Gait and postural disorders in parkinsonism: a clinical approach
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Gait and postural disorders in parkinsonism: a clinical approach Cecilia Raccagni1 · Jorik Nonnekes3 · Bastiaan R. Bloem2 · Marina Peball1 · Christian Boehme1 · Klaus Seppi1 · Gregor K. Wenning1 Received: 8 April 2019 / Revised: 13 May 2019 / Accepted: 16 May 2019 © The Author(s) 2019
Abstract Disturbances of balance, gait and posture are a hallmark of parkinsonian syndromes. Recognition of these axial features can provide important and often early clues to the nature of the underlying disorder, and, therefore, help to disentangle Parkinson’s disease from vascular parkinsonism and various forms of atypical parkinsonism, including multiple system atrophy, progressive supranuclear palsy, and corticobasal syndrome. Careful assessment of axial features is also essential for initiating appropriate treatment strategies and for documenting the outcome of such interventions. In this article, we provide an overview of balance, gait and postural impairment in parkinsonian disorders, focusing on differential diagnostic aspects. Keywords Axial disorders · Vascular parkinsonism · Multiple system atrophy · Progressive supranuclear palsy · Corticobasal syndrome
Introduction Gait disturbances, balance and postural impairments represent core axial symptoms of all parkinsonian syndromes. They lead to a loss of self-efficacy, a considerably reduced quality of life, falls and subsequent injuries as an inevitable consequence. Every clinical examination in patients with parkinsonism is incomplete without a careful evaluation of axial symptoms. As James Parkinson already noted in 1817, “…observation of patients begins while they are walking This was an academic and not an industry supported study. This work was performed at the Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-019-09382-1) contains supplementary material, which is available to authorized users. * Gregor K. Wenning gregor.wenning@i‑med.ac.at 1
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
2
Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
3
Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
into the office” [1]. A recent paper emphasized the many clinical features that can be identified immediately when patients walk from the examination room towards the clinician’s office [2]. For example, important information can even be gained from observing how patients rise from the chair in the waiting room, from listening to the step cadence or from a shuffling sound due to reduced foot clearance [2]. However, the workup of axial disorders in clinical routine is often underestimated, incomplete or not performed properly. There are various reasons for this, including time co
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