What referral criteria should I use for a patient with persistent gait abnormalities despite initial management?

Refer adults with persistent gait abnormalities despite initial management if they have any of the following features:

• Rapidly progressive unsteady gait (gait ataxia) developing within days to weeks, which requires urgent neurological assessment using a suspected cancer pathway referral.
• Gradually progressive unsteady gait (gait ataxia), which warrants neurological assessment and additional investigations including alcohol history, thyroid function tests, vitamin B12 and folate levels, and consideration of serological testing for gluten sensitivity.
• Difficulty initiating and coordinating walking (gait apraxia), which should prompt referral to neurology or elderly care clinics to exclude normal pressure hydrocephalus.
• Unsteadiness of gait in adults at risk of falling, where multifactorial falls risk assessment should be followed and referral to a falls prevention team considered.

These criteria apply when gait abnormalities persist despite initial management and are aimed at identifying underlying neurological causes that require specialist assessment and intervention.

References: NICE NG127