[Diagnostic Approaches for Patients with Difficulty Walking]

Difficulty walking is a common complaint in neurological practice which may arise from a wide range of disorders of the central nervous system, peripheral nerves, or musculoskeletal system. Because human gait requires the complex integration of multiple neural and biomechanical processes, careful clinical assessment is essential to achieve accurate diagnosis. In this review, we outlined a practical approach for patients presenting with walking difficulties. Emphasis is placed on the importance of detailed history-taking and neurological examination, including observation of gait, posture, gait initiation, and turning. We further summarize the key clinical features of the major organic causes of gait disturbance, such as lower limb weakness, pyramidal tract disorders, and Parkinsonian syndromes. Functional gait disorder is an important and increasingly recognized cause of gait disturbance. Recognizing the positive clinical signs and characteristic variability in symptoms is essential for appropriate diagnosis and management. Careful clinical evaluation remains the cornerstone for assessing gait disorders, and diagnostic tests should be used to confirm the clinical diagnosis based on the history and neurological examination.