What Gait Says About Aging and Brain Health


By the time we get to midlife, most of us have had an “Ah-hah” moment where we have considered our own mortality. While none of us can predict how or when we will meet our end, there are many things you can do now to influence how well your body ages over time. In fact, recent research suggests that how you walk at age 45 could help predict your cognitive health in the years to come.

Gait Analysis Applications

Your gait is defined by the way you walk and run. You can probably recognize familiar people from a distance, based on their gait, long before you see their faces. Gait analysis is a science that looks at all facets of human gait, including joint angles, muscle activation patterns, ground reaction forces and other measurable data. To give you an idea of how unique your gait is, gait analysis technology is now being used in China to identify individual citizens, much like facial recognition technology.

Gait analysis has many applications. It can help athletes fine-tune their performance, can be used to rehabilitate injuries and reduce their risk, and it can be used to assess and improve balance and stability in older adults. By extracting quantifiable data from technological tools, gait specialists can design rehabilitation programs that are specific to each individual patient.

The Link between Gait and Cognition

Impaired gait has always been associated with aging. Changes in gait over time are caused by multiple factors, including lifestyle behaviors, physical activity levels, changes in metabolic health, vision and hearing loss, pharmaceutical side effects, past injuries and a host of other variables. Deficits in gait increase the risk of falls and injury in older adults, and can lead to hospitalization, institutionalization and even death.

Gait performance falls under the umbrella of executive function, which governs planning, goal-based action and coordination of the complex factors involved in locomotion.

Multiple biological factors play a role in gait, including:

  • Musculoskeletal fitness
  • Cardiovascular fitness
  • Vision
  • CNS (central nervous system)
  • PNS (peripheral nervous system)
  • Cellular energy production
  • Vestibular system

In older adults with impaired cognition, or dementia, changes in gait are even more profound. The term “senile gait” refers to the reduced stride and shuffling gait often observed in cognitively impaired patients. Correlations between cognitive impairment and deficits in gait are well established in scientific literature.

How Midlife Gait Predicts Cognition in Older Age

The concept of using current health markers to predict potential future health issues is nothing new. Health care providers have been doing it for decades to predict lung cancer, heart disease, diabetes and other metabolic disorders, based on a patient’s lifestyle behaviors, blood serum profile and vital statistics.

As gait analysis technology evolves, scientists have begun to recognize that certain gait characteristics earlier in life may foreshadow cognitive decline over time. In fact, evidence suggests that gait deficits have their origins in the early developmental stages of childhood, when changes in the brain and central nervous system coincide with an infant’s mastery of crawling, standing, walking and running.

Gait Analysis and Neurodegenerative Disorders

Gait analysis at midlife is not only being used to predict potential cognitive decline, but specific gait patterns can now help differentiate between different types of dementia. By analyzing gait speed, step length variability and asymmetries in step time, up to 60 percent of dementia subtypes can be accurately identified.

For example, patients with Alzheimer’s disease have gait patterns distinct from those with Lewy body dementia. Because the two conditions are difficult to tell apart in the early stages, gait analysis can play an important role in helping patients, families and health care providers make important decisions about treatment and long-term care.

Data-Based Gait Analysis in NYC

There are many tests and assessments used to analyze gait, but many of them only give a generalized idea of gait deficits. An accurate and detailed data-based gait analysis requires advanced technological tools coupled with sophisticated computer software. NYDNRehab is one of the only private clinics in the United States equipped and trained to conduct research-grade gait analysis.

Our technological toolkit includes:

  • 3D motion capture video
  • SEMG (surface electromyography)
  • Force plate technology
  • Vestibular balance technology
  • C.A.R.E.N. (computer assisted rehabilitation environment)
  • Virtual reality feedback

Whether you are concerned about aging, want to improve your balance, or simply want to improve your gait to perform better and prevent injury, the team at NYDNRehab has the expertise and technology to provide you with accurate results and innovative interventions. Contact us today, and take the first steps toward healthy aging and a better long-term quality of life.


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Dr. Kalika’s experience comes from working with Prof. Pavel Kolar the renowned Czech School of Rehabilitation as well as Prof. Christopher Powers who is one of the worlds leader in treatment and prevention of running injuries. Another unique approach that Dr.Kalika is certified in is ISM (integrated system model) therapy.This approach is now used by most elite EPL soccer teams (Manchester city and Chelsea) to keep their players away from injuries as well as for in season rehabilitation. Dr. Kalika has knowledge not only in several different types of therapy he also has expertise with diagnostic ultrasound, gait and running analysis, orthopedics, and sports medicine. The combination of all these different experiences helps him correctly diagnose and rehabilitate athletes better than most clinics in NYC. Dr. Kalika has also studied under top leading running authorities like Brian Hidershide and Irene Davis. These experiences and extra training has given Dr. Kalika the unique expertise in running performance.


Despite 10 years of experience with instrumented gait analysis, attending multiple running medicine conferences, certification in clinical biomechanics, and personal experience with Chris Powers, I decided to undertake this additional certification to ensure that no single detail concerning the assessment and treatment of running injuries escapes me.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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