5. Associated Signs and Symptoms of
Conditions causing gait and balance
disorders
• Ataxia, erratic foot placement, instability of trunk,
wide-based stance (cerebellar disorder)
• Backpain, worsens with extensions, improves
with flexion (lumbar spinal stenosis)
• Bilateral postural or kinetic tremor
• Spasticity, hyperreflexia, bladder instability(
myelopathy from cervical spondylosis/ vitamin B
deficiency)
• Bradykinesia: slowness of movement, rigidity,
tremor (parkinsons)
6. Associated Signs and Symptoms of
Conditions causing gait and balance
disorders
• Chest pain or dyspnea: SOB on exertion, palpitation
(Arythmia, CHF (congestive heart failure), cad
(coronary heart disease))
• Cognitive impairement, focal motor/sensory deficits,
increased reflexes or tone, unilateral weakness (stroke,
vascular dementia)
• Cognitive impairment, poor judgement (alzheimers
disease, dementia)
• Dementia, parkinsonism (hydrocephalus: an increase
in ICP due to accumulation of CSF)
• Dizziness, vertigo (medication adverse effects,
vestibular)
7. Associated Signs and Symptoms of
Conditions causing gait and balance
disorders
• Joint deformities or decreased range of motion,
joint pain or buckling (osteoarthritis)
• Kyphosis, shortened stature (osteoporosis)
• Lightheadedness with head turning (carotid
sinus hypersensitivity)
• Lightheadedness with sudden rise from a sitting
or supine position, relieved with sitting
(orthostatic hypotension, medication adverse
effects)
• Proximal muscle weakness (hypothyroidism)
8. Associated Signs and Symptoms of
Conditions causing gait and balance
disorders
• Recent hospitalization, sedentary lifestyle
(deconditioning)
• Sensory loss, paresthesias (peripheral neuropathy)
• Vision changes (cataracts, glaucoma, macular
degeneration, poor visual acuity)
• Hard of hearing (cerumen impaction, sensory neural
deafness)
• History of falls with head trauma (subdural hematoma)
• Involuntary movements, use of antipsychotic (tardive
dyskinesia)
9.
10. Balance and MS
• 75% of people with MS report issues with
• Motor System Effects
– Increased BOS, reduced functional reach, reduced
gait speed/stride length, increased double stance
time, reduction in ankle range, reduction in gait
velocity, increased sway in stance with feet
together
– ASSESSMENT: berg, dynamic gait index, timed up
and go test, activities specific balance confidence
scale
11. Balance and MS
• Somatosensory system: unclear
– Likely have decreased proprioception?
– ASSESSMENT: sensory testing of light/deep touch,
passive movement and joint position sense,
vibration sense, and temperature sense
12. Balance and MS
• Vestibular System:
– Can lead to vertigo, unstable gaze during head movement, gait ataxia,
– An MS lesion may produce vertigo mimicing an acute peripheral
vestibular defect (BPPV)
– Vertigo in MS: is multi causational and reported to be 20% of people
with MS
– ASSESSMENT: assessment/questioning of vestibular systems is
warranted in order to determine central vs. peripheral (BPPV)
vestibular issues
• Peripheral vertigo: fatigable nystagmus
• Central vertigo symptoms are longer lasting, provoked in many head/body
movements
• Snellen chart: if have greater than a 2 line difference for readings between
stationary and oscillating head movement, more likely to have a vestibular
defect……
13. Balance and MS
• Visual System:
– May be damaged during MS disease process: optic
neuritis, visual field defects, saccadic eye movement
– Optic neuritis is vision loss with or without pain (20% of
MS patients) can result in visual field losses
– May or may not recover visual field loss
– People with MS often rely on vision to compensate for lack
of proprioceptive information on their body positioning
– ASSESSMENT: many symptoms only evident with special
equipment….. PT can identify visual dysfunction during
subjective examination and by administering a self-
reported questionnaire
Editor's Notes
Source= Journal of American Academy of Family Physicians, Note: This source was for older adults…….
Bladder instability: spontaneous and uncontrolled urine leakage, often accompanied by overwhelming sense of needing to voidMyelopathy: general term for pathology of spinal cord
Vascular dementia: general term describing problems with reasoning, planning, judgement, memory and other thought processes caused by impaired blood flow to the brain
Cerumen impaction: build up of layers of earwax within ear canal to the point of blocking the canal and putting pressure on eardrumTardivedyskinesia: disorder resulting in involuntary movements that have a slow or belated onset……..- usually occurs if individual on anti-psychotic drugs
Vertigo: need to differentiate from other things that could cause
Source: balance for people with multiple sclerosis (australian journal)
