Window 6: Gait – Traumatic Brain Injury, Concussion, Brain FunctionWritten By: David Burns
How we move, our gait, is a window into brain function. Do a little people watching and note the asymmetries in stride and arm swing, toe walkers that bounce. Again to appreciate the extent of how are brains influence our gait you only need to begin to observe the differences in gait seen with various neurocognitive challenges like Asperger’s, Autism, ADHD or disease states like Parkinson’s or Alzheimer’s or stroke. These are gross examples but a lot can be gained in our understanding of anybody’s function by observing gait. I see significant asymmetries within the “healthy” population all the time and my powers of observation are still not as refined as some.
Have you ever walked beside someone, and each time they start telling a story they veer off track or slow down or worse still stop all together? This is curious in the very least. We think of walking as automatic but yet if we give some people a cognitive challenge (e.g. counting backwards by 7’s or saying every second letter of the alphabet) they slow down, their speed while changing directions decreases, their arm swing changes or angulations in their wrists, elbows or shoulders change. Have a person walk up and down a hall and time them, give them a task they are capable of doing standing still, have them walk and perform the same cognitive task. This is called “dual tasking” and provides insight into brain function. What observations can you make? In general watch how your children run and play, how their bodies change when they are given cognitive challenges (e.g. running through a new drill at practice). These are all windows into areas that may need attention.
Balance is key to survival. From a evolutionary perspective, the system that keeps us upright, stable and mobile is one of the oldest. Let’s face it, if your off balance in the wild you are somebodies lunch. We talked about balance when we looked at posture. We also want to look at balance more dynamically. How well do they balance walking heel to toe, forwards and backwards, eyes open and eyes closed? Do they fall to one side or is there a general disturbance in balance. There are various areas of the cerebellum as well as the inner ear, brainstem, spinal cord, parietal cortex, insular cortex or joint receptors that could function at a lower level or in an asymmetrical manner causing disturbance in balance (i.e. vestibular deficit).
Our awareness of where we our in space and our awareness of our body itself can be tested or observed in a couple of ways. I will have a person march on the spot, with eyes closed, arms extended in front of them. I will let them go for a minute or two ensuring that they don’t run into anything. This is called a Fakuda test and is used to provide some insight into vestibular assymetries but also can reflect an abnormal perception of oneself relative to the world. I observe if they rotate, shift forward or to the side. I also note any drift of the arm or internal rotation of one or both arms. This is referred to as Parietal Drift and may reflect the awareness of the body and the integrity of various structures of the brain.
Other gait observations that can be noted include: a floppy foot, catching the toe on one side, assymetry in wear pattern on shoes. Do you ever notice tiny little head tremors, shakes, “bobbles” at rest or with movement these could mean vestibular issues that can effect joint stability or “dystonias”.
Subtle signs can exist in gait well before anybody is symptomatic. Keep your eye on how people move. The airport will never be the same!
This blog and the other blog “windows” into brain function are not intended for anybody to make any diagnosis or determine treatment for anybody. It is simply intended to help patients understand what a functional approach to neurology, brain function, concussion management, sports performance evaluation may entail. But most importantly, to help the patient or client communicate with the provider so that they or their children can achieve the best brain health possible. Achieving optimal brain health is an interdependent process, an active process that starts with communication.