Stance (standing without falling over) requires normal functioning of the musculoskeletal system, as well as the parts of the nervous system involved in motor, somatosensory, vestibular, and visual functions. Gait (walking) will usually be abnormal in the presence of abnormal stance. Postural reflexes are the normal compensatory movements that counteract any shift of the center of gravity away from being directly over the feet. Postural reflexes can be tested by pulling the standing patient in different directions to assess for normal corrective movements. Base refers to the lateral distance between the feet. Romberg’s sign is the loss of balance when standing with a narrow base and closed eyes, despite intact stance with a narrow base and open eyes. Romberg’s sign is usually seen with diminished position sense, as the vestibular system alone appears to be insufficient to maintain stance in the absence of vision and intact position sense.

Several features are examined with normal walking, which is called casual gait. A wide base is usually abnormal, and usually part of gait ataxia. During stride, the distance, fluidity, and balance during the steps should be noted. Turns in particular should be noted, as mild gait abnormalities may only occur during turns. Tandem gait refers to walking with one foot directly in front of the other to assess for mild gait ataxia, which may only be detected by using this test to narrow the base.

A common abnormal gait is called the multifactorial abnormal gait. It is also called the cautious or hesitant gait because of its appearance, which consists of a hesitant, short-striding, unsteady gait on a relatively normal base. It is usually from mild dysfunction of multiple sensory systems involved in walking, as well as abnormalities of the musculoskeletal system.

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Level 3 Unit 2 Part 35: Autonomic overview