What are Functional Gait Disorders (Walking Problems)?

A functional movement disorder means that there is abnormal movement or positioning of part of the body due to the nervous system not working properly (but not due to an underlying structural neurological condition that can be seen on a scan).

A variety of gait (walking) problems can occur as part of a functional disorder. As with all functional disorders, these do not occur because people walk like this on purpose. The movement and gait are involuntary.

In 2016 Miranda Licence, from Queensland, Australia, made a short film describing her experience with functional gait disorder with her uncle Jeff Licence, from ABC Open.

I’m really grateful to Miranda and Jeff for allowing me to share their story on this site.

This film tells you a lot about what it’s like to have a functional gait disorder and how treatment can help. Below that you can read more about different types of functional gait disorder and their treatment.

These are the most common types of functional gait disorder

1. Dragging Gait of Functional Leg Weakness

One of the most common functional gait disorders is the ‘dragging’ gait seen in patients with functional weakness of one leg. You can read more about functional leg weakness here.

People with this kind of leg weakness find that the leg drags along the ground. It doesn’t often look as dramatic as this. The ankle is often turned in or out as in this picture. Some people feel like their foot is stuck to the ground almost like a magnet.

2. Sudden knee buckling. Typically this is also associated with a finding of functional weakness in one or both legs. Sometimes if both legs buckle at the same time it leads to a ‘drop attack’, although it is important to recognise that there may be other causes of this such as knee problems.
3. Small slow steps (‘walking on ice’) gait. This is a generally unsteady gait where the person takes small steps almost as if they are ‘walking on ice’. The legs are quite stiff and the feet far apart. The reason people get in the habit of walking like this is often because they have had a fall and are concerned about future falls.
4. Swaying gait. This is a type of walking where the person sways from side to side, especially in their upper body, and the legs tend to correct the movements. The person looks as if they are going to fall over but then is able to catch themselves.
5. Hyperkinetic gait. Functional movement disorders can sometimes cause quite dramatic excessive movements of the arms, trunk or leg. Some people have these particularly when they walk.
6. Crouching gait. This is a rare form of functional gait disorder in which the person looks as if they are crouching. This is often associated with a fear of falling.

Functional Standing Problems

This is a problem called astasia. It means that the person has trouble standing still but can walk normally. It can be diagnosed by seeing if the problems standing go away when the person is distracted (for example playing a game on a phone or guessing some numbers written on their back).

How is the diagnosis made?

The diagnosis of a functional gait disorder is usually made by a neurologist. It can be a difficult diagnosis to make because it requires expert knowledge of the full range of movement disorders due to neurological disease, many of which are unusual or even bizarre.

Even neurologists should be especially careful making a diagnosis of functional gait disorder. We know from studies that gait disorder is more commonly misdiagnosed as functional than other functional disorders.

But that doesn’t mean the diagnosis can’t be made.

Features that help with the diagnosis include:

1. Evidence of positive signs of functional tremor or functional limb weakness on examination
2. Frequent sidesteps and a gait that is uneconomical (ie actually takes more energy than a normal gait)
3. Walking improves when walking backwards
4. Walking improves when changing the rhythm or speed of the gait
5. Walking improves when listening to music
6. Problems with balance when standing improve when the person is asked to carry out another task like guessing numbers written on their back or playing a game on a mobile phone

Treatment of Functional Gait Disorder

Physiotherapy from someone who understands functional neurological disorders is the most important part of treatment.

Some of the things that may help may look a bit crazy when you see them written down. But they are all designed to help the brain regain ‘automatic’ movement in a situation where the normal pattern of movement has been “corrupted”.

This is a good example of why it’s important to have confidence in the diagnosis in order for treatment to help. If you thought that no one knew what was wrong it would be understandable that you might be reluctant to try the things listed below.

1. Try humming a tune or singing a song (in your head if you need to!) while walking. Has this made it easier to walk?
2. Try walking backwards if you have difficulty walking. Walking backwards is a different ‘program’ in the brain and you may be surprised to find that it’s easier than walking forwards.
3. Running. For patients that are able, sometimes a slight jog makes it easier to move. This is a bit like someone with a stutter who has problems speaking but can sing normally.
4. If you are trying to set off walking and can’t try standing still and shifting your weight from side to side for a few seconds before carrying on.
5. Try sliding on your feet as if you are ice-skating. Does this help your walking feel any better?
6. What movement activities have you enjoyed before in your life? Did you like dancing or sports? Can you use some of those ‘learned’ movements to help promote automatic movements?