Gait and Balance Problems Health Article

Cerebellar lesions

Cerebellar lesions are one cause of disturbed balance. Depending upon the area affected, the disturbance may be slight or severe. The cerebellum also contains proprioceptive feedback loops, in addition to receiving input from the spinal cord. When these areas are affected, the postural changes that take place affect balance. It is very common to find gait problems in conjunction with cerebellar lesions; in one study, 60% of patients with cerebellar problems displayed ataxic gait, which resembles intoxicated gait.

Basal ganglia dysfunction

The basal ganglia are three nuclei at the base of the cerebral cortex. It appears that the basal ganglia play a large role in preparing an individual for motion. This may include preparing the cortex, setting postural reflexes, and organizing sensory input. When there is dysfunction in this area, such as in Parkinson's or Huntington's disease, disturbances in central sensory processing, along with rigidity and akinesia (inability to move), contribute to postural instability and gait difficulties.

Hemiplegia

Hemiplegia (paralysis of one side of the body) as a result of a cerebrovascular accident, or stroke, is also a common cause of balance and gait difficulties. Loss of trunk control results in the inability to maintain weight evenly over the pelvis. In the early stages of recovery, along with upper extremity dysfunction, lower extremity positioning in standing may be marked by pelvic depression, hip and knee flexion (decreasing the angle of the joints), and ankle plantarflexion on the affected side. Later, extensor patterns (increasing the angle of the joints) become more available, and the pelvis may be elevated, with the knee hyperextended and ankle plantarflexed. Sensory loss may manifest itself in many ways, from loss of discrimination and localization to complete neglect of the affected side. All of these factors contribute to balance and gait problems due to inadequate sensory processing, musculoskeletal tightness or weakness, and/or cognitive deficits.