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Introduction
Walking is one of the most common aspects of day-to-day living, yet a very complicated one. The nervous system along with many parts of the musculoskeletal device and the cardiorespiratory system is involved all levels of walking. A person’s gait pattern is heavily dependent on personality, age and very often the mood. Socio-cultural factors also play a big part in a person’s style of walking. For instance, people residing in metro cities are habituated walking much faster than those living in small towns or rural areas.
Gait and balance disorders increase with age, i.e. between the ages of 60 and 69, it is around 10% and for people aged 80 years and above, it is more than 60%. The quality of life is adversely affected by the deterioration in gait which may lead to underestimation of one’s own self thereby damaging one’s self-esteem. Furthermore, gait and balance issues may be forerunners of collapse and tripping over, at times causing fatal injuries in the elderly.
One’s walk is indicative of the status of health in general. The slow gait in an older, non-demented person is linked to the future appearance of dementia rather than cognitive destruction. Gait disorders and ensuing falls are hardly diagnosed properly and quite often inadequately assessed. Textbooks pertaining to neurology rarely cover gait disorders. Medical practitioners are also not adequately qualified to evaluate axial motor symptoms and gait and the same are also not well documented in medical reports.
The principal measures of gait include walking base width measured from midpoint to midpoint of both heels, walking speed, step length measured from the point of foot contact to the point of contralateral foot contact, rhythm and stride length, i.e. the linear distance covered by one gait cycle. In healthy adults up to the age of 59 years, the ideal walking speed would be approximately 1.4 m/s while the stride lengths in healthy adults would average a range between 150 and 170 cm. In young adults, the average tempo is usually between 115 and 120 steps/min. The decline in gait speed and step length due to aging is a common factor, though the pace remains comparatively constant. Older people favor a step width of over 40% compared to younger people.
What is Festinating Gait?
A gait or walking disorder exemplified by uncontrolled stiffness while walking is known as Festinating Gait. In this gait, the torso is bent and legs are loosened at the knees and hips and the steps are short and gradually become more hurried, usually classified with Parkinson’s disease and other neurological ailments.
The patient walks with uncontrolled speed and then faces a problem while trying to stop walking. The whole foot is positioned on the ground or floor immediately, while walking, though, in serious cases, patients walk according to a heel-toe manner. An individual with festinating gait will find their feet stuck to the ground for a while before taking it off the surface. This becomes more apparent while taking a turn during their walk or continuing their walking after taking some rest.
Most people with festinating gait have known to be diagnosed with Parkinson’s dsease or PD. Therefore, it is also called Parkinsonian gait. The muscles that control motor responses are generally hypertonic due to the deficiency of dopamine and this is normal in patients with Parkinson’s disease. The most recognizable characteristic in Parkinson’s disease is the gait which is most affected by Parkinson’s, though there are a variety of symptoms related to Parkinson’s disease.
Festinating gait is caused obvious by short, slow and shuffling steps that are generally known as Hypokinesia whereas the complete loss of movement is known as Akinesia.
General Causes of Festinating Gait
Common observation is that Parkinson’s disease is the main root of festinating gait because the basic ganglia (cluster of nerves) which control motor responses is badly affected, leading to impaired movements. The escalated speed of walking of the individual seems to be related to a dislocated center of gravity.
Other causes of gait disorders are orthopedic problems like osteoarthritis and skeletal deformities, neurological conditions like sensory or motor impairments and medical conditions like a respiratory problem, peripheral arterial occlusive disease, obesity, and heart failure.
There are many reasons for gait disorders in older people, which may include poor vision, a frontal gait disorder associated with vascular encephalopathy, impaired proprioceptive function in polyneuropathy, and osteoarthritis of the knees and/or hips. If there is a heightened onset of a gait disorder, spinal, neuromuscular, and cerebrovascular causes should be taken into account as well as psychiatric disorders and harmful effects of drug/medications.
Probable medical reasons for festinating gait could be metabolic or cardiorespiratory disturbances and possible infections.
Prominent Symptoms of Festinating Gait
- Individuals suffering from festinating gait are classified by an abnormal walking prototype and tautness in their manner of walking as well as a shuffling kind of walk.
- They show signs of an unrestrained rapidity while walking, thereby facing a problem when they want to cease walking.
- The heel strikes the ground/floor first instead of the toes
- A person with a normal gait usually walks with a heel-to-toe pattern, but a person with Festinating Gait will land their foot flat on the ground and adopt a toe-to-heel pattern in an advanced stage of the ailment.
- A patient with normal gait will exhibit two peaks with the ground reaction force, whereas a patient with Parkinson’s disease will demonstrate only one peak in an upright gesture.
- People suffering from festinating gaits feel as though their feet are stuck to the surface for a few seconds before they can retrieve it.
- The symptoms are visible when they commence walking or cease walking and while rotating the course.
How to Diagnose Festinating Gait?
A careful clinical observation of gait and an orthopedic, as well as a neurological examination of the patient, could be useful in recognizing a gait syndrome. All this, in turn, could be a guide manual for the various options of supplementary and suitable diagnostic procedures if required.
- The general practitioner will perform a number of tests to diagnose the cause of festinating gait together with an electromyography (EMG) to check the normalcy of leg muscles to detect if there is any decline in the movement of the tibia and triceps muscle.
- The physician will also note the patient’s background to check whether the patient has any Parkinson disease-related symptoms.
- The gait is scrutinized by observing the individual’s natural walk in an even line. It covers the following phases-
- Stance Phase – where one foot and leg are made to carry almost all the weight of the torso.
- Swing Phase – here the foot intended for walking is in touch with the walking surface while the load of the body is supported by the opposite leg and foot.
- Double Support Phase – both feet are on the surface of the floor/ground at the same time for a while.
Treatments Pertaining to Festinating Gait
If a speedy gait alteration is observed without a logical reason. it will be prudent to visit your physician immediately. Neurological as well as joint and muscle injuries could be responsible for the change in gait. The general practitioner will question the patient and examine them and recommend some tests to identify the changes going on within the body. Therefore, the faster a symptom is recognized and treated, the better the prospects.
Some of the measures for treating festinating gait:
- Dopamine deficiency is to blame for a festinating gait. To counter this problem, a drug called Levodopa is recommended as it helps to reactivate the signals from dopamine neurotransmitters which in turn restock the dopamine deficiency. This prescription is very successful with people having Parkinson’s disease. This medication also corrects the rigidity of gait and significant swaying in such patients while walking.
- A physical therapist is also engaged to coach the patient with a few gait training drills and teach the patient ways to be more cautious while teaching them to prevent any tripping or accidents due to festinating gait.
- Treating hypertonicity, the cause of festination gait, may bring about a radical change in this syndrome.
- It may not really be possible to cure Parkinson’s disease and other causes of hypertonicity, but there are medications that could be helpful in treating specific symptoms while also relaxing the patient.
- Physical therapy could also be very helpful in this case.
Festinating Gait Vs Shuffling Gait
Festinating Gait
The other name for Parkinsonian gait is festinating gait taken from the Latin word ‘festinare’ which means to hurry. It is the type of gait shown by patients with Parkinson’s disease (PD). The uniqueness of a Parkinson’s disease patient’s gait is sharply in contrast to a normal gait.
Given below is a list of abnormalities in gait:
- Heel to toe characteristics
In normal gait, the heel touches the surface before the toes, referred to as heel-to-toe walking whereas, in Parkinsonian gait, the entire foot is placed on the ground at the same time, also referred to as a flat foot strike. However, in the more developed stages of the disease, the gait is identified by toe-to-heel walking where the toes touch the ground before the heel. PD patients find it difficult to lift their foot in the normal course of swinging stage of gait, which creates a smaller free space between the toes and the ground.
Patients encountering an advanced stage of Parkinson’s disease have a diminished impact during the strike of the heel which is related to the seriousness of the disease with decreasing of impact to the progression of the disease. Parkinson patients also display a tendency towards higher comparative weight on the front foot area along with a shift in weight towards the medial foot region. This load shift is instrumental in offsetting the imbalance in posture. The variability in the foot strike pattern is substantially lower in PD patients, in contrast with normal people.
- Vertical ground reaction force
The vertical ground reaction force (GRF) signal in PD is abnormal. The vertical ground reaction force (GRF) in normal gait consists of two peaks – 1) when the foot strikes the ground and 2) during push-off force from the ground. In the initial stages of the disease, peak heights or lessened forces are found in heel contact and the push-off phase such as is found in elderly people. In the more progressive phases of the ailment, PD patients demonstrate a single narrow peak in the vertical GRF signal.
- Falls and freezing of gait
Falls and freezing of gait are two common occurrences in Parkinsonian gait. These two types of problems in PD are quite closely entwined because both symptoms are common in the highly developed stages of the ailment along with freezing (immobilization) of gait leading to falls in many cases.
Neither of the symptoms responds well to treatment with dopaminergic medication, indicating a common fundamental pathophysiology.
- Freezing of Gait
Freezing of gait is a situation where the walk is halted and the patient complains that their feet are fastened to the ground. This episode, however, lasts less than a minute. Post this episode the patient begins to walk quite smoothly. Freezing of Gait (FOG) occurs when the patient wants to start walking but becomes hesitant. FOG can also happen while adjusting one’s steps when reaching a destination like in narrow or tight areas viz. a doorway and in strenuous circumstances, such as when the elevator door opens or the telephone or doorbell rings. As the disease evolves, FOG can take place impulsively anywhere.
- Falls
Sudden change in posture results in falls. Falls are rare in the early stages of the illness, but become more regular as the disease advances. Falls generally occur when the patient attempts to perform a couple of activities at the same time while walking or balancing, especially while turning the body. Falls are also frequent while a person suffering from this ailment tries to get up from bed or while trying to sit or stand. Most patients, at least 45%, are inclined to fall forward while 20% fall sideways.
- Postural Sway
During the latter stages of Parkinson’s disease, the postural instability is highlighted where the person is unable to carry out their normal daily routines like sitting, standing, walking and turning. It is the inability to sufficiently balance the central mass of the body at the bottom of the support blended with stiffness in bodily movements causing patients having highly developed PD to fall. Postural sway is usually present in people suffering from balance disorders due to issues such as cerebellar ataxia, head injury or stroke, but it is not so evident in patients with PD, the reason being in PD the problem is generally the inability to shift from one posture to another causing the propensity to fall in these individuals.
Shuffling Gait
Shuffling gait is when a person appears to drag their feet while walking. Length of the steps is shortened in a shuffling gait. One of the traits of a shuffling gait is a lessened arm movement while walking. The foot moves forward at the time of preliminary contact with the surface or during midswing with the foot either at heel strike or flat, along with minimized arm swing, forward bent position, and reduced steps.
- Causes of a Shuffling Gait
A core medical problem could alter the way you walk or have an impact on your balance. Changes in gait do not owe it to one particular issue. The manner of walking can be predisposed to a variety of causes and the gait can reveal many clues to your doctor about your inner health.
- Arthritis
According to studies of patients with rheumatoid arthritis, they undergo a major decline in joint movement in the knees, ankle, and hip flexor which have an effect on their gait. People suffering from joint pains acquire an antalgic gait where they appear to be in an atypical position to prevent pain while walking.
- Diabetes
A change in the gait of diabetic patients could denote that their diabetes is not under control. Peripheral neuropathy or damage to the nerves affecting the legs and/or feet can be a consequence of numbness and pain in the feet which may have an effect on the way you walk.
- Hypertension
Studies have found that high blood pressure could be a strong reason for abnormal gait as the same, along with hypertension, can lead to problems in balancing, thereby altering the way we walk. However, once the blood pressure reduces due to proper medication and diet change, normal gait is generally resumed.
- Scoliosis
An abnormal curving of the spine known as Scoliosis can put a huge strain on the rest of the body, upsetting your posture and gait. As you age, your spinal cord tends to shrink and curve reducing the normal height. The quality of bones at different stages of the spine also begins to deteriorate which could also be a major cause for height loss. And if the spines carry on curving, this could make it tough to walk.
Conclusion
As seen Parkinson’s disease is the reason for many gait variants and these gait changes are recognized as Parkinson’s gait or Festinating Gait. Such drastic changes in gait are definitely an impediment to individuals suffering from Parkinson’s disease and as expected, they get in the way of the ability to do their daily chores as well as activities like work, exercise, sport, etc. Moreover, it is also very conspicuous and can attract undue attention leading to low self-esteem.
It is a general assumption that modification in gait is a common phenomenon as one age, but people often don’t realize that an unstable gait can impede the overall health of the person.
The quality of life depends on the ability to walk and difficulty in walking makes it quite impossible to accomplish a active and dynamic lifestyle. A slow, unsteady, and shuffling gait can affect a person earlier than expected. According to a research on balance and gait disorders, about 30% of people over the age of 65 face difficulty in walking or climbing a flight of stairs while 20% of them walk with the aid of a cane or some other means of support. It is therefore estimated that by the time an individual reaches the age of 80 more than 60% will be suffering from a gait problem.
Fortunately, most gait maladies can be rectified with a timely intervention like strengthening workouts. Gentle exercise regimens are recommended to stretch and strengthen the muscles that are accountable for walking. These muscles comprise the glutes, calf muscles, quadriceps, and hamstrings. Some other exercises that can make your gait better are tai chi training and challenging band exercises that build up strength and balance at a brisk pace.
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