What were you thinking?

We were just talking about cognitive tasking and arm swing, and have talked about cognition altering gait. Here is a another paper on cognition (or inattention in this case) boding not so well


ABSTRACT: We examined factors related to conditions of life function and falls, including eye movements and gait variability, in community-dwelling older adults in Japan.

METHODS: Participants were 82 older adults (21 men, 61 women, mean age 76.1 years). We measured eye movements and gait variability during walking, and cognitive, attentional and life function. We compared two groups according to their fall history, and used a multiple logistic regression analysis to determine its relevance.

RESULTS: Fixation time, which was estimated from eye movements during obstacle crossing, and gait variability (vertical) were significantly associated with falls. There was also a significant correlation between fixation time and gait variability during obstacle crossing. In other words, the higher the gait variability in older adults, the higher the risk of falls, which was due to reduced attention estimated from eye movements during obstacle crossing that required obstacle avoidance.

CONCLUSIONS: These results show that poor attention during gait is a critical risk factor for falls in community-dwelling older adults. For fall prevention, it is necessary to promote exercises for attention, and to maintain an older adult-friendly pedestrian environment.



Inoue T, Kamijo K, Haraguchi K, Suzuki A, Noto M, Yamashita Y, Nakamura T. Risk factors for falls in terms of attention during gait in community-dwelling older adults. Geriatr Gerontol Int. 2018 Jun 27. doi: 10.1111/ggi.13462. [Epub ahead of print]


Vitamin D and Gait?


So, is it the effects on calcium and nerve function (neurotransmitter release), the effects on calcium and muscular contraction, the antioxidants properties, some other function? Supplementing Vitamin D and getting people more sun exposure are easy things to do...

"These findings reveal an important new relationship between parathyroid hormone and gait stability parameters and add to understanding of the role of 25-OHD in motor control of gait and dynamic balance in community-dwelling women across a wide age span."

Bird MLEl Haber NBatchelor FHill KWark JD. Vitamin D and parathyroid hormone are associated with gait instability and poor balance performance in mid-age to older aged women. Gait Posture. 2017 Sep 28;59:71-75. doi: 10.1016/j.gaitpost.2017.09.036. [Epub ahead of print]



What? Gait and hearing....

No, not how does the gait SOUND, but can they hear? We have long payed attention to the mechanics of gait, muscles and proprioception, and many times, if you have been following us for any length of time, the interplay of all three. But how often have you considered someones hearing in your evaluation?

Anatomically, the hearing organs (hair cells, otolithic apparatus, cochlea) are conveniently located right next store to the vestibular system (utricle, saccule and semicircular canals). The hearing organs start with mechanical vibrations of the tympanic membrane (ear drum) which move 3 auditory bones (or ossicles) called the incus, malleus and stapes. The vibrations move the stapes moves in and out of the fluid filled cochlea and vibrate crystals laying on a platform (otolith) in which hair cells are imbedded and if the vibration sufficient, the nerves attached to the hair cells fire and you can hear your favorite baseline by Cliff Williams (or Cliff Burton, John Myung, Bootsy Collins or whomever you like to listen to).

The vestibular system, as you probably know, monitors position and velocity of movement of the head. There are three hula hoop type structures called “semicircular canals” (see picture above) that monitor rotational and tilt position and angular acceleration, as well as two other structures, the utricle and saccule, which monitor tilt and linear acceleration.

The vestibular apparatus (the canals and the utricle and saccule) feed into a part of the brain called the floccular nodular lobe of the cerebellum, which as we are sure you can imagine, have something to do with balance and coordination. This area of the cerebellum feeds back to the vestibular system (actually the vestibular nucleii); which then feed back up to the brain as well as (you guessed it) down the spinal cord and to predominantly the extensor muscles.

Can you see how the 2 systems are “attached” to one another and could conceivably be interrelated? When you move fluid in one system (endo or peri lymph) you HAVE to move fund in the other. The fluid displaces, (like air, in air filled shoes or insoles), it does not deform (like EVA in an insole)

It is well established that hearing impaired folks (especially kids) have gait (and often balance) problems (1-3) and the worse the hearing loss, the worse the gait disturbance (1). This can occur in middle aged (4), as well as older adults as well (5-7). Perhaps this is due to viscosity changes in the endo or perilymph (8), otosclerosis of the ossicles (9,10) or other age related changes in utricle and saccule function (5-7). Also, for the 1st time, we are documenting a “sensory reweighting” which occurs when auditory cues are changed (4), with a greater reliance on visual cues. Hmmm. We wonder how this plays out with listening to music while walking or running?

So, The next time someone you see has a gait or balance problem, check their hearing and adjust your treatment program accordingly : )


1. Melo RS.  Gait performance of children and adolescents with sensorineural hearing loss.
Gait Posture. 2017 Jun 3;57:109-114. doi: 10.1016/j.gaitpost.2017.05.031.

2. Jafarnezhadgero AA, Majlesi M, Azadian E. Gait ground reaction force characteristics in deaf and hearing children. Gait Posture. 2017 Mar;53:236-240. doi: 10.1016/j.gaitpost.2017.02.006. Epub 2017 Feb 14.

3. Janky KL, Givens D.Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants: A Preliminary Report. Ear Hear. 2015 Nov-Dec;36(6):e364-72. doi: 10.1097/AUD.0000000000000194.

4. Maheu M, Sharp A, Landry SP, Champoux F. Sensory reweighting after loss of auditory cues in healthy adults. Gait Posture. 2017 Mar;53:151-154. doi: 10.1016/j.gaitpost.2017.01.015. Epub 2017 Jan 24.

5. Agmon M, Lavie L, Doumas M. The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review. J Am Acad Audiol. 2017 Jun;28(6):575-588. doi: 10.3766/jaaa.16044. Review.

6. Layman AJ1, Li C, Simonsick E, Ferrucci L, Carey JP, Agrawal Y. Association Between Saccular Function and Gait Speed: Data From the Baltimore Longitudinal Study of Aging. Otol Neurotol. 2015 Jan 7. [Epub ahead of print]

7. Otol Neurotol. 2012 Jul;33(5):832-9. doi: 10.1097/MAO.0b013e3182545061.
Decline in semicircular canal and otolith function with age.
Agrawal Y1, Zuniga MG, Davalos-Bichara M, Schubert MC, Walston JD, Hughes J, Carey JP.

8. Wu T, Marcus DC. Age-Related Changes in Cochlear Endolymphatic Potassium and Potential in CD-1 and CBA/CaJ Mice . JARO: Journal of the Association for Research in Otolaryngology. 2003;4(3):353-362. doi:10.1007/s10162-002-3026-6.

9. Grayeli AB1, Sterkers O, Toupet M. Audiovestibular function in patients with otosclerosis and balance disorders. Otol Neurotol. 2009 Dec;30(8):1085-91. doi: 10.1097/MAO.0b013e3181b0fd5d.

10. Ozmen AO1, Aksoy S, Ozmen S, Saraç S, Sennaroğlu L, Gürsel B. Balance after stapedotomy: analysis of balance with computerized dynamic posturography. Clin Otolaryngol. 2009 Jun;34(3):212-7. doi: 10.1111/j.1749-4486.2009.01915.x.


Higher Level Gait Disorders

How deep are you willing to take your gait understanding ?

“In conclusion, these data suggest that the gait and balance deficits in higher level gait disorders (HLGD) mainly result from the lesion or dysfunction of the network linking the primary motor cortex and the mesencephalic locomotor region (MLR), brain regions known to be involved in the control of gait and balance, whereas cognitive and ‘appendicular’ hypokinetic-rigid signs mainly result from deep white matter lesions (DWML) that could be responsible for a dysfunction of the frontal cortico-basal ganglia loops.”

J Neurol. 2014 Jan;261(1):196-206. doi: 10.1007/s00415-013-7174-x. Epub 2013 Nov 8.
High-level gait and balance disorders in the elderly: a midbrain disease?
Demain A

Podcast 40: Trips, Falls and NFL Shoe Injuries

Today we talk about trip and fall incidence, the NFL shoe injury epidemic and so much more ! Join us today on The Gait Guys podcast !

A. Link to our server:


B. iTunes link:


C. Gait Guys online /download store (National Shoe Fit Certification and more !) :


D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

* Today’s show notes:

1. Foramen magnum position in erect ambulation
1b: Scientists Identify Protein Linking Exercise to Brain Health

2.  More on Cannabinoids
5.  NFL shoes and injuries
6. From a Blog reader:
Hi guys,
I have been having major leg issues sine my ACL reconstruction  … .
Our DISCLAIMER !, hear it on the podcast. We are NOT your doctor !
7.  From a Blog reader:
Hello, I’m a 19 year old runner trying to get rid of my crossover gait … 
8. Another one from a blog reader
Hi, I have a question about externally rotated hip. When i bring my knee up to my chest, my leg turns outward … 
9.  Blog
Im really confused with GaitGguys, I follow but this time mixed messages. Recent video showed was varus/lateral boarder push off gait, girl in tennis shoes … 
Hi, my name is Paige. I have been working in a sports medicine outpatient clinic for about 2 months now. I love your podcast and recommend it to as many clinicians as possible. I watched your youtube videos on the shuffle gait and have been implementing them into a patient’s home program. They are working great and the patient loves them as well! Just wanted to let you know! I love the videos and hope to take your shoe fit program at some point! You are geniuses and excellent instructors. I’ve learned so much already that we just don’t get enough of in school!
Thanks so much!