Synopsis
Recognise gait syndromes without reducing them to normal ageing, identify urgent neurological, skeletal and cardiovascular causes, and prescribe a usable mobility aid within a person-centred rehabilitation and home-safety plan.
- A new gait problem is not normal ageing: compare with the stable pre-illness baseline and identify pain, focal neurology, posture symptoms, cognition, medicines and environment.
- First-line assessment observes sit-to-stand, initiation, straight walking, step length, base, foot clearance, arm swing, turning and stopping with the usual aid.
- Examine vision, eye movements, tone, power, coordination, sensation, proprioception, reflexes, feet, footwear, joints, spine and cardiovascular physiology.
- Timed Up and Go, gait speed, five-times sit-to-stand and Short Physical Performance Battery describe function; no single score diagnoses the cause or determines safety alone.
- A single-point stick is generally held in the hand opposite a painful or weaker lower limb and advances with that limb after individual assessment and training.
- First-line aid prescription is by a physiotherapist or appropriately trained clinician who tests cognition, grip, brakes, height, turning, stairs, home dimensions and transport.
- A frame offers more support than a stick but can be hazardous if lifted, left out of reach, used on unsuitable stairs or supplied without brake and transfer training.
- Mobility management treats the cause while delivering progressive strength, balance, endurance and task practice linked to the person's goals.
- Occupational therapy checks doors, toilet and chair height, night routes, carrying tasks and whether the aid fits the actual home.
- Driving, community access and carer burden should be reviewed when lower-limb control, reaction, vision or cognition changes.
Key red flags
Acute focal weakness, speech change, visual field loss or ataxia requires immediate stroke assessment.
New urinary retention, saddle sensory change, bilateral leg weakness or rapidly progressive gait loss requires emergency spinal assessment.
Painful inability to weight bear after a fall needs fracture precautions and imaging even when bruising is limited.
Fever, severe night pain, cancer history or immunosuppression with new spinal or joint symptoms raises infection or malignancy concern.
Exertional presyncope, palpitations or falls without protective response requires cardiovascular assessment before exercise testing.
A suddenly unusable aid, recurrent brake failure or carer lifting beyond capacity creates an immediate transfer and safeguarding risk.
Broad base, irregular step timing, veering and limb or eye-movement signs indicate cerebellar dysfunction.
New asymmetric weakness, circumduction, facial or speech change is a stroke presentation until assessed urgently.
Investigation priorities
Define onset, prior function and participation loss.
Management branches
Walking has slowed, changed pattern or become unsafe.
- Establish stable baseline, onset, falls, pain, symptoms, medicines and meaningful mobility goals.
- Exclude emergency neurological, skeletal, cardiovascular and infectious causes and examine gait systems.
- Measure relevant function with the usual aid and create a cause-specific rehabilitation and equipment plan.