Walking disorders, as they are scientifically termed, are the pathologies and bodily phenomena that impact on the human walking process. Walking has also been scientifically identified. It is a complex process integrated by humans through trial and error during the learning process. It is said to be integrated because the walking process does not require any particular reflection on the part of the subject to apply it, becoming an instinctive movement. This process is identified as a cyclical movement of repetition, involving almost the entire human body. The primary phenomenon that initiates the movement of walking is the loss of voluntary balance induced by the back muscles, which walking will compensate by repeatedly re-establishing the lost balance. This cyclical repetition is therefore that of loss of balance/rebalancing, involving not only all the muscles and joints of the trunk, but also the lower and upper limbs.
Given this near-global involvement of the human body in walking, it's easy to understand that many potential disorders arise from pathologies or changes affecting the various parts of the body involved. These changes induce acyclic elements that will be reflected in the gait phenomenon by disturbances and abnormal modifications in its application.
However, it is important not to confuse gait disorders with normal changes in gait due to aging. In fact, as patients age, they do not necessarily suffer from gait disorders, but experience progressive changes in speed or time distributed between the different stages of the gait process. However, gait disorders are widespread among elderly patients, and are caused by a number of different phenomena.
When it comes to identifying the causes of possible gait disorders, there are three main categories: muscular, motor and neurological.
One of the main causes of muscle disease is myositis, also known as inflammatory myopathy. This pathology is autoimmune in nature, meaning that the immune system normally responsible for protecting the body turns against it - in this case, the muscles - as a result of a disorder. They are divided into 4 different levels/pathologies: inclusion myositis, anti-synthetase syndrome, dermatomyositis and autoimmune necrotizing myopathy. As myositis is not widespread either, there are more classic muscular origins. Obviously, current or past muscular injuries, depending on their treatment, have a strong impact on the walking movement. Alternatively, certain "simpler" muscular disorders may be to blame: false movements, damage to fascial tissues...
Motor causes are more likely to develop as the patient ages. They are quite numerous and are linked to osteoarticular affections. Rheumatism, which is particularly prevalent among ageing patients, is a typical cause. A rheumatism is a joint disorder, and the two main rheumatisms we identify are coxarthrosis (affecting the hip joints) and gonarthrosis (affecting the knee joints). On a sagittal plane, i.e. a vertical anatomical cut, the two main static disorders of the spine are kyphosis and lordosis, with or without scoliosis. Occasionally mistakenly thought to be purely pathological, kyphosis and lordosis are anatomical and necessary for the maintenance of posture. More crudely, they are the curvatures of the spine as seen from the same sagittal plane. Lordoses are cervical or lumbar (highest and lowest parts of the spine), while kyphoses are dorsal (middle and lower parts of the spine). They are therefore not necessarily subject to disorders or anomalies, only that scoliosis may have had the effect of malforming or malpositioning these kyphoses and lordoses, resulting in precisely these "static disorders" of the spine in question. Otherwise, motor disorders may be characterized by: joint or joint-related lesions resulting from potential injuries, inflammatory diseases such as arthritis, and pathologies or malformations of the lower limbs.
Finally, neurological causes can have a strong impact on the walking process. The neurological system, although the walking movement may have an unconscious or reflex aspect from the patient's point of view, is initiated by nerve impulses ordered by the brain. A neurological pathology is therefore likely to have an impact on the gait cycle, through mal-transmission of the steps or other information required for walking. Examples include cerebrovascular disorders such as hemiplegia. Hemiplegia is a brain condition that affects only one hemisphere of the body, i.e. only one half, from a vertical point of view and separation. It can be partial, affecting only certain parts of the half, or total, which in both cases inevitably affects motor skills and therefore the walking process. Other pathologies of origin may be Parkinson's disease and its tremors, post-fall blockages or the demented after-effects of Alzheimer's disease.
Of course, it's possible for gait disorders to have their origins in phenomena outside these categories, on a smaller scale. For example, an inner ear problem may cause a balance disorder, preventing the body from re-establishing the loss of balance necessary to induce the movement of walking. Alternatively, metabolism may be a determining factor in a patient's ability to walk or not. For example, excess weight leading to obesity will reduce the patient's ability to move correctly, and prevent the proper realization of certain natural movements. On the other hand, a patient who is underweight or malnourished may find his or her movements limited by a lack of strength and energy. Finally, the consumption of alcohol or other substances such as certain classes of medication or drugs will also have an impact, often only temporary, on the walking process. These latter disorders are not categorized, as they are not really walking disorders in the strict sense of the term, but pathologies in their own right.
There are several forms of walking disorders:
• Painful gait stems from pain in the pelvis, back and lower limbs, and is caused by root, muscle and joint disorders such as osteoarthritis, arthritis or gout. Painful walking may be the result of the after-effects of a fall or podiatric problems.
• Deficit gait results from damage to the pyramidal system, peripheral nerve or muscle, such as a hemiplegic gait caused by a stroke. It is also most often the result of hemiplegia or muscular dystrophy.
• Ataxic labyrinthine or cerebellar gait affects walking through reduced muscle strength, impaired movement coordination and spasticity. This symptom is found in multiple sclerosis.
• The extrapyramidal gait is characterized by a Parkinsonian gait: freezing, slow walking and rubbing of the feet.
• Psychogenic gait is characterized by cautious walking, recognized by a shortening of steps and a slowing down when walking. This disorder is present in the elderly after a fall. Depressive gait and hysterical gait are also cited.
• Gait of neurological origin is defined as standing instability with spontaneous retropulsion. This symptom is present in patients with Alzheimer's disease or related syndromes. It is very often caused by, or coupled with, high levels of anxiety on the part of the patient, particularly at the very idea of walking.
• Foot drop: Foot drop is a difficulty in lifting the front part of the foot due to weakness or possible targeted muscle paralysis. It can be identified when the person's step drags the tip of the toes along the ground.
• Retropulsion: Retropulsion is the phenomenon of taking an involuntary step backwards at the start of the walking process or falling backwards during the process.
As mentioned earlier, gait disorders are caused by three different types of event or pathology: muscular, motor and neurological. As a result, there are many different treatments and supports to choose from.
Inflammatory myopathies are usually treated by degressive prescription of corticosteroids. In fact, the dose is initially high, in order to dissipate and treat the muscular inflammation in the form of what is known as an attack treatment. Doses are then progressively reduced to reduce intake. In the case of muscular injuries, periods of immobilization or "rest" are recommended, usually accompanied by analgesics and the application of ice. This is logically followed by periods of rehabilitation and physiotherapeutic support. Often less cumbersome than myositis, this type of problem is quick to treat. When it comes to false movements and fascial tissue damage, DPA Med is an effective treatment. The machine, which precisely reproduces the movement of walking at pelvic level, will rid the patient of any possible false movements during the medical procedure, and re-acclimatize the body to the fact that it is no longer subject to them, thus getting it back into the habit of not applying them. As far as fascias are concerned, these are tissues that are ubiquitous in our bodies and often run deep. To remain in good condition, they require continuous mobilization. In the event of loss of motricity, DPA Med allows you to continue mobilizing, while addressing all fascias, superficial and deep, thanks to the sheathing exercises applicable during the medical procedure.
Rheumatism is usually treated with drugs, including NSAIDs (non-steroidal anti-inflammatory drugs) and analgesics. Treatment may also include corticosteroid injections for greater relief. From a preventive point of view, and with a progressive curative contribution, joint mobilization helps to limit rheumatism. Once again, DPA Med offers the possibility of gentle, controlled joint mobilization. But this is not the only motor pathology that the device can alleviate or cure. Indeed, lordosis and kyphosis deformities, as well as potential scoliosis, are pathologies targeted by the DPA Med. Faithfully reproducing the natural movement of walking, the DPA Med will enable the patient's posture to be reworked through active use of the machine. By re-establishing a more natural gait and muscling the deep muscles, its use will eliminate the loss of natural lordosis, particularly in the elderly, and rework the posture of the spinal column, thus correcting scoliotic attitudes.
As far as neuropathic pathologies are concerned, almost all motor losses are due to blockages or loss of nerve connections. Potential treatments for this category of disease are many and varied, ranging from hypnosis to drug therapy, right through to surgery. The aim of DPA Med is to reappropriate these pathologies. It is necessary to mobilize the body where the pathology prevents it, in order to send a message, first psychological then motor, to the brain, potentially re-establishing connections or breaking through the blockage of the nervous message, based on the principle of restoring the patient's confidence.
Although gait disorders are more prevalent in elderly patients, they are an important issue to take into account. This is because, while the average patient is living longer, he or she is also ageing, and there are many different pathologies that can lead to gait disorders. What's more, the loss of motor skills induced by these disorders is not benign, but disabling in the patient's daily life, making it a priority not to be neglected.