Gait as a Vital Sign: Integrating Wearables and AI into Vestibular and Balance Medicine

Abstract

Gait and balance are integrative markers of brain–body function, reflecting the coordination of sensory precision, motor control, and cognition. Advances in wearable inertial sensors and artificial intelligence (AI) now enable continuous, objective measurement of these processes—positioning mobility assessment as a potential "ECG of the 21st century." Dizziness and imbalance are among the most frequent primary-care complaints, affecting up to 30% of adults annually, while more than one-third of those aged ≥65 experience at least one fall each year. Digital gait metrics derived from wearable sensors quantify performance across the neuro-vestibular continuum, linking peripheral vestibular input, sensorimotor control, and higher cognitive function. Classical bedside tests such as the Romberg and Timed Up and Go have evolved into sensor-augmented paradigms that capture postural sway, gait symmetry, and head–trunk coordination with millisecond precision. Inertial measurement units detect vestibular and neurological impairments with fall-risk prediction accuracies of AUC 0.75–0.88. Rehabilitation approaches incorporating vibrotactile, proprioceptive, or virtual-reality feedback enhance balance and neuroplastic adaptation. Collectively, these developments define a paradigm shift: mobility becomes a digital vital sign. In the near future, patients may step onto intelligent floors or wear imperceptible sensors generating personalized "mobility fingerprints," linking everyday movement patterns to neural integrity. Integration of wearable analytics and AI into clinical workflows may establish digital gait analysis as a cornerstone of preventive neurology and primary care.