A sign-based approach to neurological gait disorders

Hallway observation guides gait assessment

Neurological gait assessment takes place in a hallway, using frontal and sagittal views. Clinicians observe stance, swing, and transitional phases, and also listen to gait sounds, because auditory features contribute diagnostically.

Additional gait tasks narrow differential diagnosis

Fast walking, running, turning, tandem gait, walking backwards, and dual tasking expose subtle abnormalities and help refine a sign-based differential diagnosis when only limited gait signs are initially present.

Task-dependent inconsistency suggests functional gait

Task-related normalization or incongruent performance indicates inconsistency and supports functional gait disorder, whereas disease-congruent patterns persist across tasks or change in characteristic ways, as illustrated in Parkinson’s disease, ataxia, spastic paraparesis, and dystonia.

In the continuing education session “A sign-based approach to neurological gait disorders,” organized by Klinik Barmelweid, Assoc. Prof. Jorik Nonnekes presents a structured clinical framework for gait assessment in neurology. He emphasizes that gait evaluation takes place in a hallway of sufficient length, in both frontal and sagittal planes, with attention to stance phase, swing phase, and the transitions between them. He also underlines that clinicians should not only observe but also listen to gait, as characteristic sounds can support recognition of patterns such as shuffling gait in Parkinson’s disease or gait abnormalities in neuromuscular and spastic disorders. A central message is that additional gait tasks including fast walking, running, turning, tandem gait, walking backwards, and dual tasking help reveal subtle abnormalities and narrow the differential diagnosis when a full syndrome is not yet clinically apparent. Using multiple video-based examples, Assoc. Prof. Nonnekes illustrates how task-dependent changes in arm swing, scissoring, knee hyperextension, broad-based gait, dystonic posturing, trunk flexion, and knee buckling distinguish parkinsonian, ataxic, spastic, dystonic, and functional gait disorders. He further shows that inconsistency across tasks, such as normalization during running or preserved balance during demanding postures, is particularly informative for identifying functional gait disorders. In the discussion, he notes that no single optimal dual-task paradigm exists and recommends integrating natural conversation and context-dependent cognitive tasks into routine observation, including the walk from the waiting room to the examination area.