Objective: This paper sought to elaborate on the mechanism of  higher level gait disorder and recent advances in physiotherapy practice that will be of important in its management.

Background: Higher-level gait disorders are difficult to treat because they can mimic symptoms of middle and lower-level gait dysfunction while refusing to respond to pharmacological treatments for those levels of gait dysfunction . Alternative pharmacological methods are becoming increasingly important due to the lack of effective drugs and the complexity of higher-level gait disorders. Because antiparkinsonian medicines may be ineffective for higher gait disorder, even when it present with Parkinson’s symptoms, physiotherapy is sometimes the only recommended treatment option for high-level Gait disorders.

Method: Keyword searches in PubMed and other databases include Higher level gait disorders, physiotherapy management (non-invasive brain stimulation; transcranial, alternating and direct, electrical stimulation ; and gait training in the form of exercise therapy, biomechanical support and manual therapy) were investigated.Themes were drawn from the results obtained and discussed under the following headings: Higher-level gait disorder, higher-level gait disorder mechanism and assessment and recent advances in physiotherapy management

Results: Disintegrating mechanical stimuli resulting from impaired somatic sensory thalamus and/or primary somatic sensory cortex, as well as impaired descending control systems that may be motor cortex-related, anxiety-related, or psychogenic, cause higher-level gait disorders. It necessitates a multi-disciplinary approach, and recent advances in physiotherapy management include non-invasive brain stimulation (transcranial direct current stimulation), robotic equipment, and biomechanical approach for supporting equipment, as well as multi-component gait training such as the Otago exercise regime.

Conclusion: Physiotherapeutic approaches such as therapeutic exercises in the form of gait training and non-invasive brain stimulation can help with higher-level gait disorders. However, the efficacy of transcranial direct current stimulation is still being studied, so it should be used with caution.

References: Longhurst J, Phan J, Chen E, Jackson S, Landers MR. Physical Therapy for Gait, Balance, and Cognition in Individuals with Cognitive Impairment: A Retrospective Analysis. Rehabilitation research and practice. 2020 Nov 3;2020. Modesto PC, Pinto FC. Home physical exercise program: analysis of the impact on the clinical evolution of patients with normal pressure hydrocephalus. Arquivos de neuro-psiquiatria. 2019 Dec;77(12):860-70. Pirker W, Katzenschlager R. Gait disorders in adults and the elderly. Wien Klin Wochenschr. 2017;129(3):81–95. Manji A, Amimoto K, Matsuda T, Wada Y, Inaba A, Ko S. Effects of transcranial direct current stimulation over the supplementary motor area body weight-supported treadmill gait training in hemiparetic patients after stroke. Neuroscience letters. 2018 Jan 1;662:302-5. Kaski D, Bronstein AM. Treatments for neurological gait and balance disturbance: the use of noninvasive electrical brain stimulation. Advances in Neuroscience. 2014 Dec 3;2014.

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