How Does Ataxia Impact Walking? Understanding Gait Ataxia

Have you or someone you love been diagnosed with Friedreich ataxia or another form of ataxia? If so, you have likely noticed problems with walking. This can look different for different people, depending on the form of ataxia someone has.

Here’s what you need to know about walking challenges with ataxia, including how this symptom can present, how walking is evaluated by a doctor, and how to manage these issues. This can help you keep yourself or your loved one safe and have informed conversations with healthcare professionals.

Ataxia and Walking

Ataxia involves poor muscle control that can affect a variety of movements, including walking. Issues with walking that are associated with ataxia may be called gait ataxia, or an ataxic gait.

The cerebellum is the part of the brain that controls muscle coordination. Damage to the cerebellum or its nerve pathways can result in cerebellar ataxia. Problems with walking may be one of the first signs you see in some types of ataxia, like Friedreich ataxia.

Some signs of gait ataxia are:

• Walking with the legs wide
• Unsteady walking
• Difficulty when standing up or moving quickly (running)
• Walking like someone who has had too much alcohol
• Stumbling frequently
• Veering from a straight line
• Movements that are irregular and not coordinated with each other

These problems can make walking in everyday life difficult. Some common walking challenges that people with ataxia face are:

• Trouble on uneven ground, like stairs and curbs
• Frequent falls
• A need to look at their feet, to place each step in a safe spot
• Increased problems with balance in the dark, when they can’t see their feet and the ground (typical for sensory ataxia)

This can make things like navigating grocery aisles, walking while carrying objects like shopping bags, and maneuvering through crowded spaces very difficult. People with ataxia may need additional support in these kinds of situations.

Evaluating Walking Symptoms From Ataxia

Managing walking symptoms in ataxia usually starts with assessing a person’s way of walking, or their gait. Health experts will determine exactly how much walking has been affected by ataxia. From there, they’ll be able to make specific recommendations on how to manage gait issues that can help people with ataxia stay safe and maintain their quality of life.

There are a number of tests that a healthcare provider might do to evaluate gait. Some of these are straightforward tests that can be done in an office, while others require specialized imaging. Your doctor may use one or more of these.

Heel-to-Toe Test

In the heel-to-toe test, or tandem walking, the person being tested will be asked to walk forward in a straight line while placing the heel of the front foot directly in front of the toes of the standing foot. People with ataxia may be jerky, have an unsteady gait, need to spread their legs for balance, stagger off the straight line, or even fall.

Heel-to-Shin Test

In the heel-to-shin test, the person being tested will be asked to run one heel down their opposite shin. Struggling to keep their heel on their shin may be a sign of ataxia.

Romberg Test

In the Romberg test, the person being tested will be asked to remove their shoes and stand still with their feet together and eyes open in the first stage. They will then be asked to stand still with their eyes closed. In cerebellar ataxia, the person will be unsteady in both stages, while in other conditions, the person will sway or fall over only when their eyes are closed (sensory ataxia).

Other Tests

If your doctor needs more information, they may run tests like an MRI or a nerve conduction study. The MRI allows them to see detailed images of your body, including the brain and cerebellum, to help them find the cause of your gait problems. A nerve conduction study looks at the nerves of the arms and legs and helps your doctor understand how well the nerves are working.

Managing Walking Symptoms From Ataxia

Once a healthcare professional has assessed your gait, they can help you come up with ways to manage your walking symptoms. They may work closely with you to understand how problems with walking affect your daily life, so they can come up with specific solutions based on your particular needs.

Physical Therapy

Your doctor will likely send you to physical therapy for ataxia, no matter which part of your body is affected the most. Physical therapists can help develop exercise programs that will help you move and function better.

For example, your physical therapist may design a balance program. Staying consistent with these exercises at home can help you achieve the best results. In one small study, this kind of program helped people improve their walking. They took larger steps, spent more of their walking time supported by only one foot, and even stood up and started walking faster.

Assistive Devices

If you need extra support to stay mobile and independent, assistive devices such as canes, hiking sticks, and walkers can help you walk better and avoid falls. Some people may also choose to use a wheelchair, at least some of the time, so they can stay active without walking.

Modifying Your Home

There are things you can do around your house to make balance easier and make it less likely that you’ll fall. You can implement as many of these as you need to in order to stay safe.

• Install secure handrails on both sides of stairs and anywhere else that’s difficult to navigate.
• Keep your floors clean so there’s nothing to walk around or slip on.
• Make sure you have good lighting with switches that are easy to access in locations where you need it most.
• Place grab bars in your bathroom and around any chairs that are hard to get out of.
• Use a shower chair so you can sit when you bathe.
• Use motion-activated lights in the bathroom and other places where you walk at night, so you don’t have to find switches in the dark.
• Use nonskid mats or carpets instead of throw rugs or bathroom rugs.
• Put the things you use the most in places that are easy to reach.
• Make sure all stairs are even and not broken.
• Move your furniture around until it’s arranged in a way that’s easy for you to walk around.
• Raise your sofas and chairs if this makes them easier to get in and out of.

If you’re not sure whether your home is safe or not, talk to a healthcare professional to find out more.

Talk to Your Doctor

If you don’t already have a condition that causes ataxia, you should see a doctor anytime you have neurological symptoms like loss of balance, trouble with walking, coordination issues in a hand, arm, or leg, or problems speaking or swallowing.

You should also seek urgent medical attention if you have sudden new symptoms such as:

• Numbness or weakness in a body part or on one side of the body
• Loss of balance, trouble walking, dizziness, nausea, vomiting, or problems with coordination
• Vision problems in one or both eyes
• Confusion, difficulty speaking, or problems understanding speech
• Severe headache
• Difficulty swallowing

These can be signs of a stroke and require immediate medical attention.

Join the Conversation

On MyAtaxiaTeam, people share their experiences with ataxia, get advice, and find support from others who understand.

How has walking changed for you because of ataxia? Let others know in the comments below.