Phenomenology of Gait and Balance

  • Steven J. FruchtEmail author
  • Pichet Termsarasab


Evaluation of gait is a critical part of the movement disorders examination. In addition to parkinsonian gait, balance and walking impairment in Huntington’s disease, and truncal dystonia, normal pressure hydrocephalus and functional gait disorders present clinical challenges for the clinician.


Lower body parkinsonism Normal pressure hydrocephalus Functional gait disorder Astasia-abasia 

Supplementary material

Video 13.1

Gait disorders accompany many of the primary movement disorders, and the gait disorder of PD (Chap.  3), atypical parkinsonism (Chap.  4), posthypoxic myoclonus (Chap.  5), Huntington’s disease and neuroacanthocytosis (Chap.  7), orthostatic tremor (Chap.  8), truncal dystonia (Chap.  9), and ataxia (Chap.  10) are covered elsewhere. In this video segment, we focus principally on two other conditions that affect gait, normal pressure hydrocephalus, and functional movement disorders (MP4 1420773 kb)


  1. 1.
    Jankovic J, Nutt JG, Sudarsky L. Classification, diagnosis, and etiology of gait disorders. Adv Neurol. 2001;87:119–33.PubMedGoogle Scholar
  2. 2.
    Napier J. The antiquity of human walking. Sci Am. 1967;216(4):56–66. Scholar
  3. 3.
    Jackson JH. In: Taylor J, Holmes G, Walshe FMR, editors. Selected writings of John Hughlings Jackson, Vol. 2. London: Hodder and Stoughton; 1932.Google Scholar
  4. 4.
    Nutt JG, Marsden CD, Thompson PD. Human walking and higher-level gait disorders, particularly in the elderly. Neurology. 1993;43(2):268–79. Scholar
  5. 5.
    Bruns L. Uber storungen des gleichgewichtes bei stirnhirntumoren. Dtsch Med Wochenschr. 1892;18:138–40.CrossRefGoogle Scholar
  6. 6.
    Petren K. Über den Zusammenhang swischen anatomisch bedingter und functioneller Gangstörung (besonders in der Form von trepid ander Abasie) im Griesenalter. Arch Psych Nerven. 1901;33:444–89.CrossRefGoogle Scholar
  7. 7.
    Dejerine J. Semeiologie du systeme nerveux. Paris: Masson; 1926.Google Scholar
  8. 8.
    Marie P. Des foyers lacunaires de désintégration et de differents autres etats cavitaires du cerveau. Rev Med. 1901;21:281–98.Google Scholar
  9. 9.
    von Malaise E. Studien uber wese grundlagen senile getstoringen. Arch Psychiat. 1910;46:902–1009.CrossRefGoogle Scholar
  10. 10.
    Thompson PD, Marsden CD. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger’s disease. Mov Disord. 1987;2(1):1–8. Scholar
  11. 11.
    Vizcarra JA, Lang AE, Sethi KD, Espay AJ. Vascular parkinsonism: deconstructing a syndrome. Mov Disord. 2015;30(7):886–94. Scholar
  12. 12.
    FitzGerald PM, Jankovic J. Lower body parkinsonism: evidence for vascular etiology. Mov Disord. 1989;4(3):249–60. Scholar
  13. 13.
    Gerstmann J, Schilder P. Uber eine besondere gangstorung bei stirnhirner kranting. Wien Med Schr. 1926;76:97–107.Google Scholar
  14. 14.
    van Bogaert L, Martin P. Sur deux signes du syndrome de desequilibration frontale: l’apraxie de la marche et l’atonie statique. Encéphale. 1929;24:11–8.Google Scholar
  15. 15.
    Thompson PD. Frontal lobe ataxia. Handb Clin Neurol. 2012;103:619–22. Scholar
  16. 16.
    Denny-Brown D. The nature of apraxia. J Nerv Ment Dis. 1958;126(1):9–32. Scholar
  17. 17.
    Blocq P. Sur une affection caractérisée par de l’astasie et de l’abasie. Arch Neurol (Paris). 1888;15:24–51. 187–211.Google Scholar
  18. 18.
    Okun MS, Koehler PJ. Paul Blocq and (psychogenic) astasia abasia. Mov Disord. 2007;22(10):1373–8. Scholar
  19. 19.
    Masdeu JC, Gorelick PB. Thalamic astasia: inability to stand after unilateral thalamic lesions. Ann Neurol. 1988;23(6):596–603. Scholar
  20. 20.
    O’Keeffe FM, Murray B, Coen RF, Dockree PM, Bellgrove MA, Garavan H, et al. Loss of insight in frontotemporal dementia, corticobasal degeneration and progressive supranuclear palsy. Brain. 2007;130(Pt 3):753–64. Scholar
  21. 21.
    Giladi N, Shabtai H, Rozenberg E, Shabtai E. Gait festination in Parkinson’s disease. Parkinsonism Relat Disord. 2001;7(2):135–8.CrossRefGoogle Scholar
  22. 22.
    Nonnekes J, Giladi N, Guha A, Fietzek UM, Bloem BR, Ruzicka E. Gait festination in parkinsonism: introduction of two phenotypes. J Neurol. 2019;266(2):426–30. Scholar
  23. 23.
    Rao AK, Louis ED. Ataxic gait in essential tremor: a disease-associated feature? Tremor Other Hyperkinet Mov (N Y). 2019;9.
  24. 24.
    Nutt JG. Classification of gait and balance disorders. Adv Neurol. 2001;87:135–41.PubMedGoogle Scholar
  25. 25.
    Critchley M. On senile disorders of gait, including the so-called senile paraplegia. Geriatrics. 1948;3(6):364–70.PubMedGoogle Scholar
  26. 26.
    Bloem BR, Gussekloo J, Lagaay AM, Remarque EJ, Haan J, Westendorp RG. Idiopathic senile gait disorders are signs of subclinical disease. J Am Geriatr Soc. 2000;48(9):1098–101. Scholar
  27. 27.
    Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord. 2007;22(3):395–9. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Movement DisordersNew York University Grossman School of Medicine, The Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders, NYU Langone HealthNew YorkUSA
  2. 2.Division of Neurology, Faculty of MedicineRamathibodi Hospital, Mahidol UniversityBangkokThailand

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