General Management Goals

The first management goal is patient safety, and a number of nonspecific strategies can be used to achieve this goal. Since falls are dangerous, their prevention must be of paramount concern. Stabilizing walking aids such as walkers, canes, and other support aids may be useful in weak or unstable patients, but the patients must be specifically trained to use these objects correctly. Some patients, especially those with a gait marked by freezing, may find such aids of more hazard than benefit. Padded clothing, knee pads, and elbow guards may also be used. Physical therapists are often particularly skilled in advising on the use of medical ambulation aids.

The next management goal is to identify the neural dysfunction that contributes to the patient's gait and balance difficulties. A differential list of diseases that should be investigated in the search for treatable pathologies can be developed and a prognosis established. Characterization of balance and gait disorders in terms of systems dysfunction will help to identify correctable problems such as decreased visual acuity that is amenable to refraction or cataract removal, weakness that is amenable to bracing, and so on. It is important to recognize that balance and gait disorders may have multifactorial causes y and that there need not be a unique cause for the patient's difficulties. An attempt to correct all potential contributors to gait and balance problems is worthwhile. y , y

When these goals have been accomplished, physical therapy programs for strengthening and improved balance can be refined. y Further evaluation and experimentation with various assistive devices may be useful, and therapists can instruct the patient and family in the best methods to use to assist the patient without injury to self or others. The occupational therapist can evaluate the home for safety and may suggest the use of grab bars, new lighting, floor coverings, a different furniture arrangement, and so forth to prevent falls. y

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