Ageing, pharmaceutical use, cognitive impairment, and sensory deficiencies are risk factors for falls in the elderly. A focused history with a focus on medications, a directed physical examination, and easy tests of postural control and general physical function are all part of the outpatient evaluation of a patient who has fallen. The underlying cause of the fall is the focus of treatment, which can help the patient regain baseline function.

Common Causes

• Accident, dangers in the surroundings, and bedfall.
• Gait issues, balance issues or weakness, and arthritis-related pain.
• Vertigo.
• Medication/alcohol.
• Cognitive dysfunction
• Hypertension in the spine.
• Visual disarray
• Disorder of the central nervous system.

Nursing Role in Reducing Fall

• Remove environmental risks.
• Boost the home's resources.
• Give people chances to socialize and be encouraged.
• Alter the medication.
• Provide instruction in equilibrium.
• Change the restrictions.
• Give a follow-up.
• Promote home safety awareness.
• Take out any carpets, low furniture, items on the floor, cords, and wires.
• At night, check the lighting to make sure it is bright enough.
• Add handrails to a stairway.
• Skip the floor wax.
• Make sure the phone can be accessed from the ground.
• Install grab bars by the toilet seat, in the shower, and in the bathtub.
• In the shower and bathtub, use rubber mats.
• Keep walkways leading to the main door and doorways there well-lit.