Department of Family and Community Medicine, Toronto Western Hospital, 399 Bathurst St, 2W-404, Toronto, ON M5T 2S8.
Can Fam Physician. 2011 Jul;57(7):765-70.
To provide family physicians with an approach to office management of gait disorders in the elderly.
Ovid MEDLINE was searched from 1950 to July 2010 using subject headings for gait or neurologic gait disorders combined with physical examination. Articles specific to family practice or family physicians were selected. Relevant review articles and original research were used when appropriate and applicable to the elderly.
Gait and balance disorders in the elderly are difficult to recognize and diagnose in the family practice setting because they initially present with subtle undifferentiated manifestations, and because causes are usually multifactorial, with multiple diseases developing simultaneously. To further complicate the issue, these manifestations can be camouflaged in elderly patients by the physiologic changes associated with normal aging. A classification of gait disorders based on sensorimotor levels can be useful in the approach to management of this problem. Gait disorders in patients presenting to family physicians in the primary care setting are often related to joint and skeletal problems (lowest-level disturbances), as opposed to patients referred to neurology specialty clinics with sensory ataxia, myelopathy, multiple strokes, and parkinsonism (lowest-, middle-, and highest-level disturbances). The difficulty in diagnosing gait disorders stems from the challenge of addressing early undifferentiated disease caused by multiple disease processes involving all sensorimotor levels. Patients might present with a nonspecific "cautious" gait that is simply an adaptation of the body to disease limitations. This cautious gait has a mildly flexed posture with reduced arm swing and a broadening of the base of support. This article reviews the focused history (including medication review), practical physical examination, investigations, and treatments that are key to office management of gait disorders.
Family physicians will find it helpful to classify gait disorders based on sensorimotor level as part of their approach to office management of elderly patients. Managing gait disorders at early stages can help prevent further deconditioning and mobility impairment.
为家庭医生提供一种针对老年人步态障碍的门诊管理方法。
通过主题词“步态或神经步态障碍”与体格检查相结合，在 Ovid MEDLINE 上进行了从 1950 年到 2010 年 7 月的检索。选择了专门针对家庭实践或家庭医生的文章。在适当和适用于老年人的情况下，使用了相关的综述文章和原始研究。
老年人的步态和平衡障碍在家庭实践环境中难以识别和诊断，因为它们最初表现为微妙的未分化表现，并且由于原因通常是多因素的，多种疾病同时发生。为了使问题进一步复杂化，这些表现可以被与正常衰老相关的生理变化所掩盖。基于感觉运动水平的步态障碍分类在处理该问题的方法中可能是有用的。在初级保健环境中向家庭医生就诊的患者的步态障碍通常与关节和骨骼问题有关（最低水平障碍），而不是向神经病学专业诊所转诊的患者，他们患有感觉共济失调、脊髓病、多发性中风和帕金森病（最低、中、最高水平障碍）。诊断步态障碍的困难源于解决由涉及所有感觉运动水平的多种疾病过程引起的早期未分化疾病的挑战。患者可能表现出一种非特异性的“谨慎”步态，这只是身体对疾病限制的一种适应。这种谨慎步态具有轻度弯曲的姿势，减少了手臂摆动，并扩大了支撑基础。本文回顾了有助于对步态障碍进行分类的重点病史（包括药物回顾）、实用体格检查、检查和治疗，这些是步态障碍门诊管理的关键。
家庭医生将发现根据感觉运动水平对步态障碍进行分类有助于他们对老年患者进行门诊管理。在早期阶段管理步态障碍有助于防止进一步的失健和活动能力受损。
