January 25th, 2024
Feeling unsteady on the feet? Lacking confidence in the ability to stand and balance?
Gait and Balance Essentials:
Gait, or more commonly known as “walking”, is a complex interplay of major parts of the nervous, musculoskeletal, and cardiorespiratory systems1. The human gait pattern is directly influenced by several factors including age, personality, mood, and other sociocultural factors1. Disruption in human gait and balance can significantly impact overall health and wellness. When gait and balance dysfunctions occur, this can lead to a loss of personal freedom as falls and injuries can result in a marked reduction in the quality of life1.
Gait and balance training is often a critical focus point throughout the aging process. The prevalence of gait disorders increases from 10% in people aged 60 to 69 years, to more than 60% in community dwelling subjects aged over 80 years1. Gait and balance training aims to directly combat the negative effects of various gait and balance disorders. Being able to stand, walk, and navigate a variety of surfaces and terrains is essential to maintaining long term health and wellness throughout the aging process. With 1.15 million annual deaths expected in 2040 due to physical inactivity2, it is very important to engage in regular activity and exercise. The American Heart Association recommends participating in at least 150 minutes of moderate intensity physical activity per week, with even greater benefits when reaching toward 300 total minutes in the week3. Having a strong gait ability, stability when balancing, and confidence when standing and walking are all extremely beneficial to maintaining physical activity levels when aging.
Gait and balance impairments can be caused by a wide variety of factors. Progressive muscular weakness and physical deconditioning, especially during the aging process, can lead to difficulty walking and navigating stairs or curbs. Neurological impairments, such as those caused by a stroke or a brain injury, can impact the coordination and proprioception that is critical to stability when standing on the feet. Sufficient gait and balance abilities are essential in maintaining function and independence with everyday activities. Increased injury risk, decreased physical activity levels, and an overall reduction in health and wellness are some of the many risks associated with gait and balance impairments1.
Some of the most frequently asked questions regarding gait and balance at ProMotion include:
Why am I falling more frequently?
This is a very common question that many patients ask, especially when there is growing concern about their increasing frequency of falling. There are often a wide range of possible factors contributing to more frequent falling. Some of the many factors include:
- Progressive muscular weakness
- Impaired proprioception
- Limited coordination
- Reduced endurance and physical capacity
- Increased "fear" of falling
It is important to note that many medical conditions and the side effects from these conditions can often contribute to the factors listed above. For example, impaired proprioception in the feet and feeling "unsteady" when standing are often a side effect of peripheral neuropathy. Another example is the feeling of “dizziness” when standing up after sitting down, which may be directly related to blood pressure changes or a side effect of specific medications.
Our providers at ProMotion are trained to examine the neuromusculoskeletal system to identify these factors and impairments. Our providers also perform an extensive medical history examination and screening to determine if any medical factors or past medical history variables are contributing to these balance issues.
What contributes to my balance?
In addition to the factors listed above, there are three main sensory systems that contribute to balance. The visual, vestibular, and somatosensory systems are all key components that work together to maintain balance4. The visual system provides direct feedback into how one "sees" the environment, providing visual input to gauge the environment. For example, being able to "see" the stairs that are ahead or being able to "see" the transition from pavement to a grassy area. The vestibular system involves very small semicircular canals and fluid in the inner ear area, working in harmony with the brain to detect our position "sense". For example, our vestibular system communicates with the brain to help maintain balance when turning the head from side to side before walking across the street. The somatosensory system involves the ability to "feel" and "detect" various inputs into the body. The ability to "sense" standing on a concrete floor, compared to standing on a softer ground like a grassy area or on a gravel road, all lead back to a functioning somatosensory system.
When one of these systems is not functioning appropriately, this may lead to an overreliance on other systems and can directly contribute to gait and balance impairments. It is critical to assess the integrity of each of these systems and determine if there is an overreliance on one system, or even underperformance by one or more systems.
One way to briefly screen the ability to balance is to stand with the feet together and look straight ahead. Be sure to stand close to something that you can quickly get ahold of to maintain safety when testing. To isolate the visual system, briefly close the eyes while maintaining the stance of feet together. If there is any major difference in the ability to balance with the feet together when opening or closing the eyes, this might point to an overreliance on the visual system to maintain balance.
Our team at ProMotion is trained to examine the integrity of these systems through a variety of gait and balance assessments. Balance and stability assessments like the Berg balance scale and the Clinical Test of Sensory Interaction on Balance (CTSIB) are some of the many tests that can be used to identify specific causes of gait and balance impairments5,6. These tests are essential in providing critical information to create a plan and to work on addressing the root causes of balance issues!
What can I do to improve my balance?
Fortunately, there are many ways to train gait and balance abilities. Standing in a narrow stance with the feet together, feet in front of one another, or even standing on one leg are all options to practice. The surface underneath the feet when practicing balance exercises can be modified to challenge proprioception or somatosensation, such as by standing on an airex pad or a folded-up blanket. These exercises can be easily progressed or regressed (based on the ability to balance) to provide the optimal stimulus for the body to adapt and improve upon.
ProMotion uses a combination of functional strength, balance, endurance, and mobility training to combat gait and balance impairments. Functional activities like walking, stair navigation training, sit to stand transfer practice, and marching over hurdles are all examples of activities commonly performed in therapy sessions. Modifications to each exercise and activity can further challenge the visual, vestibular, and somatosensory systems based on individual needs.
Our goal at ProMotion is to help you maintain your strength and confidence in your everyday abilities and your goals. We want you to be able to move better, live better, and ultimately BE better!
If you or a loved one are experiencing gait and balance difficulties, we would love to help! Give us a call to schedule your initial evaluation to determine the cause of your gait and balance difficulties and to create an individualized plan to regain your strength and confidence today!
References:
1. Pirker W, Katzenschlager R. Gait disorders in adults and the elderly : A clinical guide. Wien Klin Wochenschr. 2017;129(3-4):81-95. doi:10.1007/s00508-016-1096-4
2. Hamilton I, Kennard H, McGushin A, et al. The public health implications of the Paris Agreement: a modelling study. The Lancet Planetary Health. 2021;5(2):e74-e83. doi:https://doi.org/10.1016/S2542-...(20)30249-7
3. https://www.heart.org/en/healt...;
4. Grace Gaerlan M, Alpert PT, Cross C, Louis M, Kowalski S. Postural balance in young adults: the role of visual, vestibular and somatosensory systems. J Am Acad Nurse Pract. 2012;24(6):375-381. doi:10.1111/j.1745-7599.2012.00699.x
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