Additional tests to elicit informative gait and balance features

Test	Function	Implications
Quiet standing with eyes closed; Romberg test	Helps differentiate	Increased sway, or inability to stand independently, can be observed in sensory ataxia (sensory neuropathy). Involuntary movements suggest drug-induced dyskinesia or chorea. Excessive sway corrected by distraction is observed in patients with anxiety or functional gait disorders.
Response to external perturbation (pull test or push-and-release test)	Detection of symptoms	Patients with postural instability respond with more than two steps or take no steps at all.
Walking with eyes closed	Helps differentiate	Deviation to one side is seen in unilateral vestibular ataxia and unilateral cerebellar ataxia.
Turning of the head during gait	Helps differentiate	Worsening of gait is seen in vestibular ataxia.
Walking backwards compared with walking forwards	Helps differentiate	Discrepant features are seen in dystonia (suggesting task specificity) and functional gait disorders (suggesting inconsistency).
Regular walking compared with running	Helps differentiate	Better running than regular walking can be seen in PD and functional gait disorders.
Tandem walking	Helps differentiate	Tandem walking without side steps is preserved in PD but impaired in atypical parkinsonism, ataxia, and other conditions characterized by mediolateral instability.
Rapid 360° turns on the spot	Detection of symptoms	Frequently evokes freezing of gait in PD and atypical parkinsonism.
Walking rapidly with short steps	Detection of symptoms	Frequently evokes freezing of gait in PD and atypical parkinsonism.

PD: Parkinson disease.

Reproduced with permission from: Nonnekes J, Goselink RJM, Růžička E, et al. Neurological disorders of gait, balance and posture: A sign-based approach. Nat Rev Neurol 2018; 14:183. Copyright © 2018 Springer Nature.

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Additional tests to elicit informative gait and balance features