Parkinson disease is a progressive neurodegenerative disorder characterized by a variety of motor and nonmotor features. This article reviews the problems of postural instability and gait disturbance in persons with Parkinson disease through the discussion of (1) the neuropathology of parkinsonian motor deficits, (2) behavioral manifestations of gait and postural abnormalities observed in persons with Parkinson disease, and (3) pharmacologic, surgical, and physical therapy-based interventions to combat postural instability and gait disturbance. This article advances the treatment of postural instability and gait disturbance by condensing up-to-date knowledge and making it available to clinicians and rehabilitation professionals.

Walking is possible for many patients with a spinal cord injury. Avenues enabling walking include braces, robotics and FES. Among the benefits are improved musculoskeletal and mental health, however unrealistic expectations may lead to negative changes in quality of life. Use rigorous assessment standards to gauge the improvement of walking during the rehabilitation process, but also yearly. Continued walking after discharge may be limited by challenges, such as lack of accessibility in and outside the home, and complications, such as shoulder pain or injuries from falls. It is critical to determine the risks and benefits of walking for each patient.

Many people with multiple sclerosis MS (PwMS) have impaired balance and walking, and fall frequently. High-quality measures of imbalance and fall risk are essential for identifying who may benefit from interventions to improve balance and prevent falls, and for selecting the most appropriate interventions. We recommend the International Classification of Functioning, Disability and Health (ICF) model. Many measures are available to assess factors affecting balance, fall risk, and walking at the different levels of the ICF. Combining these measures provides the most complete assessment of the individual and the best guidance for interventions by the health care team.

Walking impairment is a common consequence of multiple sclerosis (MS) that can result in substantial limitations of daily activities and compromised quality of life. Walking impairment is often monitored as an indicator of disease and neurologic disability progression. The worsening of walking performance while undertaking a cognitive task underscores the role of nonmotor impairments in ambulation limitations. Walking impairment has ubiquitous and life-altering consequences, underscoring the importance of continued efforts to identify approaches to prevent and forestall this event, and to restore walking ability in persons with MS.

Neurologic rehabilitation interventions may be either therapeutic or compensatory. Included in this article are lower extremity functional electrical stimulation, body weight-supported treadmill training, and lower extremity robotic-assisted gait training. These poststroke gait training therapies are predicated on activity-dependent neuroplasticity. All three interventions have been trialed extensively in research and clinical settings to show a positive effect on various gait parameters and measures of walking performance. This article provides an overview of evidence-based research that supports the efficacy of these three interventions to improve gait, as well as providing perspective on future developments to enhance poststroke gait in neurologic rehabilitation.

Interacting with other people and the environment is fundamental to quality of life. Canes, walkers, and crutches increase, maintain, or improve functional capabilities of many individuals with neurologic disorders. Canes offer a choice of handle, shaft, and base. Walkers have various types of base, uprights, handgrips, platforms, and accessories. Crutch designs include underarm, triceps, forearm, and platform. Orthoses, particularly ankle foot orthoses and knee ankle foot orthoses, are often used to stabilize or immobilize lower limb segments while walking. Studies have shown the benefits of traditional assistive devices on gait, when prescribed and used properly.

There are several traditional and nontraditional strategies available for the rehabilitation of ambulatory limitations in adults with central neurologic disorders. Traditional strategies may include therapies such as exercise training and conventional gait training. Nontraditional rehabilitation strategies typically involve advanced therapeutic technologies or devices. We describe several ambulatory rehabilitation strategies providing advantages, disadvantages, and common applications of these modalities. Feasibility, cost effectiveness, accessibility, and training specificity of the various modalities are also compared. Rehabilitation strategies should be selected based on the specific ambulatory impairments and rehabilitation needs of each patient.

Many stroke survivors have walking limitations. The results of gait training in individuals who have had strokes are characterized by large confidence intervals for mean differences in gait parameters. An individualized approach to therapy is needed, based on personalized gait pattern indicators and sensorimotor impairments. Three-dimensional gait analysis can help clinicians design the best locomotor training strategy for their patients, and can determine whether a patient is responding to the chosen intervention. Spatiotemporal parameters allow the characterization of the gait of hemiparetic patients but, used alone, they do not allow the cause of the deviations to be inferred.