What is an ataxic gait?

What is an Ataxic Gait?

Ataxic gait is an unsteady, uncoordinated walking pattern characterized by a widened base, irregular steps, and lateral veering that results from the inability to generate coordinated voluntary movement. 1

Core Definition and Pathophysiology

Ataxia represents the inability to generate coordinated voluntary movement, manifesting clinically with clumsiness, abnormal or unsteady gait, dysmetria, dysdiadochokinesis, or dyssynergia. 1 The cerebellum is the dominant cause of ataxia, though disruptions in several neuronal circuits affecting the basal ganglia, cerebral cortex, spinal cord, peripheral nerves, sensory system, and vestibular system can also produce ataxic gait patterns. 1

Patients with ataxia demonstrate delayed movement initiation, timing errors, abnormal limb trajectories, and dysmetria. 1

Clinical Characteristics of Ataxic Gait

The cardinal features of cerebellar ataxic gait include:

• Widened base of support to compensate for instability 2
• Unsteadiness and irregularity of steps with highly variable gait measurements 2
• Lateral veering during ambulation 2
• Reduced step frequency with prolonged stance and double limb support duration 2
• Increased temporal variability of intra-limb coordination patterns, which is specific to cerebellar dysfunction and distinguishes it from other movement disorders 3

Distinguishing Types of Ataxic Gait

Cerebellar Ataxia

Cerebellar ataxia does not significantly worsen with eye closure, as the primary deficit involves coordination centers rather than sensory pathways. 4, 5 Associated cerebellar signs include nystagmus, dysmetria, and intention tremor. 4

Sensory (Proprioceptive) Ataxia

Sensory ataxia dramatically worsens when visual input is removed (positive Romberg test), as patients rely heavily on vision to compensate for proprioceptive loss. 4, 5 This wide-based, unsteady gait has a stamping quality due to impaired proprioceptive feedback about limb position. 5 Unlike cerebellar ataxia, sensory ataxia typically presents with sensory loss and hyporeflexia but lacks nystagmus, dysmetria, or intention tremor. 4, 5

Vestibular Ataxia

A lurching gait triggered by head rotation is typical of vestibular dysfunction. 1

Anatomical Correlations

Truncal ataxia specifically indicates cerebellar vermian pathology. 1 Ataxia is present in 68% to 86% of patients with brainstem stroke. 1 The temporal variability of gait patterns correlates with deficits in control of limb dynamics and intra-limb coordination for goal-directed movements, suggesting common cerebellar mechanisms are involved. 3

Important Clinical Pitfalls

• Do not confuse ataxia with muscle weakness, hypotonia, or sensory disturbances that may mimic ataxic gait patterns. 1
• "Pseudoataxia" can occur with functional disorders, requiring careful clinical distinction. 1
• Postictal ataxia may present in children with epilepsy. 1
• The Romberg test is critical for distinguishing sensory from cerebellar ataxia—sensory ataxia worsens dramatically with eye closure while cerebellar ataxia remains relatively unchanged. 4, 5

Prognosis and Functional Impact

Ataxia typically improves during acute rehabilitation, with better functional recovery when ataxia occurs without concurrent hemiparesis. 1 However, ataxia can negatively affect the quality of use of the functional hand because cerebellar lesions impair motor learning. 1 Despite this, intensive task-oriented therapy may improve motor performance and actual use of ataxic limbs. 1