In order to keep track of progress (or deterioration) in patients with gait problems, it's useful to have a set checklist of items to be evaluated at each patient visit. Here is such a checklist:

1. Perform a thorough history of the patient's gait problems, including

• Test of cognitive function
• Medication review

2. Perform a physical examination concentrating upon

• Muscular strength and symmetry
• Reflexes
• Proprioception, vibratory senses
• Foot inspection
• Vision

3. Examine the patient's gait. Items to observe include:

• Is the gait initiated without undue pelvic tilt ?
• Do the arms swing reciprocally and not reach out for support ?
• Is the head held erect without spinal curvature
• Are the steps regular without staggering or stumbling ?
• Do the feet clear the ground wich each step ?
• Does the foot strike the ground in a "heel to foe" fashion ?
• Is the step length symmetric ?
• Is the width of the stride symmetric ?

4. Complete the Performance Oriented Mobility Screen

5. Consider laboratory evaluation (as indicated):

• B12 evaluation
• Calcium, phosphorus, alkaline phosphatase
• TFT's
• Drug monitoring

6. Considering the following diagnostic studies (as indicated):

• Cervical spine films
• Hip and knee films
• Pelvic films
• CT head
• Electrophysiological studies
• Myelography

7. ASSESSMENT

8. Consider consultation with: Rehabilitation Medicine, Geriatrician, or Neurologist as available.

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