What is functional gait disorder?

Functional gait disorders involve the presence of movements or positions of parts of the body due to the malfunctioning of the nervous system (not associated with organic damage to the nervous system). Various types of gait disorders are a type of functional disorders.

The most common types of functional gait disorders are:

• Dragging gait (functional weakness). One of the most common FGDs is leg dragging, which occurs in patients with functional weakness in one leg. People with this type of gait disorder report that their foot is dragging along the ground. Often, it doesn’t look as dramatic. The foot is often turned inward or outward. Some note that their foot feels as if it is magnetized to the ground.
• Sudden bending of the knees. This type of gait disorder is usually found in functional weakness in one or both legs. Sometimes, when both knees bend at the same time, a drop attack occurs. However, it is essential to recognize other causes of this condition, such as knee problems.
• Small slow steps, as if on ice. This is mainly an unstable gait when a person takes small steps, almost like walking on ice. At the same time, the legs are tense, and the feet are far apart from each other. Usually, the reason for this gait is that the person has had a fall episode and is now afraid of repetition.
• Swinging (oscillating) gait. In this type of gait disorder, the person sways from side to side, especially the upper body, and the legs correct these movements. The person seems to be about to fall, but then he holds himself back.
• Hyperkinetic gait. Functional movement disorders can sometimes cause excessive dramatic movements in the arms, legs, or trunk, which some may experience while walking.
• Squat gait. This is a rare form of FGD in which the person appears to squat. Often associated with fear of falling. Functional disorders of standing (astasia). With these disorders, the person has problems with standing but can walk normally. Astasia can be diagnosed if the symptoms go away when the patient is distracted (playing games on the phone or guessing the numbers written on his back).

How are functional gait disorders diagnosed?

A neurologist usually diagnoses FGD. Diagnosis is not an easy task and requires detailed knowledge of all neurology diseases with movement disorders, many of which are unusual and even eccentric. Even a neurologist must be especially careful when diagnosing FGD. The error rate in the diagnosis of FGD in neurology is significantly higher than in other gait disorders.

Features to help diagnose functional gait disorders:

• Identifying positive signs of functional tremor or functional weakness in the limbs
• Frequent side steps (retreats) and other uneconomical gaits (require more energy than normal)
• Better gait when walking backward
• Improving gait when changing speed and rhythm of movement
• Improving gait when listening to music
• Balance problems while standing are reduced when the person is distracted by other tasks, such as guessing the numbers written on their back and playing on their mobile phones.

Psychotherapy is an essential component in treating functional gait disorders (the specialist must be well-versed in functional disorders). Some therapies may seem a little unusual and strange, but they are all aimed at helping the brain return to its normal automatism of movements. Correct diagnosis is essential to the success of FGD treatment.

If you doubt your diagnosis, you will be reluctant to use the methods listed below.

• Try humming a song (you can do it in your head) as you walk. Is it easier for you to walk after that?
• Try to walk backward. Walking like this is a different program in your head, and you will be surprised how much easier it is than walking.
• Run. Sometimes, light jogging allows you to move more easily. This phenomenon is observed in patients with stuttering who manage to sing normally.
• If you are trying to start walking and cannot, try to stand up straight and shift your weight from one leg to the other for a few minutes.

Why is there an imbalance or gait disorder?

There can be many causes of imbalance and gait disturbances, as they can develop from many different underlying conditions. When it comes to balancing disorders, many are associated with problems in the vestibular system, which is a delicate collection of fluid-filled chambers and sensory nerves located in the inner ear and thousands of nerve receptors in joints throughout the body. The vestibular system is responsible for your sense of position, also known as proprioception.

Some common vestibular conditions leading to gait disorders include:

• Injury or discomfort. Even if your brain and nervous system are working in harmony, sudden injury, illness, or another ailment that causes muscle weakness can upset your balance and make it difficult to maintain balance.
• Neurological problems. This can include Parkinson’s disease, brain injury, or stroke. Anything that affects your neurological system can also affect your balance.
• Benign paroxysmal positional vertigo. It happens when calcium debris breaks down in the inner ear, causing balance problems.

What diseases cause functional gait disorders?

The main coordinators of normal gait and balance are the person’s eyes and inner ear. Accordingly, poor eyesight, infectious diseases of these organs, and neurology often disturb the balance and, as a result, change its gait. The use of alcoholic beverages, narcotic drugs, uncontrolled intake of medications, including sedatives, also takes note of the last place among the causes of disturbed gait.

Any pathology in the nervous and muscular system of a person can lead to gait disorders. First of all, we are talking about the infringement of intervertebral discs.

If we talk about more severe causes of gait disorders, such diseases as multiple sclerosis, amyotrophic lateral sclerosis, muscular dystrophy, and Parkinson’s disease come to the fore.

Several different diseases are associated with gait disturbances.

• Spastic hemiparesis causes a hemiplegic gait. In such a violation, the patient has a change in the position of the upper and lower extremities relative to the body. The elbow, wrist, fingers are bent, the shoulder is turned inward, the leg in the joints – knee, hip, and ankle – is unbent. In milder cases, the arm is in a normal position, but its ability to move when walking is still limited.
• Paraparetic gait can be observed in people with varying degrees of spinal cord injury and cerebral palsy.
• Limited flexion of the foot from the dorsum causes the gait with the very sonorous name of the cock. Due to the complete or partial dangling of the foot during the step, the toes touch the surface, and the person should raise the leg as high as possible to avoid this.
• Weakness in the proximal muscles of the leg, which occurs with myopathies and spinal amyotrophy, causes a person to walk waddling from side to side. This gait disorder is called the duck gait.
• The following signs can recognize parkinsonian (akinetic-reticular) gait: the patient’s back is bent, their legs are bent, and their arms are bent while resting tremors can occur. The patient begins to move by leaning forward. While walking, a person makes mincing steps that make a shuffling sound.
• Apraxic gait can usually be observed in patients with bilateral frontal lobe lesions. Symptoms of gait disturbances, in this case, are very similar to parkinsonian, but there are several differences. The patient is easily given some of the movements that make up walking while they can lie or stand. But as soon as one has to start walking, a person is not able to do it. Finally, having moved forward, the patient stops again. Such attempts to move are repeated several times.
• Choreoathetosis gait is characterized by a violation of the walking process by abrupt, as if through force, movements.
• Legs set wide to the side, different in length and speed; steps are signs of cerebellar gait. A patient with this disorder is still able to remain in balance by closing and opening their eyes. However, as soon as they change their posture, the balance is immediately lost.
• Sensory ataxia in this gait disorder exhibits symptoms similar to cerebellar gait. They differ in that the patient loses their balance, barely closing their eyes.
• If a person falls on one side while walking, we are talking about vestibular ataxia.
• Hysteria is also often accompanied by gait disorders. The simultaneous manifestation of disturbances in balance and walking is typical. To stand without outside help, and even more so to move, a person suffering from hysteria is simply not able to.

In cases where a person has a gait disturbance, they should seek help from an orthopedist, neurologist, traumatologist, or ENT specialist. It all depends on the symptoms of gait disturbance and, of course, the reasons for its occurrence. It is necessary to undergo a detailed examination and thorough diagnosis to determine what caused the gait disturbance.