From the Guidelines
The recommended workup for a patient with rigid gait should begin with a comprehensive neurological examination, including assessment of muscle tone, strength, reflexes, and coordination, followed by a detailed history and laboratory tests, and for physiotherapy, a regimen focusing on improving mobility, strengthening, balance, and gait training is suggested, as supported by the most recent guidelines 1. The workup should include:
- A comprehensive neurological examination to assess muscle tone, strength, reflexes, and coordination
- A detailed history focusing on symptom onset, progression, medication use, and family history
- Laboratory tests such as complete blood count, metabolic panel, thyroid function, vitamin B12, and inflammatory markers
- Imaging studies like brain and spine MRI to rule out structural lesions
- Additional specialized tests like dopamine transporter scan (DaTscan) for Parkinson's disease, electromyography for neuromuscular disorders, and cerebrospinal fluid analysis if inflammatory or infectious causes are suspected For physiotherapy instructions, the regimen should focus on:
- Improving mobility through stretching exercises targeting hip flexors, hamstrings, and calf muscles
- Strengthening exercises for core and lower extremities
- Balance training
- Gait training with appropriate assistive devices
- Cueing strategies to overcome freezing episodes This comprehensive approach is necessary because rigid gait can result from various neurological conditions, each requiring specific physiotherapy approaches to address the underlying pathophysiology of increased muscle tone and impaired motor control, as noted in recent guidelines 1. Key considerations for physiotherapy include:
- The use of functional electrical stimulation or traditional ankle foot orthoses to improve gait speed, as both are equally effective 1
- The recommendation of botulinum toxin for patients with focal spasticity that is painful, impairs function, or compromises proper positioning or skin care 1
- The suggestion of body-weight support treadmill training as an adjunct to gait training in non-ambulatory patients 1
- The incorporation of rhythmic auditory cueing as a modality to improve walking speed 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommended Workup for Rigid Gait
The workup for a patient with a rigid gait requiring detailed physiotherapy instructions may involve the following:
- A comprehensive assessment of gait coordination using a measure such as the Gait Assessment and Intervention Tool (G.A.I.T.) 2, 3
- Evaluation of muscle activity and spasticity, particularly in the lower limbs, to determine the underlying cause of the rigid gait 4, 5
- Consideration of botulinum toxin therapy to reduce spasticity and improve gait ability, particularly in patients with focal spasticity 4, 5
- A physical therapy program that includes exercises to improve balance, strength, and flexibility, as well as gait training to enhance mobility and reduce the risk of falls 6
Assessment Tools
- The G.A.I.T. is a 31-item measure of coordinated movement components of gait and associated gait deficits, which has been shown to be reliable, valid, and sensitive to change 2, 3
- Kinematic gait measures, such as electromyography (EMG) and dynamic posturography, may also be used to assess gait coordination and muscle activity 5, 6
Treatment Options
- Botulinum toxin therapy may be an effective treatment for reducing spasticity and improving gait ability in patients with focal spasticity 4, 5
- Whole body vibration (WBV) and conventional physiotherapy may also be effective in improving balance and gait in patients with Parkinson's disease 6
- A comprehensive rehabilitation program that includes physical therapy, occupational therapy, and speech therapy may be necessary to address the complex needs of patients with rigid gait 6