Balance disorder, also called ataxia, is a dysfunction of motor coordination. It manifests itself in a person’s loss of control over the position in space of his body, as well as in violation of the accuracy of movements. In this case, as a rule, the strength of the limbs themselves is completely preserved or decreases slightly. Experts distinguish between static ataxia, that is, imbalance in a standing position, and dynamic ataxia, which is a lack of coordination during movements.
A balance disorder occurs when the interaction between the vestibular apparatus and the central nervous system, namely the spinal cord, the cortex of some areas of the brain and the cerebellum, is disrupted.
1.General information
Gait, plasticity and, in general, psychomotor skills are the most important components of a unique human individuality, which can tell a lot about the personality in general and about the emotional state in particular. We fly or wander, rush past or barely drag our feet; while others, you see, have their legs tangled because they drank the wrong drink and in the wrong quantities. However, for a neuropsychiatrist, gait is an informative and diagnostically significant indicator, which the specialist necessarily pays attention to (even at that short stage, while the patient walks from the office door to the chair).
As is known, all processes, acts, functions of the body are directly or indirectly controlled by the central nervous system, i.e. brain and spinal cord. Gait, of course, can be impaired due to uncomfortable shoes, an accidental stone, a bruise or an ingrown toenail, but identifying and eliminating such factors is much easier than diseases of the musculoskeletal system, and especially than disorders of psychomotor and psychokinetic functions, including gait , due to organic damage to the central nervous system. At the same time, certain gait disorders (dysbasia) are very widespread and correlate, among other factors, with age: dysbasia is observed in approximately 15-20% of older people. But not only them.
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Dizziness and unsteadiness of gait
Natalia
February 14, 2020
I am 30 years old. Height 173, weight 75 kg. It all started with a sharp rise in blood pressure in December 2021. The pressure jumped sharply and reached 180, while my normal pressure was 120/130'80. During this period, one fine morning I could not get out of bed. In the morning, nausea, dizziness, feeling that all the blood in the head has gone. (Indeed, it was easier lying down than standing) They took me to the hospital, they gave me vasodilators (Vinpocetine, Cerecard) that didn’t really help. The vasodilator gave me a severe headache, but the hospital didn’t hear me and continued to drip. There were some fears throughout my stay in the hospital. There is an unreasonable feeling of fear and anxiety inside. She didn’t recognize herself and couldn’t understand what was happening at all. Doctors assumed that my condition was due to instability of the vertebrae in my neck. The vertebrae compress the blood vessels. After 10 days he was discharged home. The condition has improved, but the feeling of disgust still does not go away. There were several serious cases in 2021 when it was impossible to even stand up: the nausea was severe, it was impossible to walk, or even stand. I thought I was going to fall. I walked along the wall. My face went numb. The ambulance arrived: an injection of Mexidol into a vein, and I began to somehow move around. The last such case was six months ago. But the feeling of disgust still doesn’t leave me. Of course, it's not like it was before... When I lie down, all the symptoms go away. Nausea is minimal or absent at all. There is no true dizziness (when objects spin or spin). There is a feeling of faintness, that I am about to fall or step into the abyss. This condition can appear out of nowhere and also disappear. There are days when everything is generally ok, nothing bothers me, there are days when it sways a lot, it’s even hard to stand. There were also headaches, frequent and severe. (7-8 points) Painkillers did not help. Now they have headaches, but not so often. Treated with painkillers. I associated my headaches with the presence of the Mirena intrauterine device (hormonal). They took it off for me almost a month ago, my head became fresher, and the headaches were not so lingering. During this time, here are the studies: MRI of the head, neck (without blood vessels), normal blood count, normal sugar (although in some cases I noticed that it became better if I ate something sweet when I was feeling unwell. I have diabetes in my relatives.) Cholesterol is normal, hormone tests are normal. Ultrasound of neck vessels is normal. X-ray - instability Shop, C3-C4 posteriorly. Gastroscopy - erosive gastritis. Treated. In the past, cholecystectomy. Also, extrasystole has been present since childhood. Mitral valve prolapse 1st degree. (Latest research October 19) Sotahexal was prescribed on an ongoing basis, it helps. A CT scan of the lumbar region was also performed; there is a median hernia l5-s1, spondeloarthrosis. There is pain syndrome. At the moment I am taking betagestin, the feeling of disgust does not go away. Vascular headaches cause headaches, as if everything inside is bursting. Dear doctors, explain to me what is happening. Could instability of the cervical vertebrae affect me like this???? I heard doctors say that the neck has nothing to do with it. Is it so???? I keep skidding and swaying. How long will it take for me to continue living like this???
The question is closed
nausea
dizziness
unsteadiness are similar
2. Reasons
One of the frequent direct causes of gait disturbance is dysfunction of the vestibular apparatus, when dysbasia acts as a symptom in the general syndrome of impaired coordination of movements and orientation in space. Vestibular disorders, in turn, can be caused by the following factors:
- pathology of the visual and auditory systems (in particular, damage to the inner ear, optical elements of the eyeball or optic nerve);
- biochemical factors associated with excessive concentrations of various substances (alcohol and many other plant, animal, bacterial, viral toxins, some medications, etc.);
- intervertebral disc herniation with pinching of nerve roots in the lumbosacral spine;
- diabetes mellitus and other endocrine and metabolic disorders;
- psychotrauma and other psychopathological factors (in particular, the most pronounced dysbasia, i.e. the inability to walk or stand, is called “astasia-abasia” in psychoneurological sciences and is observed not only with organic lesions of the central nervous system, but also with hysteria).
All other causes are in one way or another associated with damage to the cells of the brain and/or spinal cord, as well as conduction neurons, muscles and the interaction between all these structures. These are all kinds of atrophic processes, neuromyopathies, consequences of stroke (acute cerebrovascular accident, including strokes - massive tissue necrosis in any part of the brain due to hemorrhage or cessation of blood supply), cerebral palsy, polyneuropathy, oncological processes, severe head injuries, etc.
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What dangerous diseases does your gait reveal?
If you want to learn more about health, take a closer look at your gait
Photo: Evgenia GUSEVA
EVEN INTELLIGENCE IS CONNECTED WITH GAIT
Researchers at the University of Southern California recently proposed adding one more to the list of standard health indicators such as blood pressure, weight and temperature: a person's walking speed. According to American scientists, this indicator can tell doctors a lot about the state of the body. What can you learn by looking at a person walking, and how can changing your gait affect your health? the famous neurologist, sports medicine doctor, member of the American Academy of Neurology, Candidate of Medical Sciences Viktor Koss to talk about this
— Do you agree that the higher a person’s usual walking pace, the better his health and the lower the risk of premature death?
— In general, I agree. In this case, it is necessary to take into account the individual characteristics of each person: height, weight, state of the muscular system. Everyone has their own type of walking. And it is important to walk within the physiological norm. Let's say, if you walk quickly, your heart rate rises to 200 beats per minute, and you start breathing more than 20 times per minute, this will not be useful at all . Everything that happens in the body is controlled by the brain. To work, it needs a full blood supply, and the heart can pump out blood well only with normal gait. It turns out that even intelligence is associated with gait.
— Research suggests that observing gait can tell doctors a lot about cardiovascular and cognitive impairment and other diseases. Is this really so?
— An attentive and competent doctor can really understand a lot about the patient based on gait characteristics. If a person has an uneven gait, different amplitudes of steps, unsteadiness, poor coordination of leg movements, stiffness, and so on - all of these may be signs of specific diseases. But it’s difficult to speak abstractly. In each specific case, a specific diagnosis will be made based on the set of symptoms.
STAY IN TOUCH
What diseases change gait
* Walking is definitely related to the heart, explains Dr. Koss. If a person has serious problems with the cardiovascular system, then an experienced cardiologist will immediately distinguish such a patient while moving - at least by the nature of breathing, shortness of breath.
* Neurodegenerative diseases also noticeably change gait: cerebral palsy, Parkinson's disease, multiple sclerosis.
* In schoolchildren, poor posture when walking may indicate the child’s intellectual fatigue, insecurity and other psychological problems. “If a child does not play sports, sits at the computer all the time, is overloaded at school, and then his parents scold him for not studying well, then a conflict with reality arises,” says the expert. “The child closes up, shrinks like a turtle, his muscles tighten, and his gait is disrupted.” In such cases, additional parental attention and sports activities will help. But in no case is it forced into a section, but the selection of a type of physical activity that will truly captivate and at the same time relax the child - be it dancing or a taekwondo club.
*If a person actively waves his arms and sways while walking, then several options are possible. The first, the most harmless: some people are accustomed to walking like this since childhood, then this is their individual feature, which, as a rule, does not indicate any deviations. If such a gait appears in adulthood, it may be a consequence of cerebral atherosclerosis (that is, “clogging” of blood vessels with cholesterol plaques) and a lack of oxygen supply to certain areas of the brain. Problems in the cervical spine are also possible; herniated vertebral discs; stenosis (narrowing) of the intervertebral canal, which can be life-threatening. The diagnosis of all these conditions is primarily carried out by neurologists.
TRY AT HOME: SIMPLE TEST
You can do it yourself - while someone from the outside observes and evaluates. Or - ask your household and loved ones to go through, observing them, advises Dr. Koss.
Place two chairs at opposite ends of the hallway or room. A person needs to get up from the first chair, walk in a straight line and sit on the second. By observing the movements, how the rise, landing and walking occur, the doctor will understand a lot, and the average observer will at least see alarm bells. In particular, such a test can indicate the condition of the back, joints, hip, lumbar and cruciate spine, and whether there are problems with coordination of movements, with the vascular and muscular system. A very important characteristic is how confidently a person walks.
DO YOU GO FASTER - ARE YOU YOUNGER?
— Is it possible to influence your health by changing your gait?
- Yes. Faster walking speed helps increase endurance and even reduce biological age. Just without fanaticism - I repeat once again that while walking the heart should work calmly and normal breathing should be maintained. If a person begins to breathe frequently and the pulse jumps (see above), then this is overexertion, which is unsafe for the body. In a word, the skill of fast walking can be very useful, but it does not arise by itself; training is needed with a gradual increase in speed.
ON A NOTE
Seven benefits of walking
1. This is an excellent, most physiological, that is, useful and safe for the body training. It develops muscles and improves overall fitness.
2. The human psyche is trained, since long walking helps to achieve a state of relaxation (relaxation), get rid of bad thoughts, if you focus specifically on steps and breathing.
3. Long walking at a reasonably fast pace trains the heart and strengthens the cardiovascular system.
4. Joints are strengthened. Moreover, unlike a marathon or running, the cartilage tissue is not overloaded, so there are practically no injuries when walking.
5. The functioning of the gastrointestinal tract is normalized, since the abdominal muscles are constantly tense, and peristalsis improves.
6. Due to the load on the lower back muscles, the kidneys work better and the microcirculation of the renal system improves.
7. In the prostate gland in men and in the pelvis in women, walking causes processes that prevent the formation of adenomas and benign tumors.
THIS WILL BE USEFUL
What to do on the road as a pedestrian
If you don’t mind that passers-by may start turning around, then walking can be combined with simple exercises that will significantly increase its benefits.
* Option 1 - breathing exercises, suggests Dr. Koss. While walking, as you inhale, lower your head, as you exhale, lift it, as you inhale, turn it to the left, as you exhale, turn it to the right. To this you can add bloating and retraction of the abdomen.
* If you actively swing your arms while walking, this will give additional useful load to the arm muscles and shoulder girdle.
* You can buy special Velcro weights for arms and legs at a sports store. Victor Koss recommends taking 300 gram weights on your legs and 100 grams on your arms. Walking with weights will help you lose excess weight faster and at the same time build muscles. It’s also good to squeeze the expander.
QUESTION ON THE TOPIC
What about Nordic walking and running?
Walking with special poles, similar to ski poles, has been very popular lately.
“This kind of walking is good because the upper shoulder girdle is activated, and the quality of gait itself improves. Those muscles are activated that, without the use of sticks, do not work at all or work very little, the doctor explains.
— What are the advantages and disadvantages of walking compared to jogging?
- Depends on age. Until the age of 40-45, jogging may be more beneficial than walking. It perfectly trains the nervous, cardiovascular system and musculoskeletal system. But in older age, when joints, muscles, spine and the body as a whole become weaker, regular walking for most people becomes healthier and safer than running.
3. Symptoms and diagnosis
There are numerous types of dis- and abasias, almost each of which is designated by a special term, indicating, as a rule, the cause of the disorders. It is too long to list them all, and it is hardly advisable: cerebellar, spastic-atactic, hemiplegic, psychogenic, hyperkinetic and many others. etc. For example, the “cock step” (a step when the leg bent at the knee is raised high above the floor and then “slammed” back with force) with lesions of the peroneal nerve or multiple sclerosis is fundamentally different from mincing small steps with senile dementia or parkinsonian syndrome.
Regardless of the type of motor function disorder, it is very important to tell the doctor a number of key points that are important for diagnosing the causes: when and after what the disorders developed, did they arise simultaneously, remaining in the same severity, or gradually progress, are they accompanied by other symptoms and disorders ( joint or headaches, dizziness, fainting, disorders of coordination of movements, speech, cognitive functions, etc.). Perhaps the first call will be in the wrong place, and the doctor (for example, an orthopedist or vertebrologist) will redirect the patient to a specialized specialist (neurologist, otolaryngologist, etc.). Next, depending on the suspected etiology, a diagnostic examination will be prescribed, both laboratory (clinical tests, biopsy, bacteriological, immunological or toxicological examination) and instrumental (MRI, CT, electromyography, stabilography, etc.).
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4.Treatment
Gait disturbance is not a disease, but a symptom, so the most important step is timely and accurate diagnosis of the etiopathogenetic factors of dysbasia or astasia-abasia. Therapy is prescribed with the goal of eliminating these factors as much as possible, and it is, of course, impossible to even briefly talk about all possible protocols and schemes for vertebrological, neurological, and neurosurgical treatment. It is more important to emphasize that in some cases, a changed gait may be the first, early and almost the only symptom that will help at the initial stage to identify a developing process that is much more serious and dangerous than dysbasia itself. In this case, timely contact with a doctor is of key importance, and delaying the visit is highly not recommended.
