This book provides a detailed review of gait disorders arising from abnormalities of the brain that commonly accompany aging. The book comprises twenty-four chapters by twenty-seven authors, most of whom are neurologists. Other contributors include internists, physiologists, physical therapists, epidemiologists, a neurosurgeon, and an orthopaedic surgeon. Each chapter is strengthened by extensive use of the literature.
This is a very informative volume, but the material is a bit difficult to extract because of the authors' conversational style, the repetition of information, and the lengthy introductions. The book also is a compendium of detail, which makes it difficult to summarize.
The text covers four major categories: falls, balance, the mechanics of gait, and neurological etiologies. Five chapters that focus specifically on falls address incidence and epidemiology, methods of evaluating individuals who fall, and interventional measures designed to reduce the risk of falling. The chapters on balance address such topics as physiology, the effects of aging and disease, study methods, and therapeutic approaches for improving balance.
Particular attention is directed toward several neurological diseases that impair the gait of elderly persons, including parkinsonism, cerebrovascular disorders, symptomatic hydrocephalus, vestibular and cerebellar disorders, peripheral neuropathy, and cervical spondylotic myelopathy. There also is a chapter on a unique dysfunction known as cautious gait. The pathological anatomy is presented in considerable detail, and the gait characteristics of elderly patients are thoroughly discussed. One of the authors, a neurologist, analyzes gait on the basis of such characteristics as trunk posture, arm mobility, gait initiation, turning ability, balance, walking speed, step length, and the duration of double-limb stance.
In summary, this book contains a wealth of information. The material most pertinent to the practice of the average orthopaedist is found in the chapters entitled "Falls in the Elderly, Risk Factors and Prevention," "Foot and Ankle Disorders Affecting Gait and Balance," "Resistance Training," and "Environmental Factors in the Prevention of Falls." The chapters describing specific neurological disorders may be useful for managing particular patients. The excellent summaries of treatment measures, including comparisons of the effectiveness of different techniques, are particularly valuable.
Jacquelin Perry, M.D.
Polio Department and Pathokinesiology Service
Rancho Los Amigos Medical Center
Downey, California