Gait: Striding Towards Accurate Diagnosis

Podcast Transcript

Neuro Pathways Podcast Series

Release Date: July 15, 2025
Expiration Date: July 14, 2026

Estimated Time of Completion: 30 minutes

Gait: Striding Towards Accurate Diagnosis
James Liao, MD

Description
Each podcast in the Neurological Institute series provides a brief, review of management strategies related to the topic.

Learning Objectives

• Review up to date and clinically pertinent topics related to neurological disease
• Discuss advances in the field of neurological diseases
• Describe options for the treatment and care of various neurological disease

Target Audience
Physicians and Advanced Practice providers in Family Practice, Internal Medicine & Subspecialties, Neurology, Nursing, Pediatrics, Psychology/Psychiatry, Radiology as well as Professors, Researchers, and Students.

ACCREDITATION

In support of improving patient care, Cleveland Clinic Center for Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

CREDIT DESIGNATION

• American Medical Association (AMA)
  Cleveland Clinic Center for Continuing Education designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  
  Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit.

• American Nurses Credentialing Center (ANCC)
  Cleveland Clinic Center for Continuing Education designates this enduring material for a maximum of 0.50 ANCC contact hours.

• Certificate of Participation
  A certificate of participation will be provided to other health care professionals for requesting credits in accordance with their professional boards and/or associations.

• American Board of Surgery (ABS)
  Successful completion of this CME activity enables the learner to earn credit toward the CME requirements of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

Credit will be reported within 30 days of claiming credit.

Podcast Series Director
Andreas Alexopoulos, MD, MPH
Epilepsy Center

Additional Planner/Reviewer
Cindy Willis, DNP

Faculty
James Liao, MD
Center for Neurological Restoration

Host
Glen Stevens, DO, PhD
Cleveland Clinic Brain Tumor and Neuro-Oncology Center

Agenda

Gait: Striding Towards Accurate Diagnosis
James Liao, MD

Disclosures

In accordance with the Standards for Integrity and Independence issued by the Accreditation Council for Continuing Medical Education (ACCME), The Cleveland Clinic Center for Continuing Education mitigates all relevant conflicts of interest to ensure CME activities are free of commercial bias.

The following faculty have indicated that they may have a relationship, which in the context of their presentation(s), could be perceived as a potential conflict of interest:

James Liao, MD	Strolll Consulting Advisor or review panel participant
Glen H Stevens, DO	DynaMed Consulting

All other individuals have indicated no relationship which, in the context of their involvement, could be perceived as a potential conflict of interest.

CME Disclaimer

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by The Cleveland Clinic Foundation. In no event will The Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provided through this CME activity.

HOW TO OBTAIN AMA PRA Category 1 Credits™, ANCC Contact Hours, OR CERTIFICATE OF PARTICIPATION:

Go to: Neuro Pathways Podcast July 15, 2025 to log into myCME and begin the activity evaluation and print your certificate If you need assistance, contact the CME office at myCME@ccf.org

Copyright © 2025 The Cleveland Clinic Foundation. All Rights Reserved.

Introduction: Neuro Pathways, a Cleveland Clinic podcast exploring the latest research discoveries and clinical advances in the fields of neurology, neurosurgery, neurorehab, and psychiatry.

Glen Stevens, DO, PhD: Subtle changes in a patient's walking pattern can serve as an early indicator of an underlying neurologic condition. In today's episode, we're exploring the latest advancements in assistive technologies, including augmented reality and genetic testing that are helping clinicians track and interpret these cues more effectively. Join us as we translate groundbreaking research into practical knowledge, equipping you with the tools to enhance your diagnostic acumen and patient care.

I'm your host, Glen Stevens, neurologist, neuro-oncologist at Cleveland Clinic's Neurological Institute. And joining me for today's conversation is Dr. James Liao. Dr. Liao is a movement disorders neurologist and researcher in Cleveland Clinic Neurological Institute's Center for Neurological Restoration. James, welcome to Neuro Pathways.

James Liao, MD: Thank you. It's great to be here.

Glen Stevens, DO, PhD: So James, if you were one of my kids growing up, the game that we used to play was I would say to the kids, "Name that disorder." And we would see somebody walking, and I would ask them what the patient's neurologic disorder was. It was always my belief that if we could only ever do one physical exam test, it would be having somebody walk. And my kids have, none of them are in the medical field, but they're really good at diagnosing someone's abnormality based on what their gait pattern looks like.

And even though the kids have gone, I still do it with my wife who's pretty good, but I think they're all getting tired of it. But I think it's such an important part. And I remember back in the day when we'd have patients come back, it was a great opportunity to see them out in the waiting room and come back to the office, and you could learn so much just watching their gait pattern as they came back. And now there's so much virtual and that type of stuff that I think we lose some of that. But thoughts on that or do you do that with your family? Am I the only one?

James Liao, MD: So, it's so funny that you say that. One of my favorite hobbies is people watching and I am thinking about what type of gait problem that those people may have. So I do the same thing I think. I agree that if you only had to do one part of the neuro exam, it's the gait because you can see the whole body working together to accomplish a normal gait. It's very high yield dense part of the exam, so I agree.

Glen Stevens, DO, PhD: The other thing I'll mention is that people don't appreciate your coming up and talking to them though about their gait abnormality, so you do need to keep it to yourself.

James Liao, MD: Absolutely, yes.

Glen Stevens, DO, PhD: Tell us a little bit about yourself. Tell us where you came from, how you made it to Cleveland, and what you do on a regular basis.

James Liao, MD: Yeah, I grew up in California, and I applied to medical schools. I was looking at MD-PhD programs. My undergraduate training was in electrical engineering and computer science, so basically I applied for every program that had a biomedical engineering PhD program and Case was one of them. And I happened to get in here and I've been in Cleveland ever since. So I went to Case Med and did neurology residency at UH across the street from Cleveland Clinic, got a PhD in the Case BME program, biomedical engineering, did a fellowship training at Cleveland Clinic in movement disorders, and now I'm doing things that harness technologies to help diagnose and monitor and treat movement disorders.

Glen Stevens, DO, PhD: Well, with your engineering background, it's just perfect.

James Liao, MD: Yes. I'm very lucky to be able to leverage all of that experience. Yeah.

Glen Stevens, DO, PhD: And where are you on Main Campus? Do you go to any of the other campuses? Where are you?

James Liao, MD: Yeah, mostly at Main Campus. I do go to Hillcrest on Fridays. All the patients love going to Hillcrest because it's easier to park, so we're booked out quite far there. But Main Campus the other days.

Glen Stevens, DO, PhD: What are some of the most common causes of gait disorder that are out there?

James Liao, MD: Yeah, great question. So in the age of patients that we typically see, I would say probably lumbar spine issues or peripheral neuropathy is the most common. But as you know, and as all neurologists know, really the entire nervous system and the entire body is involved in producing a normal gait, so it can range from a cognitive problem or a mood problem. We might call those a higher level gait disorder. Could be a neurodegenerative condition like Parkinson's affecting the speed of movements. It could be a cerebellar problem, brain stem, spinal cord, the vestibular system, the visual system, the muscles, if there's any weakness that would affect the gait, peripheral nerves, joints, blood pressure, pain, everything. So when people come in with a gait problem, we really have to keep our mind open and be willing to find all kinds of potential problems.

Glen Stevens, DO, PhD: So, I guess the ask would be that unless if it's not an orthopedic structural problem and someone's having an abnormal gait, would probably be worthwhile to have them evaluated by someone that's used to looking at gait disorders and take the appropriate history and move forward.

James Liao, MD: Absolutely. Yes. So I think one key message that I want to convey is that we often do identify treatable causes of gait impairment that have just kind of been missed because, I'm not blaming anybody, but these gait impairments, they do all look similar, so it's easy to overlook something, but I think it's pretty common that we, for instance, identify someone with unrecognized vitamin B12 deficiency and a severe neuropathy or a cervical stenosis with cord compression. I think we've probably, every neurologist has identified one of those cases, so it definitely can only help to refer to a neurologist.

Glen Stevens, DO, PhD: Can you elaborate on some of the different types of gait that you see based on various disorders?

James Liao, MD: Yeah. Yeah, absolutely. There are some classic gait impairments. There's, for instance, a steppage gait that we see in people with neuropathies. There's the Trendelenburg gait that if there's a hip weakness. There's a ataxic gait where the width of the steps can vary, sometimes wide, sometimes narrow.

Glen Stevens, DO, PhD: I think that's the Friday night gait.

James Liao, MD: Yes.

Glen Stevens, DO, PhD: For a lot of people.

James Liao, MD: That does happen. There's a hemiplegic or circumducting gait, there's a Parkinsonian gait, and there's more than that. There's a choreiform gait. So sometimes these classic gaits, they are more associated with particular underlying causes. Sometimes it's not clear. For instance, in a Parkinsonian gait for instance, there's many conditions that manifest as a Parkinsonian gait, so we do have to be careful and sometimes apply additional tests to try to clarify which one it is.

Glen Stevens, DO, PhD: One of the things I like about going to a movement disorders talk is there's always lots of videos.

James Liao, MD: Absolutely.

Glen Stevens, DO, PhD: And I love looking at the videos. I find a lot of the movement disorders things difficult. You hear something and you can talk about it, but visualizing it becomes just embedded in your brain and you've seen it and now you go, "Yes, I recognize that." And hence you and I when we're out in public and we see that happening, it becomes so much easier to recognize as you move through, but it's always one of the things I liked.

What techniques do you employ to identify the gait disorders?

James Liao, MD: Yeah, the most important part is to do a complete neuro exam and take a good history. I would say that several times a week a patient comes in and the problem is a gait disorder and I have to do this. I do this all the time. Sometimes it's clear that there's a collection of symptoms that add up to a pretty solid explanation. For instance, we do see a lot of people with Parkinson's. If we see rest tremor on one side, usually rigidity and some kind of shuffling gait with short steps, well that's Parkinson's is high in the differential there.

The challenging part is that most people as we get older, we develop multiple gait impairments. So it's rare to see someone who doesn't really have neuropathy and has no arthritis and doesn't have a hint of lumbar stenosis and maybe on top of that there's Parkinson's and maybe they've had a stroke, unfortunately, and there's some residual weakness from the stroke. So I think that's where it gets challenging, the overlap between the different possible diagnoses.

Glen Stevens, DO, PhD: But I think like all things in neurology, it's a good history.

James Liao, MD: Yes.

Glen Stevens, DO, PhD: It's a good exam.

James Liao, MD: Absolutely.

Glen Stevens, DO, PhD: And you know what they always say, if you don't have a pretty good idea of where you're going after the history, you need to go take some more history.

James Liao, MD: Yes.

Glen Stevens, DO, PhD: Because while you can do an exam and figure it out, the history is really probably the most helpful.

James Liao, MD: Absolutely.

Glen Stevens, DO, PhD: If you can take a detailed history.

James Liao, MD: The timeline, how sudden things happened, the associated symptoms, the review of system, that all is part of it.

Glen Stevens, DO, PhD: So clearly, I'm sure a lot of your practice is on neurodegenerative disorders. Can you take us through how you manage gait in patients primarily with Parkinson's disease and then we'll also discuss normal pressure hydrocephalus. So Parkinson's first.

James Liao, MD: Yes. So with Parkinson's, unfortunately there hasn't been a groundbreaking advance in terms of the medicines for Parkinson's. So we're still relying on Carbidopa-levodopa, Sinemet. So Sinemet should improve some aspects of the Parkinson's gait. It should improve the overall gait velocity, the step length. It doesn't improve everything about the gait. So for instance, later on we might talk about a symptom called freezing of gait, which is an intermittent gait impairment that happens in Parkinson's that happens when people are going through tight spaces or multitasking. Or it can even happen when the flooring changes from a carpet to tile for instance. That is more challenging. But the step one really is to optimize the Sinemet dosing, make sure you're in the optimal range, not too low, not too high. And beyond that, it's really a lot of physical therapy.

The main treatment for Parkinson's I would say is exercise, and exercise has been shown to slow down disease progression. If we can get people active, maintain their current general cardiovascular health, maintain their muscle strength, and work on balance, practicing things that require balance, that is very useful. Oftentimes we need to do that in physical therapy as a way to safely practice the balance. So we rely heavily on physical therapy, heavily on safe exercises for people with Parkinson's, and also optimizing the dopaminergic medicines.

Glen Stevens, DO, PhD: So I hear a lot about boxing with Parkinson's and cycling.

James Liao, MD: Absolutely.

Glen Stevens, DO, PhD: And why is it that those are helpful? What are they doing? Are they affecting dopamine levels or what are they doing?

James Liao, MD: That's a great question. There has been research showing that the type of exercise actually doesn't matter as long as the heart rate is in the moderate to high intensity range, which is approximately 75% of someone's max heart rate. So it doesn't really matter if you box or dance or run or row or pedal. In terms of cycling, it is nice because in Cleveland it can be done in the wintertime, and it's hard to fall off of a stationary bike. So just from a practical standpoint, it's a nice exercise to do. Boxing is really interesting. There's a large organization called Rock Steady Boxing that's quite popular among Parkinson's patients. I don't have a great answer for you on why it's so popular, but I think there's kind of a personal satisfaction maybe just out of doing something that involves punching, and it is good to practice large amplitude, fast movements because usually in Parkinson's the problem is the movements are slow and not big enough in terms of amplitude. So that is something that's good about boxing.

Glen Stevens, DO, PhD: And what do you think the link is with the heart rate? Any thoughts about that? That's quite interesting. I'm not sure I've heard that.

James Liao, MD: Yes, so that is a great question. So, what is it about exercise that actually slows down disease progression? So, what I can say is that there are several high-quality studies that show that people who routinely exercise at a certain intensity, moderate to high intensity, their Parkinson's symptoms do not worsen over short periods of time, like up to six months. And there's a large study, multi-site study now that's taking it to 18 months to see if it can last that long. It doesn't last forever, but there are other studies looking at what is it about the exercise that is changing the brain and the body. It changes inflammatory markers, it may change how the basal ganglia neurons are behaving, and we can measure that using electrodes, deep brain stimulation electrodes, to measure the so-called the beta signal in the basal ganglia. So my colleague, Jay Alberts, does have a project looking at that on how exercise changes the neural behaviors of the brain. And there's other studies out there that are looking at how exercise changes inflammatory markers to try to figure out what is it about exercise that helps.

Glen Stevens, DO, PhD: It's fascinating. The compliance of patients. I mean, I can imagine having this discussion, I would be, "You got to exercise, you got to exercise, you got to exercise." And I'm sure people are concerned they're going to fall, but again, you can be on a recumbent bike or do something where that's not an issue. Do people buy into it? What's the compliance?

James Liao, MD: I think that some people take it very seriously and almost become like a professional athlete. And anecdotally those people tend to do better. It is hard for some people, maybe there's another comorbidity that makes it so you can't really get that much exercise. Maybe they have a heart condition or a lung condition or arthritis where it's as painful to do that and then it's difficult. But we always emphasize, and the AAN, this is one of the quality metrics for caring for Parkinson's patients is that we always have to talk about exercise, always do our best to emphasize and remind people to get 150 minutes of moderate to high intensity exercise per week.

Glen Stevens, DO, PhD: And does anybody give people some type of kinetic monitor to determine what their movement is? And I guess then you have to decide how they use it, right? Is it them or not? But it would almost seem like a good idea to give everybody some sort of a monitor. You said you had forgot your Apple Watch, but some type watch, and I know in brain tumor we're actually doing this. Right now we have a project going on where one of our staff is looking at these types of processes and determine can you link the activity with outcome?

James Liao, MD: Yes. That is such a great question and a timely question. I will say that the kind of popularity of smart watches and smartphones, it does make it a little bit easier. So, I just saw a patient today who does have Apple devices, and we just pull up his health app on the iPhone, and we can look at the step counts, we can look at the double support time. And in that particular patient's case, the phone metrics matches what he's telling me about his gait is worsening recently. So that is quite useful.

There are apps out there specific for Parkinson's that actually gathers the Apple Health information. So, there's a company called Rune, and they make a product called Strive PD. I'm not affiliated with them, but they make a great platform and if you have Parkinson's, you just download their app, you tell them that your doctor is at such-and-such hospital and we're all in the database. And then I can log into their portal and see the walking and see the tremor and the dyskinesia that's measured by the Apple devices. So, it's pretty cool. We're trying to see just how useful it is. One of my interests is in doing just what you said, like real-world motion tracking. If we prescribe physical therapy, does it actually help? Do people actually walk more in the real world? So that's grants that I'm trying to write nowadays.

Glen Stevens, DO, PhD: Well, as an engineer, you must be very excited about this.

James Liao, MD: It is pretty exciting, yes.

Glen Stevens, DO, PhD: So, let's move on to normal pressure hydrocephalus. Remind our audience again what it is and what the gait is that you see with it.

James Liao, MD: Right. So, I will say that most of our referrals for this condition come from people who have some gait instability and they go to the emergency room and there's a head CT done, and there's large ventricles. So normal pressure hydrocephalus is a condition where the ventricles are large, so the fluid-filled spaces in the brain are large for some reason. We don't know why they're large. And if you do a puncture, the pressure is in the normal range. So, it's normal pressure hydrocephalus as opposed to an obstructive hydrocephalus where the pressure might be building up because there is a tumor or something blocking the flow.

Normal pressure hydrocephalus is actually very poorly understood. But what we do know is that people who have this condition have gait impairment. They can have memory problems, they can have urination control problems, and if you remove a little bit of fluid, it improves those symptoms.

So, it is considered a form of Parkinsonism. It's one of the atypical Parkinsonian conditions. It's also a form of dementia. It's actually considered a treatable form of dementia. So, the problem is that the symptoms are very nonspecific, so it looks a lot like a Parkinson's gait. In terms of the memory problems, there's a lot of things out there that cause memory problems. And in terms of the size of the ventricles, there are people who have large ventricles, but they don't have any of these symptoms. So, none of it is very specific. So the challenge is to identify who these patients are and to determine which of them would improve if we treated them. The current treatment is a surgery that basically shunts or continually removes some of the fluid, and if we remove some of the fluid, those symptoms get better.

Glen Stevens, DO, PhD: And they talk about a festinating gait and an en bloc turning gait.

James Liao, MD: Yes.

Glen Stevens, DO, PhD: Can you tell our audience what those are?

James Liao, MD: Yes. So, the gait of NPH is very similar to the gait of Parkinson's, and both of them have this feature called festination, which is when people are walking and the steps just get shorter and shorter and shorter until you're basically stopped. Again, that happens in Parkinson's and in NPH and in other conditions that are similar to Parkinson's. And the turning, the en bloc turning, it's a French phrase I believe, it means that when you're turning, the whole upper body is stiff. So, the only thing that's causing the turn is the feet. So, it looks like the whole upper body is a block, if you will, and that happens in Parkinson's and NPH and all the other Parkinsonian conditions.

Glen Stevens, DO, PhD: Let's move on to some of the stuff that I'm sure you as an engineer you enjoy quite a bit, some of the augmented reality. We'll also talk a little bit on genetics, but talk a little bit about augmented reality or options that you have for treatment or evaluation of patients.

James Liao, MD: Yeah, yeah. So augmented reality is a pretty cool technology. So, what is augmented reality? It's a way to display images in glasses, and the images are displayed as if they are objects in the real world. So, the headset has a transparent lens. You're actually looking at the real world and the technology is able to say put a ball that's floating in space, and if you move around, it knows where your head is, it knows where your eyes are. So it can draw the ball to be stationary in space.

And there are all the big tech companies are trying to develop this. Google is, Facebook or Meta is, and basically all the companies have some prototype of this. And here at the Cleveland Clinic we have several projects that involve AR. One of them I was the PI of. And what we did with AR is we used it to draw visual cues on the ground. So, people who have Parkinson's who have frisium gait, for some people it gets better if there's just lines on the ground oriented correctly. So there is really a laser light attachment that you can get for your cane or for your walker.

Glen Stevens, DO, PhD: Yeah, I've seen that, right, where it draws a line, they step over it.

James Liao, MD: So, it just draws a line on the floor, and you step over it. And for some reason, having that visual thing on the ground changes your cognitive strategy of walking and it prevents you from freezing. So, the AR technique is basically a fancier way to do that. It's a little bit more flexible. You can draw the lines in what, they don't have to be straight, they can be colorful, they can adapt, so they can only appear when necessary. So, we developed a study for this and showed that circular visual cues that appear on the ground when people are frozen, they reduce the duration of freezes, and they reduce how often freezes happen. So, there's a little bit more to it than that. But basically, to my knowledge, that's the first study that shows that visual cues from an AR headset actually directly reduce freezing metrics. So, it's pretty cool.

Full disclosure; Cleveland Clinic did license that to a company called Stroll, so I do have that licensing agreement. So overall, it's very cool. I would say the next step is AR can help increase access to good physical therapy. That's one way AR can help. We don't have to have people who live 200 miles from the nearest Parkinson's physical therapist come in for so many visits. There's a certain amount of therapy that can be done at home and in the future when companies like Facebook release their ultimate AR glasses that are basically the same size as normal glasses, then people can wear these all the time and they can display the cues that help them become unfrozen all the time in the real world at home, and that would really help people.

Glen Stevens, DO, PhD: Does the color of the object make a difference in their visual field?

James Liao, MD: We haven't looked at that. I'm guessing that it will make a difference, but probably if the cue is there all the time, then people kind of get used to it, and it loses its ability to change the attention, change the cognitive strategy of that moment of walking. So yeah, perhaps varying the color or having some element of randomness to it, unpredictability might actually be even better.

Glen Stevens, DO, PhD: So, genetics.

James Liao, MD: Yes.

Glen Stevens, DO, PhD: Talk about genetics and NPH. I'm not sure I'd heard about this before.

James Liao, MD: Yes. So, it's a new, relatively new area. So recently our team here at Cleveland Clinic did write a systematic review paper about NPH genetics. The motivation is really to help better define what NPH is because there's actually some debate in the literature and in the field about whether NPH is a distinct condition or is it some final common pathway of other neurodegenerative conditions. So, one way to answer that is to do genetic testing and find genes that are associated with NPH and show that NPH has a different genetic pattern or profile than other neurodegenerative conditions. So far, here, we haven't actually done the genetic testing for NPH, but we wrote a review paper and we hope to start doing that soon here.

Glen Stevens, DO, PhD: So, this would be the next talk.

James Liao, MD: Yeah. Yes. But basically, the genes that have been identified so far, they tend to be endothelial cell expressed, so they could be expressed in the inner lining of the ventricles basically. It changes their function. Some of them are related to ciliary function, so some aspect of moving the CSF around in the brain is affected, but really a lot more work has to be done there.

Glen Stevens, DO, PhD: And finally, I know there's going to be a new neurologic building opening in the next year and a half or so. It gives you an opportunity to bring some of these things forward. Are you doing anything in the new building to utilize these techniques?

James Liao, MD: Yes, absolutely. So, the new building, we are all, I think very excited about it. In my view, one of its coolest features will be a gait check-in assessment that is done on the first floor of the building. So, everyone who comes in is going to get their vital signs taken, get the heart rate, blood pressure, weight, but also everyone's going to do a standardized gait exam that's videoed, and there's a computer software to extract gait parameters from the videos. So theoretically we're going to have gait velocity, step width, step length, asymmetry, variability metrics like stride time, coefficient of variation. Theoretically, we're going to have that for every patient who comes in at every in-person visit. And that's going to be huge. We're going to be able to do science, try to figure out if for instance, NPH has a distinct profile than Parkinson's because to the naked eye, they do look very similar.

And then there's also going to be a personalized medicine or individualized medicine approach that we can create a computer alert to say, "This person's gait is deteriorating. We think their falls risk is too high. You should do something about this, doctor." Or, "Think about a referral to physical therapy or say, a movement disorders." So, there's a clinical decision support that could come out of this, so we are actively working on that. There's a lot of work to be done, but we're very excited to get this implemented in the new building.

I will say that in the movement disorders group, we already have a prototype of this system, and we are starting to use it for research purposes and also a little bit for clinical care right now.

Glen Stevens, DO, PhD: Excellent. Well, it's clearly an exciting time in the field.

James Liao, MD: It is.

Glen Stevens, DO, PhD: And any final takeaways for our audience?

James Liao, MD: Yes. I think the main thing to just remember is that we shouldn't attribute a gait change just to old age. There may actually be some other process that's happening that is identifiable and treatable, so we don't want to leave patients in a more risky situation than they need to be in.

Glen Stevens, DO, PhD: Well, James, I want to thank you for taking the time to bring us up to speed on what's going on, all the exciting things, and look forward to additional inputs and updates from you in the future as time goes on in determining and evaluating gait disorders. Thank you very much.

James Liao, MD: Thank you. It was great to be here.

Closing: This concludes this episode of Neuro Pathways. You can find additional podcast episodes on our website, clevelandclinic.org/neuropodcast, or subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcasts. And don't forget, you can access real-time updates from experts in Cleveland Clinic's Neurological Institute on our Consult QD website. That's @CleClinicMD, all one word. And thank you for listening.