Why does one feel unsteady, unsteady, or dizzy when walking: possible causes and treatment for an unsteady, slow gait. How to get rid of a shaky, uncertain gait: medicine, vestibular gymnastics

Violations and their causes in alphabetical order:

gait disturbance -

Walking- one of the most complex and at the same time common types of physical activity.

Cyclic walking movements trigger the lumbosacral centers of the spinal cord and regulate the cerebral cortex, basal ganglia, brain stem structures and cerebellum. This regulation involves proprioceptive, vestibular and visual feedback afferentation.

Gait The human brain is a harmonious interaction of muscles, bones, eyes and inner ear. The coordination of movements is carried out by the brain and the central nervous system.

If there are disturbances in certain parts of the central nervous system, various movement disorders may occur: a shuffling gait, sudden jerking movements, or difficulties in bending joints.

Abasia(Greek ἀ- prefix with the meaning of absence, non-, without- + βάσις - walking, gait) – also dysbasia– disturbance of gait (walking) or inability to walk due to gross gait disturbances.

1. In a broad sense, the term abasia means gait disturbances with lesions involving various levels of the system of organizing the motor act, and includes such types of gait disturbances as ataxic gait, hemiparetic, paraspastic, spastic-atactic, hypokinetic gait (with parkinsonism, progressive supranuclear paralysis and other diseases), apraxia of walking (frontal dysbasia), idiopathic senile dysbasia, peroneal gait, duck gait, walking with pronounced lordosis in the lumbar region, hyperkinetic gait, gait in diseases of the musculoskeletal system, dysbasia in mental retardation, dementia, psychogenic disorders, iatrogenic and drug dysbasia, gait disturbances in epilepsy and paroxysmal dyskinesia.

2. In neurology the term is often used astasia-abasia, with integrative sensorimotor disorders, more often in the elderly, associated with a violation of postural or locomotor synergies or postural reflexes, and often a variant of imbalance (astasia) is combined with a walking disorder (abasia). In particular, frontal dysbasia (gait apraxia) is distinguished with damage to the frontal lobes of the brain (as a result of stroke, dyscirculatory encephalopathy, normal pressure hydrocephalus), dysbasia in neurodegenerative diseases, senile dysbasia, as well as gait disturbances observed during hysteria (psychogenic dysbasia).

What diseases cause gait disturbance:

A certain role in the occurrence of gait disorders belongs to the eye and inner ear.

Older people with deteriorating vision develop gait disturbances.

A person with an inner ear infection may exhibit balance problems that lead to disturbances in their gait.

One of the common sources of gait disturbances is functional disorders of the central nervous system. These may include conditions associated with sedatives, alcohol, and drug abuse. Poor nutrition appears to play a role in the development of gait disturbances, especially in older people. Vitamin B12 deficiency often causes numbness in the limbs and poor balance, leading to changes in gait. Finally, any disease or condition that affects nerves or muscles can cause gait disturbances.

One such condition is a pinched disc in the lower back. This condition is treatable.

More serious disorders that cause gait changes include amyotrophic lateral sclerosis (Lou Gehrig's disease), multiple sclerosis, muscular dystrophy, and Parkinson's disease.

Diabetes often causes loss of sensation in both legs. Many people with diabetes lose the ability to determine the position of their legs in relation to the floor. Therefore, they experience postural instability and gait disturbances.

Some diseases are accompanied by gait disturbances. If there are no neurological symptoms, the cause of the gait disorder is difficult to find out even for an experienced doctor.

Hemiplegic gait is observed with spastic hemiparesis. In severe cases, an altered position of the limbs is characteristic: the shoulder is adducted and turned inward, the elbow, wrist and fingers are bent, the leg is extended at the hip, knee and ankle joints. The step with the affected leg begins with abduction of the hip and movement in a circle, while the body deviates in the opposite direction (“the hand asks, the leg squints”).
With moderate spasticity, the position of the arm is normal, but its movements in time with walking are limited. The affected leg bends poorly and is turned outward.
Hemiplegic gait is a common residual disorder after stroke.

With a paraparetic gait, the patient moves both legs slowly and tensely, in a circle - the same as with hemiparesis. Many patients have legs that cross like scissors when walking.
Paraparetic gait is observed with spinal cord lesions and cerebral palsy.

Cock gait is caused by insufficient dorsiflexion of the foot. When stepping forward, the foot partially or completely hangs down, so the patient is forced to raise his leg higher - so that the toes do not touch the floor.
Unilateral disorder occurs with lumbosacral radiculopathy, neuropathy of the sciatic nerve or peroneal nerve; bilateral - for polyneuropathy and lumbosacral radiculopathy.

The duck gait is explained by the weakness of the proximal muscles of the legs and is usually observed with myopathies, less often with lesions of the neuromuscular junction or spinal amyotrophy.
Due to weakness of the hip flexors, the leg is lifted off the floor due to the tilt of the torso, the rotation of the pelvis promotes the movement of the leg forward. Weakness of the proximal leg muscles is usually bilateral, so the patient walks in a waddling manner.

With a parkinsonian (akinetic-rigid) gait, the patient is hunched over, his legs are bent, his arms are bent at the elbows and pressed to the body, and a pronation-supination rest tremor (with a frequency of 4-6 Hz) is often noticeable. Walking begins by leaning forward. Then follow mincing, shuffling steps - their speed steadily increases, as the body “overtakes” the legs. This is observed when moving both forward (propulsion) and backward (retropulsion). Having lost balance, the patient may fall (see "Extrapyramidal disorders").

Apraxic gait is observed with bilateral damage to the frontal lobe due to impairment of the ability to plan and execute a sequence of actions.

Apraxic gait resembles Parkinsonian gait - the same “supplicant pose” and mincing steps - however, upon detailed examination, significant differences are revealed. The patient easily performs the individual movements necessary for walking, both lying and standing. But when he is asked to go, he cannot budge for a long time. Having finally taken a few steps, the patient stops. After a few seconds, the attempt to walk is repeated.
Apraxic gait is often associated with dementia.

With choreoathetotic gait, the rhythm of walking is disrupted by sudden, violent movements. Due to chaotic movements in the hip joint, the gait looks “loose.”

With a cerebellar gait, the patient places his legs wide apart, the speed and length of steps change all the time.
When the medial zone of the cerebellum is damaged, a “drunk” gait and ataxia of the legs are observed. The patient maintains balance both with open and closed eyes, but loses it when the position changes. The gait may be fast, but it is not rhythmic. Often, when walking, the patient experiences uncertainty, but this goes away if he is at least slightly supported.
When the cerebellar hemispheres are damaged, gait disturbances are combined with locomotor ataxia and nystagmus.

The gait with sensory ataxia resembles a cerebellar gait - legs widely spaced, loss of balance when changing position.
The difference is that when the eyes are closed, the patient immediately loses balance and, if not supported, may fall (instability in the Romberg position).

Gait of vestibular ataxia. With vestibular ataxia, the patient always falls to one side - regardless of whether he is standing or walking. There is obvious asymmetrical nystagmus. Muscle strength and proprioceptive sensation are normal - in contrast to unilateral sensory ataxia and hemiparesis.

Gait during hysteria. Astasia - abasia is a typical gait disorder during hysteria. The patient has preserved coordinated movements of the legs, both lying and sitting, but he cannot stand or move without assistance. If the patient is distracted, he maintains his balance and takes several normal steps, but then defiantly falls - into the hands of the doctor or onto the bed.

Which doctors should you contact if gait disturbance occurs:

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Is your gait impaired? It is necessary to take a very careful approach to your overall health. People don't pay enough attention symptoms of diseases and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of the disease. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to do it several times a year. be examined by a doctor, in order not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the organism as a whole.

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Unsteadiness of gait can be both a sign of problems with the musculoskeletal system and a symptom of pathologies in the central, peripheral nervous system, and blood vessels. This often affects older people. Therefore, when it appears, you should consult a doctor who will find out the cause of instability when walking.

Causes of unsteady gait

Walking is carried out thanks to the coordinated work of the muscles of the whole body. They are controlled by the nervous system by releasing special neurotransmitter substances such as acetylcholine. In some diseases, normal motor activity is disrupted and movements become erratic.

The main causes of unsteady gait:

1. Diseases of the musculoskeletal system: problems with muscles, joints, tendons, bones.
2. Pathologies of the spinal cord, brain, including the cerebellum, subcortical nuclei, extrapyramidal system and pyramidal tract.
3. Ischemic or hemorrhagic strokes.
4. Deficiency of vitamins B12, B1, folate.
5. Multiple sclerosis, myasthenia gravis.
6. Traumatic brain injuries: concussions, bruises.
7. Tumors of the brain or the eighth pair of cranial nerves.
8. Thrombarteritis obliterans, varicose veins.
9. Drug and alcohol intoxication.
10. Uncomfortable shoes and clothes.
11. Fainting.

There are many diseases in which the coordinated work of the leg muscles is disrupted.

It is useful to know how the main symptoms of cerebellar damage are related.

All about the consequences of defeat and: diagnosis and treatment of disorders.

Musculoskeletal problems

Diseases of the osteochondral system: arthritis, arthrosis, osteochondrosis, osteomyelitis can cause staggering when walking. With inflammation and degenerative changes in the knee and hip joints due to pain, a person is forced to reduce the load on the injured limb. Therefore, the movements become asymmetrical.

Unsteadiness of gait in osteochondrosis is caused by pinching of efferent and afferent fibers going to and from the legs. There may be a disturbance in their sensitivity or weakening of the muscles due to pinched nerves.

Muscle weakness may occur after the cast is removed from the fracture site. Since the affected limb did not participate in movement and the muscles on it atrophied, asymmetry and unsteadiness occur when walking.

Traumatic muscle paralysis, sprains and tendon ruptures are common causes of unsteady gait in both children and adults, as well as the elderly.

Brain pathologies

It is in the brain that there are centers that provide motor acts when walking. When their activity is disrupted, a person loses stability and his gait becomes unsteady.

Coordination of movements is regulated by the cerebellum, as well as the extrapyramidal and pyramidal systems. The cerebral cortex transmits impulses to the underlying sections along the pyramidal pathways.

Injuries to the base of the skull often damage the cerebellum. Ataxia is one of the causes of unsteadiness when walking. Along with this, a person after a TBI loses his sense of balance and nystagmus appears (involuntary movements of the eyeballs). Nausea and vomiting, sometimes a short-term unconsciousness, are also characteristic.

The cerebellum can be affected by genetic abnormalities, autoimmune processes, inflammation, and circulatory disorders.

Pathologies of the extrapyramidal system manifest themselves with chorea, hyperkinesis, and tremor. These diseases are included in the list of reasons why a person staggers when walking. Accumulation of copper in the subcortical nuclei during hepatolenticular degeneration (Konovalov's disease) gives similar symptoms.

Birth injuries, cerebral palsy

Cerebral palsy can result in both (or one) lower limbs being paralyzed or a specific muscle group being affected by spasm. Then the person also staggers when walking. Cerebral palsy is caused by intrauterine hypoxia or birth trauma.

Vitamin deficiency

Vitamin B12 is necessary for the proper functioning of the central nervous system and spinal cord. With diseases of the digestive tract, helminthic infestations, and unbalanced nutrition, its lack leads to a rooster gait. Vitamin B1 and folic acid also affect the functions of the central and peripheral nervous systems.

Acoustic neuroma

This is a tumor on the nerve that leads to disruption of the functioning of the vestibular apparatus. In addition, nausea and dizziness at rest may occur. Movements change and their coordination becomes disrupted, as the sense of the body in space is lost.

Multiple sclerosis, myasthenia gravis

– disruption of the conduction of nerve fibers, both motor and sensory, due to scar changes. In this case, spastic or flaccid paralysis of the limbs occurs, which leads to unsteadiness of the body.

Myasthenia gravis is an autoimmune disease caused by the production of antibodies against acetylcholine, a mediator that ensures muscle movement. A mild course of the disease leads to muscle weakness, rapid fatigue, and instability when walking.

Vascular problems

Vasculitis, diabetic arterial disease, venous diseases lead to swelling, pain in the lower extremities, and as a result, an asymmetrical desynchronized gait.

All about: causes, symptoms, treatment.

A note about: causes of occurrence and treatment tactics.

It is important to understand what they are depending on the location of the lesion.

Diagnosis and treatment

MRI, CT, EEG are examination methods for identifying pathologies of the central nervous system. An examination by a neurologist or orthopedic surgeon is necessary. The treatment strategy for unsteady gait depends on its causes. This is done by a neuropathologist and surgeon. Treatment tactics:

1. In cerebral palsy, spastic paralysis of the legs is corrected by cutting the tendons of these muscles.
2. Multiple sclerosis and myasthenia gravis are treated with glucocorticoid hormones, immunosuppressants that suppress autoimmune reactions.
3. Flaccid paralysis is corrected with the help of cholinesterase inhibitors: Neostigmine, Kalimina.
4. B complex vitamins (Neuromultivit, Milgamma, Combilipen) are used to support the nervous system.
5. Treatment of osteochondrosis, arthrosis, and arthritis includes physical therapy. Patients take chondroprotectors (injections of Mucosat, Dona). Muscle relaxants and mineral complexes are prescribed.

Conclusion

How to treat unsteadiness of gait is decided by a neurologist or orthopedic surgeon. It all depends on the cause of the disorder in the motor function of the lower extremities. To clarify it, an examination by specialized specialists and instrumental examinations are necessary.

Walking dysbasia or gait disturbance - causes of unsteadiness in older people

Balance and gait disorders are relatively common phenomena, also called unsteadiness of gait.

Walking dysbasia occurs more often in older people with deteriorating vision.

This condition is caused by various diseases, alcoholic beverages, drugs, and sedatives.

The appearance of gait disturbances in some cases is associated with infections of the inner ear.

Symptoms of gait dysbasia

The name of the disease contains the Greek prefix dys, meaning “disturbance.” A typical manifestation of the disease is gait asymmetry.

For example, a person takes a normal step with his leading leg, and then slowly pulls up the second. Difficulties may arise at the very beginning of the movement.

The patient cannot lift his feet off the floor, he stomps in one place and takes small steps.

Common symptoms of dysbasia:

• inability to bend the leg joints normally;
• constant collisions with objects around;
• difficulties in performing turns;
• difficulty walking up stairs;
• feeling of stiff muscles;
• stumbling, falling;
• muscle weakness;
• trembling in the legs.

Similar symptoms can occur when blood vessels are damaged and connections between brain structures (BM) are disrupted. More bizarre gait changes are associated with hysteria.

This is walking in a zigzag, sliding movements, half-bent legs. Joint diseases are often manifested by a slow, unsteady gait and shortened stride.

Causes of the disease

Two main groups of factors that lead to gait dysbasia are anatomical and neurological.

Diseases of the musculoskeletal system, brain and spinal cord cause gait disturbances.

Thus, based on a disorder of vascular innervation, angioedema occurs.

Lesions of the intervertebral disc in the lower back also affect gait.

Anatomical reasons

Anatomical causes of gait dysbasia:

1. excessively inwardly rotated femur;
2. lower limbs of unequal length;
3. congenital dislocations of the legs.

Most often, dysbasia appears in various diseases of the central nervous system.

Shaking paralysis, muscular dystrophy, sclerosis are serious lesions in which walking is often impaired.

The same effect occurs with the abuse of alcohol, sedatives, and drug use.

Neurological causes of dysbasia

Neurological causes of dysbasia:

• damage to the sheaths of nerve fibers of the GM and SC (sclerosis);
• peroneal nerve palsy of the lower limb;
• shaking palsy or;
• circulatory disorders in the vessels of the brain;
• functional disorders in the cerebellum;
• pathologies of the frontal lobe of the brain;
• cerebral palsy.

A deficiency of vitamin B12 in the body leads to a feeling of numbness in the limbs.

As a result, a person cannot determine the position of his feet in relation to the floor surface.

Diabetes mellitus worsens balance problems due to decreased sensation in the lower extremities.

Types of dysbasia

A cautious, shuffling gait and difficulty maintaining balance are the most common symptoms of gait dysbasia.

There are other manifestations, on the basis of which experts distinguish several types of violations.

Ataxia is a violation of the coordination of muscle movements. The sick person staggers when walking and cannot move without assistance.

There are several causes of ataxia, one of the main ones is damage to the cerebellum. The coordination of muscle movements is disrupted in vestibular disorders.

Frontal dysbasia

The sick person partially or completely loses the ability to walk.

Such disorders appear with extensive damage to the frontal lobes of the brain. This type of dysbasia is often accompanied by,.

Hemiparetic gait (“squinting”)

The victim has difficulty lifting the affected leg from the surface and moving it forward, performing an outward circular movement with the limb.

The person tilts his body in the opposite direction. Hemiparetic gait occurs with injuries, tumors of the cerebral and spinal cord.

Hypokinetic gait (“shuffling”)

The patient stomps on the spot for a long time, then makes slow, stiff movements of his legs.

The body posture is tense, steps are short, turns are difficult. The causes can be many diseases and syndromes.

"Duck" gait

Muscle weakness, paresis, congenital hip dislocations are the main causes of difficulty in lifting the leg and moving forward.

The patient tries to carry out such actions by turning the pelvis and tilting the body.

The pathology usually occurs in both limbs, so a person’s gait resembles the movement of a duck - the body waddles to the left and then to the right.

The fact is that walking dysbasia is characterized by a variety of symptoms and causes.

This makes it difficult to choose which doctor the patient should see first.

You will need the help of a neurologist, traumatologist, or surgeon. Sometimes consultations with an endocrinologist, otolaryngologist or ophthalmologist are needed.

When a patient has dysbasia, a neurologist uses various diagnostic techniques.

The patient is prescribed a study of the cerebrospinal fluid, x-ray, CT, MRI, ultrasound. You need to take general and biochemical blood tests.

Treatment of walking disorders

Medications can help relieve pain.

Complex treatment will be required, long-term and requiring persistence on the part of the patient.

Piracetam - a remedy for dysbasia

The course of therapy often includes massage, therapeutic exercises, and physiotherapy.

Drug treatment of dysbasia:

1. Piracetam is a nootropic drug. Improves microcirculation and metabolism in neurons. An analogue of the active substance is the drug Memotropil;
2. Tolperisone is a muscle relaxant. Reduces pain in the area of ​​peripheral nerve endings, eliminates increased muscle tone;
3. Mydocalm - tolperisone in combination with lidocaine (local anesthetic);
4. Tolpecaine is a muscle relaxant and local anesthetic;
5. Ginkoum is an angioprotector of plant origin. Reduces permeability and normalizes metabolic processes in the vascular wall.

Conclusion

Walking dysbasia occurs in many dangerous diseases.

It is necessary to undergo an examination as early as possible so that specialists can establish the causes, type of walking impairment and prescribe adequate treatment.

The course of therapy is long and includes the use of nootropic drugs, muscle relaxants and angioprotectors.

Video: How to fix a duck walk

Walking is a biomechanical process that involves both the muscles, joints and bones of a person, as well as his nervous system. Therefore, a violation of even one of the systems leads to quite significant changes in walking.

Joint disorders

Duck walk. With it, a person shifts from one leg to another. This gait occurs with congenital dislocation, pelvic distortion, or loss of mobility in the hip joint (hip dysplasia). In this case, the person tries to spare the sore leg and move the healthy leg more.

Compass. When walking, your knees do not bend. Pain in the knee joints leads to the fact that over time a person gets used to walking like this. The cause may be arthrosis or valgus deformity of the knees (X-shaped curvature of the legs).

Small steps cause long periods of walking in high heels. In this case, the joints and bones of the thumbs are deformed.

Sometimes people walk with caution, trying not to turn their heads. This happens with cervical osteochondrosis, when the muscles of the neck and shoulders are tense, as well as with severe headaches and migraines.

Nervous disorders

If a person walks hunched over on half-bent legs with mincing shuffling steps, while the body is tilted forward, and the legs seem to lag behind him, then he most likely has Parkinson's disease.

Overly nervous step, when a person is all “on hinges,” then this is a sign of neuroses. On the contrary, low hand mobility and retardation of movements indicate serious psychological disorders, including schizophrenia.

The inability of a person to move in the dark indicates sensory-motor disorders, and the gait of a “drunk person” can indicate not only intoxication, but also a disorder of the cerebellum.

Vascular disorders

Intermittent claudication is a disease of smokers, which is caused by spasms of the peripheral vessels of the lower extremities. Due to poor circulation in the legs, a person gets tired quickly. After walking 100-200 meters, the step deteriorates and the person must stop in order to go further.

Uncertainty when walking, unsteadiness, frequent falls and constant search for support indicate a disorder of the brain. In turn, the causes of these disorders may be vascular disorders of a discirculatory nature, which are typical for older people.

If a person walks with one leg puts it normally, but drags the second one, describing an arc to it, then most likely he had a cerebral hemorrhage.

Unsteady position when walking Poor blood supply to the lower extremities may also occur due to varicose veins, diabetes mellitus or atherosclerosis of the lower extremities.

Biomechanical disorders

Lameness occurs when the leg is anatomically shortened, that is, when one leg is shorter than the other. The causes may be a congenital feature, trauma, fractures, as well as osteomelitis. Also, a lame gait can develop due to functional shortening of the leg. Here, the culprits are usually scoliosis, hip dysplasia, pelvic distortion, arthritis or arthrosis.

See a doctor urgently!

Psychologists say that an ugly gait caused by illness directly affects the feeling of self-confidence and creates additional psychological complexes. With the correct gait, a person’s entire system works in harmony and nothing hurts. Incorrect gait, not associated with serious illnesses, is corrected with the help of gymnastics and special devices. Therefore, it is recommended to consult a doctor and stay healthy physically and psychologically.