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Chmielewska D, Sobota GS, Stania M, Błaszczak E, Słomka K, Juras G. A comparison of a step-initiation task in women with and without urinary incontinence. A case-control study. Neurourol Urodyn 2018; 37:2571-2577. [PMID: 30152526 DOI: 10.1002/nau.23580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022]
Abstract
AIMS The aim of the study was to objectively determine differences in postural response by women with and without urinary incontinence during a step-initiation task depending on the degree of bladder filling. METHODS The study comprised 22 women with stress urinary incontinence and 20 women without urinary incontinence. All women participated in four trials: unperturbed and perturbed (obstacle crossing) transition between platforms, step-up and step-down trials. Velocities of center of pressure displacement, double-support period, time from exit from steady standing until the lead foot resting on the other platform and time from raising the foot from the first platform until gaining quiet standing on the other platform were measured and compared. RESULTS No significant differences were noted between the performance of a step-initiation task by incontinent women with full/empty bladder whereas continent women performed differently during unperturbed transition with full/empty bladder. The step-up trial revealed significant intergroup differences. The antero-posterior mean velocity of center of pressure during the empty bladder test was significantly higher in women with stress urinary incontinence (effect size = 1.02). During the same bladder condition the women with stress urinary incontinence performed significantly more slowly in unperturbed (effect size = 1.09) and perturbed (effect size = 0.84) transition compared to control group. CONCLUSIONS Our results indicate that women with incontinence performed the step initiation task slowly on the empty bladder tests compare to continent women.
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Affiliation(s)
- Daria Chmielewska
- Faculty of Physiotherapy, Department of Physiotherapy Basics, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Grzegorz Sobota Sobota
- Department of Human Motor Behaviour, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Magdalena Stania
- Faculty of Physiotherapy, Department of Physiotherapy Basics, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Edward Błaszczak
- Faculty of Medical Biophysics, Department of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Kajetan Słomka
- Department of Human Motor Behaviour, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Grzegorz Juras
- Department of Human Motor Behaviour, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
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102
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Koene S, Stolwijk NM, Ramakers R, de Vries M, de Boer L, Janssen MCH, de Groot I, Smeitink J. Quantification of gait in children with mitochondrial disease. J Inherit Metab Dis 2018. [PMID: 29532198 DOI: 10.1007/s10545-018-0148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mitochondrial disorders are multisystem conditions that can potentially affect gait in many ways. The aim of this study was to select the optimal protocol to quantify the spatiotemporal parameters of gait in ambulatory children with mitochondrial disorders based on feasibility, test-retest reliability, and the difference between patients and controls. Gait at self-selected pace was quantified in ambulatory children with a genetically confirmed primary mitochondrial disease using the GAITRite electronic walkway. Three protocols were tested: pre-exercise, post-exercise (after a 3-min walking test), and recovery. In 14 ambulatory patients, we showed good to perfect reliability for velocity, cadence, step length, step time, step time variability, and step width in the recovery condition. The difference between patients and 70 individually age- and gender matched healthy controls only became apparent in the post-exercise protocol. In conclusion, measuring spatiotemporal parameters of gait using the GAITRite in ambulatory children with mitochondrial disease is feasible and reliable for most of the parameters measured. When using gait analysis in future studies in children with mitochondrial disease, we advise i) to use an exercise test prior to the gait analysis, ii) to let children practice the test before the actual data collection, and iii) not to use symmetry parameters.
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Affiliation(s)
- Saskia Koene
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Niki M Stolwijk
- Research Group Musculoskeletal Rehabilitation Nijmegen, HAN University of Applied Sciences, Kapittelweg 33, Nijmegen, The Netherlands
| | - Rob Ramakers
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maaike de Vries
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Lonneke de Boer
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mirian C H Janssen
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Imelda de Groot
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan Smeitink
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
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103
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Turcato AM, Godi M, Giardini M, Arcolin I, Nardone A, Giordano A, Schieppati M. Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed. PLoS One 2018; 13:e0197264. [PMID: 29750815 PMCID: PMC5947908 DOI: 10.1371/journal.pone.0197264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases? Methods We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated. Results Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase. Conclusion The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.
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Affiliation(s)
- Anna Maria Turcato
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
- * E-mail:
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Antonio Nardone
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Giordano
- Unit of Bioengineering, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Schieppati
- Department of Exercise & Sports Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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104
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Rennie L, Löfgren N, Moe-Nilssen R, Opheim A, Dietrichs E, Franzén E. The reliability of gait variability measures for individuals with Parkinson's disease and healthy older adults - The effect of gait speed. Gait Posture 2018; 62:505-509. [PMID: 29679922 DOI: 10.1016/j.gaitpost.2018.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/13/2018] [Accepted: 04/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Step-to-step variability is a marker of reduced motor control and a frequently studied outcome measure in neurodegenerative disorders such as Parkinson's disease (PD) as compared to healthy older adults (HOA). To challenge motor control of gait, walking should be tested at different gait speeds. Good reliability is essential, and gait variability estimates show good reproducibility when sampled at normal gait speed. The aim was therefore to investigate if gait variability could be reliably sampled at slow and fast speeds for individuals with PD and HOA by evaluating test-retest reliability. METHODS 29 (14 males) subjects with idiopathic PD, Hoehn &Yahr 2 (n = 18) and 3, ≥ 60 years, and 25 age matched HOAwere included. Spatiotemporal gait data was collected (GAITRite) during slow, normal, and fast walking on two occasions. RESULTS Measurement error was lowest for gait variability estimates based on 40 steps in both groups. This was true across all speeds in HOA, but only for normal and fast gait speeds in the PD cohort. Due to increased homogeneity in the variability estimates intraclass correlation coefficients (ICC) were low for HOA, except for step width variability. In the PD cohort ICCs were good to excellent for temporal- and step width gait variability across speeds. CONCLUSION HOA demonstrated reliable gait variability estimates across all speeds, whereas Individuals with PD were reliable at normal and fast gait speeds only Estimates should be based on at least 40 steps. Step width variability was overall the most reliable variable across groups and speed conditions.
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Affiliation(s)
- Linda Rennie
- Sunnaas Rehabilitation Hospital, Research Department, Nesodden, Norway.
| | - Niklas Löfgren
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden; Karolinska University Hospital, Function Allied Health Professionals, Function Area Occupational Therapy and Physiotherapy, Stockholm, Sweden.
| | - Rolf Moe-Nilssen
- Physiotherapy Research Group, Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Arve Opheim
- Sunnaas Rehabilitation Hospital, Research Department, Nesodden, Norway; Rehabilitation Medicine, Institute of Neuro Science and Physiology, University of Gothenburg, Gothenburg, Sweden; Habilitation & Health, Region Västra Götaland, Gothenburg, Sweden.
| | - Espen Dietrichs
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Erika Franzén
- Sunnaas Rehabilitation Hospital, Research Department, Nesodden, Norway; Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden; Karolinska University Hospital, Function Allied Health Professionals, Function Area Occupational Therapy and Physiotherapy, Stockholm, Sweden.
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105
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Koren Y, Raanan Y, Parmet Y, Bar-Haim S. Treading on the unknown—the feasibility of a novel approach to investigating the motor control of walking. Physiol Meas 2018. [DOI: 10.1088/1361-6579/aab659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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106
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Memar S, Delrobaei M, Pieterman M, McIsaac K, Jog M. Quantification of whole-body bradykinesia in Parkinson's disease participants using multiple inertial sensors. J Neurol Sci 2018; 387:157-165. [PMID: 29571855 DOI: 10.1016/j.jns.2018.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/10/2018] [Accepted: 02/01/2018] [Indexed: 11/29/2022]
Abstract
Bradykinesia (slowness of movement) is a common motor symptom of Parkinson's disease (PD) that can severely affect quality of life for those living with the disease. Assessment and treatment of PD motor symptoms largely depends on clinical scales such as the Unified Parkinson's Disease Rating Scale (UPDRS). However, such clinical scales rely on the visual assessment by a human observer, naturally resulting in inter-rater variability. Although previous studies have developed objective means for measuring bradykinesia in PD patients, their evaluation was restricted by the type of movement and number of joints assessed. These studies failed to provide a more comprehensive, whole-body evaluation capable of measuring multiple joints simultaneously. This study utilizes wearable inertial measurement units (IMUs) to quantify whole-body movements, providing novel bradykinesia indices for walking (WBI) and standing up from a chair (sit-to-stand; SBI). The proposed bradykinesia indices include the joint angles at both upper and lower limbs and trunk motion to compute a complete, objective score for whole body bradykinesia. Thirty PD and 11 age-matched healthy control participants were recruited for the study. The participants performed two standard walking tasks that involved multiple body joints in the upper and lower limbs. The WBI and SBI successfully identified differences between control and PD participants. The indices also effectively identified differences within the PD population, distinguishing participants assessed with (ON) and without (OFF) levodopa; the gold-standard of treatment for PD. The goal of this study is to provide health professionals with an objective score for whole body bradykinesia by simultaneously measuring the upper and lower extremities along with truncal movement. This method demonstrates potential to be used in conjunction with current clinical standards for motor symptom assessment, and may also be promising for the remote assessment of PD patients and in cases where experienced clinicians may not be available. In conclusion, the intelligent use of this technology for the measurement of bradykinesia (among other symptoms) has vast implications for optimizing treatment in Parkinson's disease, ultimately leading to an improvement in quality of life.
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Affiliation(s)
- Sara Memar
- Robarts Research Institute, London, ON, Canada.
| | - Mehdi Delrobaei
- Center for Research and Technology (CREATECH), Faculty of Electrical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | - Marcus Pieterman
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Kenneth McIsaac
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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107
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Penko AL, Streicher MC, Koop MM, Dey T, Rosenfeldt AB, Bazyk AS, Alberts JL. Dual-task Interference Disrupts Parkinson's Gait Across Multiple Cognitive Domains. Neuroscience 2018; 379:375-382. [PMID: 29577998 DOI: 10.1016/j.neuroscience.2018.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
Gait dysfunction, a hallmark of Parkinson's disease, contributes to a relatively high incidence of falling. Gait function is further diminished during the performance of a motor-cognitive task (i.e., dual-task). It is unclear if Parkinson's disease-related dual-task deficits are related to a specific area of cognitive function or are the result of a more global decline in executive function. The aim of this project was to systematically evaluate gait performance to determine if gait dysfunction is restricted to certain types of executive function or a global phenomenon in individuals with Parkinson's disease. Twenty-three individuals with mild-moderate Parkinson's disease completed a series of dual-task conditions in which gait was paired with cognitive tasks requiring: working memory (0, 1, and 2-back), attention and problem solving (serial-7 subtraction), verbal memory (digit recall), semantic memory (Controlled Oral Word Association) and information processing speed (visual Stroop test). The results demonstrate that individuals with mild-moderate Parkinson's disease have a generalized worsening of spatial-temporal gait parameters regardless of the specific cognitive demand being performed concurrently. Overall, gait velocity decreased (p < 0.01) and stride and stance time both increased (p < 0.01) across all cognitive conditions. The attention and problem solving task resulted in the greatest number of gait parameter decrements. Results indicated that performance on cognitive tasks remained unchanged from single-task to dual-task conditions. Diminished gait performance under dual-task conditions across different cognitive function domains suggests a global Parkinson's disease-related deficit in information processing and regulation of gait.
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Affiliation(s)
- Amanda L Penko
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Tanujit Dey
- Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew S Bazyk
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
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108
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Tian Q, Bair WN, Resnick SM, Bilgel M, Wong DF, Studenski SA. β-amyloid deposition is associated with gait variability in usual aging. Gait Posture 2018; 61:346-352. [PMID: 29428714 PMCID: PMC5866772 DOI: 10.1016/j.gaitpost.2018.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Higher amyloid burden predicts gait slowing in aging. Whether and which gait characteristics are associated with amyloid burden is less clear. Gait variability may be more sensitive to amyloid burden than mean gait characteristics. METHODS In the Baltimore Longitudinal Study of Aging, 99 older participants without neurological disease had concurrent amyloid imaging and assessment of gait characteristics. β-amyloid burden was measured using 11C-Pittsburgh compound B (PiB) positron emission tomography. PiB+/- status was based on a mean cortical distribution volume ratio (DVR) cut point. Gait characteristics were quantified by 3D motion analysis. Cross-sectional associations of PiB+/- status and DVR in motor-related regions (primary motor cortex, putamen, caudate) with gait characteristics were examined using linear regression, adjusted for age, sex, height, body mass index, gait speed and covariates (memory, executive function, visuoperceptual speed, depressive symptoms, cardiovascular risk, ApoE ε4, cerebrovascular burden, neurodegeneration, peripheral arterial disease, knee pain). RESULTS Being PiB+ and higher DVR in motor-related regions were associated with greater gait speed variability, cadence variability, and gait cycle time variability but not with mean gait characteristics. Associations remained similar after adjustment for gait speed and covariates, except for memory, which attenuated associations of PiB+/- with cadence variability and gait cycle time variability. Associations were prominent in men but were not found in women. CONCLUSIONS In usual aging, integrated temporal gait variability measures, but not mean performance, appear related to amyloid burden from cortical and motor-related cortical and subcortical regions, especially in men. Increased gait variability may be a subclinical indicator of increased amyloid burden in men.
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Affiliation(s)
- Qu Tian
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA.
| | - Woei-Nan Bair
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Murat Bilgel
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Dean F Wong
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie A Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
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Baillieul S, Wuyam B, Pépin JL, Marillier M, Tamisier R, Pérennou D, Verges S. Continuous positive airway pressure improves gait control in severe obstructive sleep apnoea: A prospective study. PLoS One 2018; 13:e0192442. [PMID: 29474363 PMCID: PMC5825012 DOI: 10.1371/journal.pone.0192442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 01/11/2018] [Indexed: 01/10/2023] Open
Abstract
Study aim Severe obstructive sleep apnoea (OSA) can lead to neurocognitive alterations, including gait impairments. The beneficial effects of continuous positive airway pressure (CPAP) on improving excessive daytime sleepiness and daily functioning have been documented. However, a demonstration of CPAP treatment efficacy on gait control is still lacking. This study aims to test the hypothesis that CPAP improves gait control in severe OSA patients. Material and methods In this prospective controlled study, twelve severe OSA patients (age = 57.2±8.9 years, body mass index = 27.4±3.1 kg·m-2, apnoea-hypopnoea index = 46.3±11.7 events·h-1) and 10 healthy matched subjects were included. Overground gait parameters were recorded at spontaneous speed and stride time variability, a clinical marker of gait control, was calculated. To assess the role of executive functions in gait and postural control, a dual-task paradigm was applied using a Stroop test as secondary cognitive task. All assessments were performed before and after 8 weeks of CPAP treatment. Results Before CPAP treatment, OSA patients had significantly larger stride time variability (3.1±1.1% vs 2.1±0.5%) and lower cognitive performances under dual task compared to controls. After CPAP treatment, stride time variability was significantly improved and no longer different compared to controls. Cognitive performance under dual task also improved after CPAP treatment. Conclusion Eight weeks of CPAP treatment improves gait control of severe OSA patients, suggesting morphological and functional cerebral improvements. Our data provide a rationale for further mechanistic studies and the use of gait as a biomarker of OSA brain consequences.
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Affiliation(s)
- Sébastien Baillieul
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
- * E-mail:
| | - Bernard Wuyam
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Mathieu Marillier
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
| | - Renaud Tamisier
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Dominic Pérennou
- LPNC laboratory (UMPR CNRS 5105), Grenoble Alpes University, Grenoble, France
- MPR Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Samuel Verges
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
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Kribus-Shmiel L, Zeilig G, Sokolovski B, Plotnik M. How many strides are required for a reliable estimation of temporal gait parameters? Implementation of a new algorithm on the phase coordination index. PLoS One 2018; 13:e0192049. [PMID: 29420580 PMCID: PMC5805232 DOI: 10.1371/journal.pone.0192049] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
Background The Phase coordination index (PCI), a temporal gait measure that quantifies consistency and accuracy in generating the anti-phased left-right stepping pattern, assesses bilateral coordination of gait in various cohorts (e.g., Parkinson's disease, post stroke). As PCI is based on mean values calculated across a series of gait cycles, individuals are required to perform lengthy walking trials, prolonging gait assessments which cause discomfort to some of them. This study introduces an algorithm to identify the required number of strides to obtain a reliable, characteristic PCI value. Methods Simulated data sets, as well as physiological data (obtained from healthy elderly and young persons, from over ground and treadmill trials) were used in this research. A series of N-1 PCI values was calculated for i = 2,3,4…N gait cycles for each participant. There is a value i = k, representing certain number of cycles, for which no significant change in PCI occurs as additional cycles are added, termed point of stabilization (POS). The algorithm presented here uses a 2-stage iterative process to determine POS. Stage 1 searches for the gross location of the interval of PCI values containing the POS. In stage 2, the algorithm performs a high-resolution recursive, iterative process within this interval to find the exact point. The criterion for defining stability within a window of PCI values is a coefficient of variation (CV) of ≤ 5%. Results Our recursive, iterative algorithm indicates that ~23 strides on average should be captured to attain a characteristic PCI. Conclusions Gait trials with at least 23 strides on average should suffice to obtain a reliable estimation of PCI in healthy young adults. While this methodology may be considered generic, future studies should obtain POS values based on additional cohorts (e.g., disabled participants, fixed walking speeds).
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Affiliation(s)
- Lotem Kribus-Shmiel
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel
| | - Gabi Zeilig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Boris Sokolovski
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
- * E-mail:
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111
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Buckley E, Mazzà C, McNeill A. A systematic review of the gait characteristics associated with Cerebellar Ataxia. Gait Posture 2018; 60:154-163. [PMID: 29220753 DOI: 10.1016/j.gaitpost.2017.11.024] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/07/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cerebellar Ataxias are a group of gait disorders resulting from dysfunction of the cerebellum, commonly characterised by slowly progressing incoordination that manifests as problems with balance and walking leading to considerable disability. There is increasing acceptance of gait analysis techniques to quantify subtle gait characteristics that are unmeasurable by current clinical methods This systematic review aims to identify the gait characteristics able to differentiate between Cerebellar Ataxia and healthy controls. METHODS Following systematic search and critical appraisal of the literature, gait data relating to preferred paced walking in Cerebellar Ataxia was extracted from 21 studies. A random-effect model meta-analysis was performed for 14 spatiotemporal parameters. Quality assessment was completed to detect risk of bias. RESULTS There is strong evidence that compared with healthy controls, Cerebellar Ataxia patients walk with a reduced walking speed and cadence, reduced step length, stride length, and swing phase, increased walking base width, stride time, step time, stance phase and double limb support phase with increased variability of step length, stride length, and stride time. CONCLUSION The consensus description provided here, clarifies the gait pattern associated with ataxic gait disturbance in a large cohort of participants. High quality research and reporting is needed to explore specific genetic diagnoses and identify biomarkers for disease progression in order to develop well-evidenced clinical guidelines and interventions for Cerebellar Ataxia.
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Affiliation(s)
- Ellen Buckley
- Department of Neuroscience, University of Sheffield, UK.
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, UK; INSIGNEO Institute for In Silico Medicine, University of Sheffield, UK.
| | - Alisdair McNeill
- Department of Neuroscience, University of Sheffield, UK; INSIGNEO Institute for In Silico Medicine, University of Sheffield, UK; Sheffield Children's Hospital, UK.
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Aşuroğlu T, Açıcı K, Berke Erdaş Ç, Kılınç Toprak M, Erdem H, Oğul H. Parkinson's disease monitoring from gait analysis via foot-worn sensors. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2018.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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113
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Tamburini P, Storm F, Buckley C, Bisi MC, Stagni R, Mazzà C. Moving from laboratory to real life conditions: Influence on the assessment of variability and stability of gait. Gait Posture 2018; 59:248-252. [PMID: 29100144 DOI: 10.1016/j.gaitpost.2017.10.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
The availability of wearable sensors allows shifting gait analysis from the traditional laboratory settings, to daily life conditions. However, limited knowledge is available about whether alterations associated to different testing environment (e.g. indoor or outdoor) and walking protocols (e.g. free or controlled), result from actual differences in the motor behaviour of the tested subjects or from the sensitivity to these changes of the indexes adopted for the assessment. In this context, it was hypothesized that testing environment and walking protocols would not modify motor control stability in the gait of young healthy adults, who have a mature and structured gait pattern, but rather the variability of their motor pattern. To test this hypothesis, data from trunk and shank inertial sensors were collected from 19 young healthy participants during four walking tasks in different environments (indoor and outdoor) and in both controlled (i.e. following a predefined straight path) and free conditions. Results confirmed what hypothesized: variability indexes (Standard deviation, Coefficient of variation and Poincaré plots) were significantly influenced by both environment and walking conditions. Stability indexes (Harmonic ratio, Short term Lyapunov exponents, Recurrence quantification analysis and Sample entropy), on the contrary, did not highlight any change in the motor control. In conclusion, this study highlighted an influence of environment and testing condition on the assessment of specific characteristics of gait (i.e. variability and stability). In particular, for young healthy adults, both environment and testing conditions affect gait variability indexes, whereas neither affect gait stability indexes.
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Affiliation(s)
- Paola Tamburini
- Department of Electric, Electronic and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum - University of Bologna, Italy.
| | - Fabio Storm
- Insigneo Institute for in silico medicine, University of Sheffield, Sheffield, United Kingdom; Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Chris Buckley
- Insigneo Institute for in silico medicine, University of Sheffield, Sheffield, United Kingdom; Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Maria Cristina Bisi
- Department of Electric, Electronic and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum - University of Bologna, Italy
| | - Rita Stagni
- Department of Electric, Electronic and Information Engineering "Guglielmo Marconi" - DEI, Alma Mater Studiorum - University of Bologna, Italy
| | - Claudia Mazzà
- Insigneo Institute for in silico medicine, University of Sheffield, Sheffield, United Kingdom; Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
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114
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Myllymäki A, Löyttyniemi E, Kaunismäki M, Pesonen M, Oksanen A. Concurrent validity and repeatability of inertial sensor gait analysis system for the measurement of gait parameters of young healthy adults. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1484600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Annukka Myllymäki
- Department of Health and Well-being, Turku University of Applied Sciences, University of Turku, FI-20720 Turku, Finland
| | | | - Maria Kaunismäki
- Department of Health and Well-being, Turku University of Applied Sciences, University of Turku, FI-20720 Turku, Finland
| | - Maiju Pesonen
- Department of Health and Well-being, Turku University of Applied Sciences, University of Turku, FI-20720 Turku, Finland
| | - Airi Oksanen
- Department of Physical and Rehabilitation Medicine, Turku University Hospital, University of Turku, Turku, Finland
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115
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Moore SA, Hickey A, Lord S, Del Din S, Godfrey A, Rochester L. Comprehensive measurement of stroke gait characteristics with a single accelerometer in the laboratory and community: a feasibility, validity and reliability study. J Neuroeng Rehabil 2017. [PMID: 29284544 DOI: 10.1186/12984-017-0341-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Application of objective measurement of stroke gait with accelerometer-based wearable technology and associated algorithms is increasing, despite reports questioning the accuracy of this technique in quantifying specific stroke-related gait impairments. The aim of this study is to determine the feasibility, validity and reliability of a low-cost open-source system incorporating algorithms and a single tri-axial accelerometer-based wearable to quantify gait characteristics in the laboratory and community post-stroke. METHODS Twenty-five participants with stroke wore the wearable (AX3, Axivity) on the lower back during a laboratory 2 minute continuous walk (preferred pace) on two occasions a week apart and continuously in the community for two consecutive 7 day periods. Video, instrumented walkway (GaitRite) and an OPAL accelerometer-based wearable were used as laboratory references. RESULTS Feasibility of the proposed system was good. The system was valid for measuring step count (ICC 0.899). Inherent differences in gait quantification between algorithm and GaitRite resulted in difficulties comparing agreement between the different systems. Agreement was moderate-excellent (ICC 0.503-0.936) for mean and variability gait characteristics vs. OPAL. Agreement was moderate-poor between the system and OPAL for asymmetry characteristics. Moderate-excellent reliability (ICC 0.534-0.857) was demonstrated for 11/14 laboratory measured gait characteristics. Community test-retest reliability was good-excellent (ICC 0.867-0.983) for all except one (ICC 0.699) of the 19 gait characteristics. CONCLUSION The proposed system is a low-cost, reliable tool for quantifying gait post-stroke with multiple potential applications. Further refinement to optimise gait quantification algorithms for certain gait characteristics including gait asymmetry is required.
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Affiliation(s)
- Sarah A Moore
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.
- Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Aodhan Hickey
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Sue Lord
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
- Auckland University of Technology, Auckland, New Zealand
| | - Silvia Del Din
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan Godfrey
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
- Department of Computer and Information Science, Northumbria University, Newcastle upon Tyne, NE2 1XE, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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116
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Moore SA, Hickey A, Lord S, Del Din S, Godfrey A, Rochester L. Comprehensive measurement of stroke gait characteristics with a single accelerometer in the laboratory and community: a feasibility, validity and reliability study. J Neuroeng Rehabil 2017; 14:130. [PMID: 29284544 PMCID: PMC5747176 DOI: 10.1186/s12984-017-0341-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/13/2017] [Indexed: 11/20/2022] Open
Abstract
Background Application of objective measurement of stroke gait with accelerometer-based wearable technology and associated algorithms is increasing, despite reports questioning the accuracy of this technique in quantifying specific stroke-related gait impairments. The aim of this study is to determine the feasibility, validity and reliability of a low-cost open-source system incorporating algorithms and a single tri-axial accelerometer-based wearable to quantify gait characteristics in the laboratory and community post-stroke. Methods Twenty-five participants with stroke wore the wearable (AX3, Axivity) on the lower back during a laboratory 2 minute continuous walk (preferred pace) on two occasions a week apart and continuously in the community for two consecutive 7 day periods. Video, instrumented walkway (GaitRite) and an OPAL accelerometer-based wearable were used as laboratory references. Results Feasibility of the proposed system was good. The system was valid for measuring step count (ICC 0.899). Inherent differences in gait quantification between algorithm and GaitRite resulted in difficulties comparing agreement between the different systems. Agreement was moderate-excellent (ICC 0.503–0.936) for mean and variability gait characteristics vs. OPAL. Agreement was moderate-poor between the system and OPAL for asymmetry characteristics. Moderate-excellent reliability (ICC 0.534–0.857) was demonstrated for 11/14 laboratory measured gait characteristics. Community test-retest reliability was good-excellent (ICC 0.867–0.983) for all except one (ICC 0.699) of the 19 gait characteristics. Conclusion The proposed system is a low-cost, reliable tool for quantifying gait post-stroke with multiple potential applications. Further refinement to optimise gait quantification algorithms for certain gait characteristics including gait asymmetry is required.
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Affiliation(s)
- Sarah A Moore
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK. .,Institute of Neuroscience (Stroke Research Group), Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE, UK.
| | - Aodhan Hickey
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Sue Lord
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,Auckland University of Technology, Auckland, New Zealand
| | - Silvia Del Din
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan Godfrey
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,Department of Computer and Information Science, Northumbria University, Newcastle upon Tyne, NE2 1XE, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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117
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Mollaei N, Bicho E, Sousa N, Gago MF. Different protocols for analyzing behavior and adaptability in obstacle crossing in Parkinson's disease. Clin Interv Aging 2017; 12:1843-1857. [PMID: 29158667 PMCID: PMC5683812 DOI: 10.2147/cia.s147428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Imbalance and tripping over obstacles as a result of altered gait in older adults, especially in patients with Parkinson’s disease (PD), are one of the most common causes of falls. During obstacle crossing, patients with PD modify their behavior in order to decrease the mechanical demands and enhance dynamic stability. Various descriptions of dynamic traits of gait that have been collected over longer periods, probably better synthesize the underlying structure and pattern of fluctuations in gait and can be more sensitive markers of aging or early neurological dysfunction and increased risk of falls. This confirmation challenges the clinimetric of different protocols and paradigms used for gait analysis up till now, in particular when analyzing obstacle crossing. The authors here present a critical review of current knowledge concerning the interplay between the cognition and gait in aging and PD, emphasizing the differences in gait behavior and adaptability while walking over different and challenging obstacle paradigms, and the implications of obstacle negotiation as a predictor of falls. Some evidence concerning the effectiveness of future rehabilitation protocols on reviving obstacle crossing behavior by trial and error relearning, taking advantage of dual-task paradigms, physical exercise, and virtual reality have been put forward in this article.
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Affiliation(s)
- Nafiseh Mollaei
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Estela Bicho
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga
| | - Miguel Fernandes Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga.,Neurology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
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118
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Mc Ardle R, Morris R, Wilson J, Galna B, Thomas AJ, Rochester L. What Can Quantitative Gait Analysis Tell Us about Dementia and Its Subtypes? A Structured Review. J Alzheimers Dis 2017; 60:1295-1312. [DOI: 10.3233/jad-170541] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ríona Mc Ardle
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - Rosie Morris
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospital NHS Foundation Trust, UK
| | - Joanna Wilson
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - Brook Galna
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
- School of Biomedical Sciences, Newcastle University, UK
| | - Alan J. Thomas
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospital NHS Foundation Trust, UK
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119
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Anwar N, Labuschagne I, Simpson K, Smith L, Georgiou-Karistianis N. Impairments in Spatiotemporal Gait Adaptation During Obstacle Navigation in Huntington's Disease. Neurorehabil Neural Repair 2017; 31:934-943. [PMID: 29082783 DOI: 10.1177/1545968317736818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Navigating obstacles whilst walking might be associated with poorer balance and a higher risk of falling in individuals with symptomatic Huntington's disease (symp-HD). However, this issue has not been investigated within the literature. OBJECTIVE A unique obstacle navigation experiment was designed to examine adaptive gait patterns in order to identify spatiotemporal gait characteristics that might be associated with poorer balance and a higher risk of falling in symp-HD. METHOD Sixteen diagnosed symp-HD participants and 16 age- and sex-matched healthy controls were included. Gait was examined in 3 experimental conditions: baseline walking, walking while navigating around 1 obstacle, and walking while navigating around 2 obstacles. Navigation around obstacle walks was divided into three step phases (approach, navigation, recovery). Group differences in gait variables were analyzed at baseline and during walking for each obstacle condition respectively. Gait variables were also correlated with the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test. RESULTS Symp-HD participants, compared with controls, performed significantly poorer on most gait variables during baseline walking. Symp-HD participants significantly decreased their step-length while navigating around 1 obstacle, and increased their step-time while navigating around 1 and 2 obstacles. There were no significant group differences in step-width. Variables associated with navigating around obstacles correlated significantly with BBS and TUG clinical tools, which have been associated in the literature with an increased risk of falling in symp-HD. CONCLUSION These findings could aid clinicians in better managing risk of falls in people with Huntington's disease through targeted and effective strategies.
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Affiliation(s)
| | - Izelle Labuschagne
- 1 Monash University, Melbourne, Victoria, Australia.,2 Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Luke Smith
- 3 Cabrini Health, Melbourne, Victoria, Australia
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120
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Ladha C, Del Din S, Nazarpour K, Hickey A, Morris R, Catt M, Rochester L, Godfrey A. Toward a low-cost gait analysis system for clinical and free-living assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1874-1877. [PMID: 28268692 DOI: 10.1109/embc.2016.7591086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gait is an important clinical assessment tool since changes in gait may reflect changes in general health. Measurement of gait is a complex process which has been restricted to bespoke clinical facilities until recently. The use of inexpensive wearable technologies is an attractive alternative and offers the potential to assess gait in any environment. In this paper we present the development of a low cost analysis gait system built using entirely open source components. The system is used to capture spatio-temporal gait characteristics derived from an existing conceptual model, sensitive to ageing and neurodegenerative pathology (e.g. Parkinson's disease). We demonstrate the system is suitable for use in a clinical unit and will lead to pragmatic use in a free-living (home) environment. The system consists of a wearable (tri-axial accelerometer and gyroscope) with a Raspberry Pi module for data storage and analysis. This forms ongoing work to develop gait as a low cost diagnostic in modern healthcare.
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121
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Hobert MA, Meyer SI, Hasmann SE, Metzger FG, Suenkel U, Eschweiler GW, Berg D, Maetzler W. Gait Is Associated with Cognitive Flexibility: A Dual-Tasking Study in Healthy Older People. Front Aging Neurosci 2017; 9:154. [PMID: 28596731 PMCID: PMC5442228 DOI: 10.3389/fnagi.2017.00154] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 05/04/2017] [Indexed: 01/06/2023] Open
Abstract
Objectives: To analyze which gait parameters are primarily influenced by cognitive flexibility, and whether such an effect depends on the walking condition used. Design: Cross-sectional analysis. Setting: Tübingen evaluation of Risk factors for Early detection of Neurodegenerative Disorders. Participants: A total of 661 non-demented individuals (49–80 years). Measurements: A gait assessment with four conditions was performed: a 20 m walk at convenient speed (C), at fast speed (F), at fast speed while checking boxes (FB), and while subtracting serial 7s (FS). Seven gait parameters from a wearable sensor-unit (McRoberts, Netherlands) were compared with delta Trail-Making-Test (dTMT) values, which is a measure of cognitive flexibility. Walking strategies of good and poor dTMT performers were compared by evaluating the patterns of gait parameters across conditions. Results: Five parameters correlated significantly with the dTMT in the FS condition, two parameters in the F and FB condition, and none in the C condition. Overall correlations were relatively weak. Gait speed was the gait parameter that most strongly correlated with the dTMT (r2 = 7.4%). In good, but not poor, dTMT performers differences between FB and FS were significantly different in variability-associated gait parameters. Conclusion: Older individuals need cognitive flexibility to perform difficult walking conditions. This association is best seen in gait speed. New and particularly relevant for recognition and training of deficits is that older individuals with poor cognitive flexibility have obviously fewer resources to adapt to challenging walking conditions. Our findings partially explain gait deficits in older adults with poor cognitive flexibility.
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Affiliation(s)
- Markus A Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TübingenTübingen, Germany.,DZNE, German Center for Neurodegenerative DiseasesTübingen, Germany.,Department of Neurology, University of KielKiel, Germany
| | - Sinja I Meyer
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TübingenTübingen, Germany.,DZNE, German Center for Neurodegenerative DiseasesTübingen, Germany
| | - Sandra E Hasmann
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TübingenTübingen, Germany.,DZNE, German Center for Neurodegenerative DiseasesTübingen, Germany
| | - Florian G Metzger
- Department of Psychiatry and PsychotherapyUniversity Hospital Tübingen, Tübingen, Germany.,Geriatric Center, University of TübingenTübingen, Germany
| | - Ulrike Suenkel
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TübingenTübingen, Germany.,DZNE, German Center for Neurodegenerative DiseasesTübingen, Germany
| | - Gerhard W Eschweiler
- Department of Psychiatry and PsychotherapyUniversity Hospital Tübingen, Tübingen, Germany.,Geriatric Center, University of TübingenTübingen, Germany
| | - Daniela Berg
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TübingenTübingen, Germany.,DZNE, German Center for Neurodegenerative DiseasesTübingen, Germany.,Department of Neurology, University of KielKiel, Germany
| | - Walter Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of TübingenTübingen, Germany.,DZNE, German Center for Neurodegenerative DiseasesTübingen, Germany.,Department of Neurology, University of KielKiel, Germany.,Geriatric Center, University of TübingenTübingen, Germany
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Ramakers R, Koene S, Groothuis JT, de Laat P, Janssen MC, Smeitink J. Quantification of gait in mitochondrial m.3243A > G patients: a validation study. Orphanet J Rare Dis 2017; 12:91. [PMID: 28506302 PMCID: PMC5432977 DOI: 10.1186/s13023-017-0644-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background More than half of the patients harbouring the m.3243A > G mutation were found to have trouble maintaining balance when walking in a recent study by our group. Others demonstrated that these patients had an abnormal gait pattern, as quantified by gait analysis. Gait analysis is an emerging method to quantify subtle changes in walking pattern, also during therapeutic interventions. Therefore, we aimed to test the reliability and reproducibility of gait analysis and select the most suitable protocol for this group of patients using a GAITRite electronic walkway. Four different protocols were tested: normal walking, dual task, post exercise and after a ten minutes of rest. Results In total 36 patients with the m.3243A > G mutation and 50 healthy controls were enrolled in this study. Overall high intra class correlation coefficients were found in all experimental conditions for both patients and healthy controls indicating good reproducibility. Marked differences in gait between patients and controls were observed and were in line with the only available exploratory study performed. There was a good correlation between both the overall NMDAS score, NMDAS subscale scores, both markers for disease severity, and specific gait parameters. Conclusions The observed reliability of the test makes GAITRite a suitable instrument for intervention studies in patients with mitochondrial disease.
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Affiliation(s)
- Rob Ramakers
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Saskia Koene
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jan T Groothuis
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Paul de Laat
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mirian Ch Janssen
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.,Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan Smeitink
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
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Rennie L, Dietrichs E, Moe-Nilssen R, Opheim A, Franzén E. The validity of the Gait Variability Index for individuals with mild to moderate Parkinson's disease. Gait Posture 2017; 54:311-317. [PMID: 28395171 DOI: 10.1016/j.gaitpost.2017.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 02/02/2023]
Abstract
Increased step-to-step variability is a feature of gait in individuals with Parkinson's disease (PD) and is associated with increased disease severity and reductions in balance and mobility. The Gait Variability Index (GVI) quantifies gait variability in spatiotemporal variables where a score ≥100 indicates a similar level of gait variability as the control group, and lower scores denote increased gait variability. The study aim was to explore mean GVI score and investigate construct validity of the index for individuals with mild to moderate PD. 100 (57 males) subjects with idiopathic PD, Hoehn & Yahr 2 (n=44) and 3, and ≥60 years were included. Data on disease severity, dynamic balance, mobility and spatiotemporal gait parameters at self-selected speed (GAITRite) was collected. The results showed a mean overall GVI: 97.5 (SD 11.7) and mean GVI for the most affected side: 94.5 (SD 10.6). The associations between the GVI and Mini- BESTest and TUG were low (r=0.33 and 0.42) and the GVI could not distinguish between Hoehn & Yahr 2 and 3 (AUC=0.529, SE=0.058, p=0.622). The mean GVI was similar to previously reported values for older adults, contrary to consistent reports of increased gait variability in PD compared to healthy peers. Therefore, the validity of the GVI could not be confirmed for individuals with mild to moderate PD in its current form due to low associations with validated tests for functional balance and mobility and poor discriminatory ability. Future work should aim to establish which spatiotemporal variables are most informative regarding gait variability in individuals with PD.
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Affiliation(s)
- Linda Rennie
- Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway.
| | - Espen Dietrichs
- Department of Neurology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Norway.
| | - Rolf Moe-Nilssen
- Physiotherapy Research Group, Department of Global Public Health and Primary Health Care, University of Bergen, Norway.
| | - Arve Opheim
- Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway; Institute of Neuroscience and Physiology, University of Gothenberg, Sweden; Habilitation & Health, Region Västra Götaland, Sweden.
| | - Erika Franzén
- Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway; Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden; Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
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Carroll LM, Volpe D, Morris ME, Saunders J, Clifford AM. Aquatic Exercise Therapy for People With Parkinson Disease: A Randomized Controlled Trial. Arch Phys Med Rehabil 2017; 98:631-638. [DOI: 10.1016/j.apmr.2016.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/04/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
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Krishnamurthi N, Shill H, O'Donnell D, Mahant P, Samanta J, Lieberman A, Abbas J. Polestriding Intervention Improves Gait and Axial Symptoms in Mild to Moderate Parkinson Disease. Arch Phys Med Rehabil 2017; 98:613-621. [PMID: 27984031 PMCID: PMC5367944 DOI: 10.1016/j.apmr.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/19/2016] [Accepted: 10/02/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effects of 12-week polestriding intervention on gait and disease severity in people with mild to moderate Parkinson disease (PD). DESIGN A-B-A withdrawal study design. SETTING Outpatient movement disorder center and community facility. PARTICIPANTS Individuals (N=17; 9 women [53%] and 8 men [47%]; mean age, 63.7±4.9y; range, 53-72y) with mild to moderate PD according to United Kingdom brain bank criteria with Hoehn & Yahr score ranging from 2.5 to 3.0 with a stable medication regimen and ability to tolerate "off" medication state. INTERVENTIONS Twelve-week polestriding intervention with 12-week follow-up. MAIN OUTCOME MEASURES Gait was evaluated using several quantitative temporal, spatial, and variability measures. In addition, disease severity was assessed using clinical scales such as Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr scale, and Parkinson's Disease Questionnaire-39. RESULTS Step and stride lengths, gait speed, and step-time variability were improved significantly (P<.05) because of 12-week polestriding intervention. Also, the UPDRS motor score, the UPDRS axial score, and the scores of UPDRS subscales on walking and balance improved significantly after the intervention. CONCLUSIONS Because increased step-time variability and decreased step and stride lengths are associated with PD severity and an increased risk of falls in PD, the observed improvements suggest that regular practice of polestriding may reduce the risk of falls and improve mobility in people with PD.
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Affiliation(s)
- Narayanan Krishnamurthi
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ; Muhammad Ali Parkinson Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
| | - Holly Shill
- Banner Sun Health Research Institute, Sun City, AZ
| | - Darolyn O'Donnell
- Muhammad Ali Parkinson Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Padma Mahant
- Banner Good Samaritan Medical Center, Phoenix, AZ
| | | | - Abraham Lieberman
- Muhammad Ali Parkinson Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - James Abbas
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ
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Rochester L, Galna B, Lord S, Yarnall AJ, Morris R, Duncan G, Khoo TK, Mollenhauer B, Burn DJ. Decrease in Aβ42 predicts dopa-resistant gait progression in early Parkinson disease. Neurology 2017; 88:1501-1511. [PMID: 28330963 DOI: 10.1212/wnl.0000000000003840] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This prospective observational study investigates the role of CSF biomarkers in predicting progression of dopa-resistant gait impairments in Parkinson disease (PD) in the first 36 months from diagnosis. METHODS Quantitative gait analysis was carried out longitudinally using an instrumented walkway (GAITRite) in 108 people with PD and 130 age-matched controls. A subgroup of 44 people with PD underwent lumbar puncture from which a battery of CSF biomarkers was measured: β-amyloid 1-42 and 1-40 (Aβ42 and Aβ40), total and phosphorylated tau protein (t-tau/p-tau181), and α-synuclein (αSyn). Linear mixed models examined the association between CSF and dopa-resistant gait characteristics (defined as substantial progression despite optimal medication). RESULTS Low baseline CSF Aβ42, and to a lesser extend Aβ40, predicted decline in gait characteristics in the first 3 years following diagnosis, independently explaining up to 12% of progression of step time variability (single task) and step length variability (dual-task). Interestingly, these findings were independent of age and cognition. CONCLUSIONS These findings implicate underlying amyloid pathology in neural networks involved in locomotor control. Results suggest that disturbed Aβ metabolism may be a biomarker for dopa-resistant gait impairments in early PD. Our findings raise interesting questions regarding therapeutic interventions such as compounds or molecules aimed at reducing amyloid burden to mitigate gait disturbance in early PD and potentially falls risk. Finally, progression of discrete gait characteristics suggests they may have potential as clinical biomarkers of pathology and disease progression.
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Affiliation(s)
- Lynn Rochester
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany.
| | - Brook Galna
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
| | - Sue Lord
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
| | - Alison J Yarnall
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
| | - Rosie Morris
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
| | - Gordon Duncan
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
| | - Tien K Khoo
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
| | - Brit Mollenhauer
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
| | - David J Burn
- From the Institute of Neuroscience (L.R., B.G., S.L., A.J.Y., R.M., G.D., T.K.K., D.J.B.), Clinical Ageing Research Unit, Newcastle University; Department of Geriatric Medicine (G.D.), University of Edinburgh, UK; School of Medicine & Menzies Health Institute (T.K.K.), Griffith University, Australia; and Paracelsus-Elena Klinik, Kassel and University Medical Centre (Institute of Neuropathology and Department of Neurosurgery) (B.M.), Göttingen, Germany
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Szturm TJ, Sakhalkar VS, Kanitkar A, Nankar M. Computerized Dual-Task Testing of Gait and Visuospatial Cognitive Functions; Test-Retest Reliability and Validity. Front Hum Neurosci 2017; 11:105. [PMID: 28367119 PMCID: PMC5355418 DOI: 10.3389/fnhum.2017.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
The common occurrence of age decline in mobility and cognition does cause a decrease in the level of physical activity and an increased falls risk. Consequently, dual -task (DT) assessment that simultaneously addresses both mobility skills and cognitive functions are important because, continued difficulties and fall injuries will have a sizable impact in this population. The first objective of the present study was to assess test-retest reliability of a computerized DT treadmill walking protocol and concurrent outcome measures of gait and visuospatial executive function in a group of healthy older adults. Secondly, discriminative validity was evaluated by examining the effect of DT conditions (single task vs. dual-task) on; (a) spatiotemporal gait measures (average and coefficient of variation) and (b) visuomotor and visuospatial executive performance measures. Twenty-five community-dwelling individuals median age 65 (range 61-67) were recruited from a Fitness Facility. Participants performed a computerized visuomotor tracking task and a visuospatial executive game task in standing and while treadmill walking. Testing was conducted on two occasions, 1 week apart. Moderate to high test-retest reliability (ICC values of 0.65-0.88) were observed for spatiotemporal gait variables. No significant differences between the group means were observed between test periods in any gait variable. Moderate test-retest reliability (ICC values of 0.6-0.65) was observed for measures of visuomotor and visuospatial executive performance during treadmill walking. Significant DT effects were observed for both spatiotemporal gait variables and visuospatial executive performance measures. This study demonstrates the reliability and reproducibility of the computer-based assessment tool for dual task treadmill walking. The high to moderate ICC values and the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable data from community-dwelling older adults. The present computerized dual-task protocols broaden the types of standardized visuomotor and visuospatial executive activities for use with DT treadmill walking that has previously been reported.
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Affiliation(s)
- Tony J Szturm
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Department of Physical Therapy, University of ManitobaWinnipeg, MB, Canada
| | - Vedant S Sakhalkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; School of Medical Rehabilitation, University of ManitobaWinnipeg, MB, Canada
| | - Anuprita Kanitkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Applied Health Sciences, University of ManitobaWinnipeg, MB, Canada
| | - Mayur Nankar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of Manitoba Winnipeg, MB, Canada
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128
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O'Keefe JA, Robertson-Dick EE, Hall DA, Berry-Kravis E. Gait and Functional Mobility Deficits in Fragile X-Associated Tremor/Ataxia Syndrome. THE CEREBELLUM 2017; 15:475-82. [PMID: 26298472 DOI: 10.1007/s12311-015-0714-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) results from a "premutation" (PM) size CGG repeat expansion in the fragile X mental retardation 1 (FMR1) gene. Cerebellar gait ataxia is the primary feature in some FXTAS patients causing progressive disability. However, no studies have quantitatively characterized gait and mobility deficits in FXTAS. We performed quantitative gait and mobility analysis in seven FMR1 PM carriers with FXTAS and ataxia, six PM carriers without FXTAS, and 18 age-matched controls. We studied four independent gait domains, trunk range of motion (ROM), and movement transitions using an instrumented Timed Up and Go (i-TUG). We correlated these outcome measures with FMR1 molecular variables and clinical severity scales. PM carriers with FXTAS were globally impaired in every gait performance domain except trunk ROM compared to controls. These included total i-TUG duration, stride velocity, gait cycle time, cadence, double-limb support and swing phase times, turn duration, step time before turn, and turn-to-sit duration, and increased gait variability on several measures. Carriers without FXTAS did not differ from controls on any parameters, but double-limb support time was close to significance. Balance and disability scales correlated with multiple gait and movement transition parameters, while the FXTAS Rating Scale did not. This is the first study to quantitatively examine gait and movement transitions in FXTAS patients. Gait characteristics were consistent with those from previous cohorts with cerebellar ataxia. Sensitive measures like the i-TUG may help determine efficacy of interventions, characterize disease progression, and provide early markers of disease in FXTAS.
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Affiliation(s)
- Joan A O'Keefe
- Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina Street, Office 505B, Chicago, IL, 60612, USA.
| | - Erin E Robertson-Dick
- Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina Street, Office 505B, Chicago, IL, 60612, USA
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA.,Department of Biochemistry, Rush University Medical Center, Chicago, IL, USA
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Buckley C, Galna B, Rochester L, Mazzà C. Quantification of upper body movements during gait in older adults and in those with Parkinson's disease: impact of acceleration realignment methodologies. Gait Posture 2017; 52:265-271. [PMID: 27992850 PMCID: PMC5343666 DOI: 10.1016/j.gaitpost.2016.11.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/21/2016] [Accepted: 11/29/2016] [Indexed: 02/02/2023]
Abstract
The upper body accelerations of people with Parkinson's disease (PD) measured by inertial measurement units (IMUs) may contribute towards diagnostic algorithms and help track disease progression. Before extracting variables related to upper body motion, acceleration signals require realignment to a global reference; however, the impact of these techniques on the resulting upper body variables is unclear. Therefore, the aim of this investigation was to examine the impact of four different realignment methods designed to correct acceleration signals on a range of upper body variables in older adults and in patients with PD. Two minutes of continuous gait were measured in 54 community-dwelling older adults (71.1±6.7 years) and 60 people with PD (age: 68.5±9.1 years). Three IMUs placed on the 5th lumbar vertebra, 7th cervical vertebra and the back of the head recorded the acceleration of the upper body. A selection of upper body variables sensitive to impaired upper body control in PD and four acceleration realignment methods were compared. A mixed-model ANOVA showed that the choice of realignment method significantly affected the values of upper body variables as well as their ability to discriminate between the PD and control group. Our findings indicate researchers and clinicians should be cautious when comparing upper body variables extracted from IMUs using different realignment methods, and consideration of realignment technique will be important when identifying the most sensitive markers of disease presence and progression. Therefore, it's strongly recommend that researchers consider and report their realignment methods when assessing upper body variables during gait.
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Affiliation(s)
- Christopher Buckley
- MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Pam Liversidge Building, University of Sheffield, Sheffield S1 3JD, UK; Department of Mechanical Engineering, University of Sheffield, Sir Frederick Mappin Building, Sheffield S1 3JD, UK; INSIGNEO Institute for in Silico Medicine, University of Sheffield, Pam Liversidge Building, Sheffield S1 3JD, UK.
| | - Brook Galna
- Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, Sir Frederick Mappin Building, Sheffield S1 3JD, UK; INSIGNEO Institute for in Silico Medicine, University of Sheffield, Pam Liversidge Building, Sheffield S1 3JD, UK
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Volpe D, Pavan D, Morris M, Guiotto A, Iansek R, Fortuna S, Frazzitta G, Sawacha Z. Underwater gait analysis in Parkinson's disease. Gait Posture 2017; 52:87-94. [PMID: 27888696 DOI: 10.1016/j.gaitpost.2016.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.
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Affiliation(s)
- Daniele Volpe
- Neurorehabilitation Department, Casa di Cura "Villa Margherita", Vicenza, Italy; G.V.D.R. Cadoneghe, Padova, Italy, Italy.
| | - Davide Pavan
- Department of Information Engineering, University of Padova, Padova, Italy.
| | - Meg Morris
- School of Clinical Science, Monash University, Monash Health, Clayton, Victoria, 3168.
| | - Annamaria Guiotto
- Department of Information Engineering, University of Padova, Padova, Italy.
| | - Robert Iansek
- School of Clinical Science, Monash University, Monash Health, Clayton, Victoria, 3168.
| | - Sofia Fortuna
- Neurorehabilitation Department, Casa di Cura "Villa Margherita", Vicenza, Italy.
| | - Giuseppe Frazzitta
- Parkinson's Centre Pelascini Riuniti Hospital, Gravedona, Italy; G.V.D.R. Cadoneghe, Padova, Italy, Italy.
| | - Zimi Sawacha
- Department of Information Engineering, University of Padova, Padova, Italy.
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Morris R, Hickey A, Del Din S, Godfrey A, Lord S, Rochester L. A model of free-living gait: A factor analysis in Parkinson's disease. Gait Posture 2017; 52:68-71. [PMID: 27883986 DOI: 10.1016/j.gaitpost.2016.11.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Gait is a marker of global health, cognition and falls risk. Gait is complex, comprised of multiple characteristics sensitive to survival, age and pathology. Due to covariance amongst characteristics, conceptual gait models have been established to reduce redundancy and aid interpretation. Previous models have been derived from laboratory gait assessments which are costly in equipment and time. Body-worn monitors (BWM) allow for free-living, low-cost and continuous gait measurement and produce similar covariant gait characteristics. A BWM gait model from both controlled and free-living measurement has not yet been established, limiting utility. METHODS 103 control and 67 PD participants completed a controlled laboratory assessment; walking for two minutes around a circuit wearing a BWM. 89 control and 58 PD participants were assessed in free-living, completing normal activities for 7 days wearing a BWM. Fourteen gait characteristics were derived from the BWM, selected according to a previous model. Principle component analysis derived factor loadings of gait characteristics. RESULTS Four gait domains were derived for both groups and conditions; pace, rhythm, variability and asymmetry. Domains totalled 84.84% and 88.43% of variance for controlled and 90.00% and 93.03% of variance in free-living environments for control and PD participants respectively. Gait characteristic loading was unambiguous for all characteristics apart from gait variability which demonstrated cross-loading for both groups and environments. The model was highly congruent with the original model. CONCLUSIONS The conceptual gait models remained stable using a BWM in controlled and free-living environments. The model became more discrete supporting utility of the gait model for free-living gait.
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Affiliation(s)
- Rosie Morris
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Aodhán Hickey
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Silvia Del Din
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alan Godfrey
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sue Lord
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom.
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Tian Q, Chastan N, Bair WN, Resnick SM, Ferrucci L, Studenski SA. The brain map of gait variability in aging, cognitive impairment and dementia-A systematic review. Neurosci Biobehav Rev 2017; 74:149-162. [PMID: 28115194 DOI: 10.1016/j.neubiorev.2017.01.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
While gait variability may reflect subtle changes due to aging or cognitive impairment (CI), associated brain characteristics remain unclear. We summarize structural and functional neuroimaging findings associated with gait variability in older adults with and without CI and dementia. We identified 17 eligible studies; all were cross-sectional; few examined multiple brain areas. In older adults, temporal gait variability was associated with structural differences in medial areas important for lower limb coordination and balance. Both temporal and spatial gait variability were associated with structural and functional differences in hippocampus and primary sensorimotor cortex and structural differences in anterior cingulate cortex, basal ganglia, association tracts, and posterior thalamic radiation. In CI or dementia, some associations were found in primary motor cortex, hippocampus, prefrontal cortex and basal ganglia. In older adults, gait variability may be associated with areas important for sensorimotor integration and coordination. To comprehend the neural basis of gait variability with aging and CI, longitudinal studies of multiple brain areas are needed.
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Affiliation(s)
- Qu Tian
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, 251 Bayview Blvd., Suite 100, Baltimore, MD 21224, USA.
| | - Nathalie Chastan
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, 251 Bayview Blvd., Suite 100, Baltimore, MD 21224, USA; Neurophysiology Department, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France; INSERM U1075, COMETE, Normandy University, Espl. de la Paix, 14032 Caen, France
| | - Woei-Nan Bair
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, 251 Bayview Blvd., Suite 100, Baltimore, MD 21224, USA
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, 251 Bayview Blvd., Suite 100, Baltimore, MD 21224, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, 251 Bayview Blvd., Suite 100, Baltimore, MD 21224, USA
| | - Stephanie A Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, 251 Bayview Blvd., Suite 100, Baltimore, MD 21224, USA
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Hickey A, Gunn E, Alcock L, Del Din S, Godfrey A, Rochester L, Galna B. Validity of a wearable accelerometer to quantify gait in spinocerebellar ataxia type 6. Physiol Meas 2016; 37:N105-N117. [DOI: 10.1088/0967-3334/37/11/n105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ryan JM, Theis N, Kilbride C, Baltzopoulos V, Waugh C, Shortland A, Lavelle G, Noorkoiv M, Levin W, Korff T. Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy. BMJ Open 2016; 6:e012839. [PMID: 27707836 PMCID: PMC5073599 DOI: 10.1136/bmjopen-2016-012839] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gait is inefficient in children with cerebral palsy, particularly as they transition to adolescence. Gait inefficiency may be associated with declines in gross motor function and participation among adolescents with cerebral palsy. Resistance training may improve gait efficiency through a number of biomechanical and neural mechanisms. The aim of the Strength Training for Adolescents with cerebral palsy (STAR) trial is to evaluate the effect of resistance training on gait efficiency, activity and participation in adolescents with cerebral palsy. We also aim to determine the biomechanical and neural adaptations that occur following resistance training and evaluate the feasibility and acceptability of such an intervention for adolescents with cerebral palsy. METHODS AND ANALYSIS 60 adolescents (Gross Motor Function Classification System level I-III) will be randomised to a 10-week resistance training group or a usual care control group according to a computer-generated random schedule. The primary outcome is gait efficiency. Secondary outcomes are habitual physical activity, participation, muscle-tendon mechanics and gross motor function. General linear models will be used to evaluate differences in continuous data between the resistance training and usual care groups at 10 and 22 weeks, respectively. A process evaluation will be conducted alongside the intervention. Fidelity of the resistance training programme to trial protocol will be quantified by observations of exercise sessions. Semistructured interviews will be conducted with participants and physiotherapists following the resistance training programme to determine feasibility and acceptability of the programme. ETHICS AND DISSEMINATION This trial has ethical approval from Brunel University London's Department of Clinical Sciences' Research Ethics Committee and the National Research Ethics Service (NRES) Committee London-Surrey Borders. The results of the trial will be submitted for publication in academic journals, presented at conferences and distributed to adolescents, families and healthcare professionals through the media with the assistance of the STAR advisory group. TRIAL REGISTRATION NUMBER ISRCTN90378161; Pre-results.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Nicola Theis
- School of Sport, Health and Applied Science, St. Mary's University, Twickenham, UK
| | - Cherry Kilbride
- College of Health and Life Sciences, Brunel University London, London, UK
| | | | - Charlie Waugh
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Grace Lavelle
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Marika Noorkoiv
- College of Health and Life Sciences, Brunel University London, London, UK
| | - Wendy Levin
- Department of Physiotherapy, Royal Free London NHS Foundation Trust, Swiss Cottage School Development and Research Centre, London, UK
| | - Thomas Korff
- College of Health and Life Sciences, Brunel University London, London, UK
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Del Din S, Hickey A, Hurwitz N, Mathers JC, Rochester L, Godfrey A. Measuring gait with an accelerometer-based wearable: influence of device location, testing protocol and age. Physiol Meas 2016; 37:1785-1797. [DOI: 10.1088/0967-3334/37/10/1785] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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136
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Lord S, Galna B, Yarnall AJ, Coleman S, Burn D, Rochester L. Predicting first fall in newly diagnosed Parkinson's disease: Insights from a fall-naïve cohort. Mov Disord 2016; 31:1829-1836. [PMID: 27621153 DOI: 10.1002/mds.26742] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls are common and associated with reduced independence and mortality in Parkinson's disease. Previous research has been conducted on falls-prevalent or advanced disease cohorts. OBJECTIVE This study identifies risk factors for first fall for 36 months in a newly diagnosed, falls-naïve cohort. METHODS A total of 121 consecutive Parkinson's disease patients were recruited. Falls data were collected prospectively during 36 months from diagnosis via monthly falls diaries and telephone follow-up for 117 participants. Assessment comprised a comprehensive battery of clinical, gait, and cognitive measures. Significant predictors were identified from decision-tree analysis and survival analysis with time to first fall during 36 months as the dependent variable. FINDINGS At baseline, 26 (22%) participants reported retrospective falls. At 36 months, the remaining cohort (n = 91) comprised 47 fallers (52%) and 30 (33%) nonfallers and 14 (15%) participants with incomplete diaries. Fallers presented with a significantly higher disease severity, poorer ability to stand on one leg, slower gait speed, increased stance time variability, and higher swing time asymmetry. Median time to first fall was 847 days. Gait speed, stance time, and Hoehn & Yahr III stage emerged as significant predictors of first fall, hazard ratio 3.44 (95% confidence interval [CI] 1.58 to 7.48), 3.31(95% CI 1.40 to 7.80), and 2.80 (95% CI 1.38 to 5.65), respectively. The hazard ratio for risk factors combined was 7.82 (CI 2.80 to 21.84). CONCLUSIONS Interventions that target gait deficit and postural control in early Parkinson's disease may limit the potential for first fall. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sue Lord
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Brook Galna
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Shirley Coleman
- UK and Industrial Statistics Research Unit, Newcastle University, Newcastle upon Tyne, UK
| | - David Burn
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University Institute for Aging, Newcastle upon Tyne, UK
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137
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Hypokinetic gait changes induced by bilateral pallidal deep brain stimulation for segmental dystonia. Gait Posture 2016; 49:358-363. [PMID: 27491053 DOI: 10.1016/j.gaitpost.2016.07.301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/24/2016] [Accepted: 07/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been established as an effective and safe treatment for dystonia. In general, side effects are rare, but there is increasing evidence that GPi DBS in dystonia can induce hypokinetic symptoms like micrographia or freezing of gait. We aimed to evaluate and quantify possible changes of gait following bilateral chronic GPi DBS for dystonia by computerized gait analyses. METHODS We prospectively performed computerized gait analysis in ten consecutive patients (mean age 57.8+/-14.3 years) with segmental dystonia but without involvement of lower trunk or legs who were treated with bilateral GPi DBS. Using pressure sensitive insoles, several parameters were measured preoperatively (pre-OP) and at a median of 7 months postoperatively. RESULTS The mean step length significantly decreased from 60.0+/-6.9cm pre-OP to 54.3+/-6.4cm with GPi DBS (p<0.01). Due to only small changes of walking distance and gait velocity, the cadence correspondingly increased from 105.6+/-9.2 steps/min to 111.3+/-11.4 steps/min (p<0.05). More importantly, the variance of several gait parameters significantly decreased postoperatively. CONCLUSIONS In patients with segmental dystonia, chronic DBS of the posteroventral lateral GPi is associated with only mild hypokinesia of gait, but with a relevant decrease in gait variability. Given other recently reported hypokinetic effects of GPi DBS for dystonia and recent results of electrophysiological coherence studies, these findings support the hypothesis of a general alteration of neuronal activity in striato-pallido-thalamo-cortical motor pathways following chronic stimulation of the posteroventral lateral GPi.
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Test-Retest Reliability of Dual-Task Outcome Measures in People With Parkinson Disease. Phys Ther 2016; 96:1276-86. [PMID: 26847010 DOI: 10.2522/ptj.20150244] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dual-task (DT) training is gaining ground as a physical therapy intervention in people with Parkinson disease (PD). Future studies evaluating the effect of such interventions need reliable outcome measures. To date, the test-retest reliability of DT measures in patients with PD remains largely unknown. OBJECTIVE The purpose of this study was to assess the reliability of DT outcome measures in patients with PD. DESIGN A repeated-measures design was used. METHODS Patients with PD ("on" medication, Mini-Mental State Examination score ≥24) performed 2 cognitive tasks (ie, backward digit span task and auditory Stroop task) and 1 functional task (ie, mobile phone task) in combination with walking. Tasks were assessed at 2 time points (same hour) with an interval of 6 weeks. Test-retest reliability was assessed for gait while performing each secondary task (DT gait) for both cognitive tasks while walking (DT cognitive) and for the functional task while walking (DT functional). RESULTS Sixty-two patients with PD (age=39-89 years, Hoehn and Yahr stages II-III) were included in the study. Intraclass correlation coefficients (ICCs) showed excellent reliability for DT gait measures, ranging between .86 and .95 when combined with the digit span task, between .86 and .95 when combined with the auditory Stroop task, and between .72 and .90 when combined with the mobile phone task. The standard error of measurements for DT gait speed varied between 0.06 and 0.08 m/s, leading to minimal detectable changes between 0.16 and 0.22 m/s. With regard to DT cognitive measures, reaction times showed good-to-excellent reliability (digit span task: ICC=.75; auditory Stroop task: ICC=.82). LIMITATIONS The results cannot be generalized to patients with advanced disease or to other DT measures. CONCLUSIONS In people with PD, DT measures proved to be reliable for use in clinical studies and look promising for use in clinical practice to assess improvements after DT training. Large effects, however, are needed to obtain meaningful effect sizes.
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139
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Morgan SJ, Hafner BJ, Kelly VE. The effects of a concurrent task on walking in persons with transfemoral amputation compared to persons without limb loss. Prosthet Orthot Int 2016. [PMID: 26209423 DOI: 10.1177/0309364615596066] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many people with lower limb loss report the need to concentrate on walking. This may indicate increased reliance on cognitive resources when walking compared to individuals without limb loss. OBJECTIVE This study quantified changes in walking associated with addition of a concurrent cognitive task in persons with transfemoral amputation using microprocessor knees compared to age- and sex-matched controls. STUDY DESIGN Observational, cross-sectional study. METHODS Quantitative motion analysis was used to assess walking under both single-task (walking alone) and dual-task (walking while performing a cognitive task) conditions. Primary outcomes were walking speed, step width, step time asymmetry, and cognitive task response latency and accuracy. Repeated-measures analysis of variance was used to examine the effects of task (single-task and dual-task) and group (transfemoral amputation and control) for each outcome. RESULTS No significant interactions between task and group were observed (all p > 0.11) indicating that a cognitive task did not differentially affect walking between groups. However, walking was slower with wider steps and more asymmetry in people with transfemoral amputation compared to controls under both conditions. CONCLUSION Although there were significant differences in walking between people with transfemoral amputation and matched controls, the effects of a concurrent cognitive task on walking were similar between groups. CLINICAL RELEVANCE The addition of a concurrent task did not differentially affect walking outcomes in people with and without transfemoral amputation. However, compared to people without limb loss, people with transfemoral amputation adopted a conservative walking strategy. This strategy may reduce the need to concentrate on walking but also contributed to notable gait deviations.
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140
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Byun S, Han JW, Kim TH, Kim KW. Test-Retest Reliability and Concurrent Validity of a Single Tri-Axial Accelerometer-Based Gait Analysis in Older Adults with Normal Cognition. PLoS One 2016; 11:e0158956. [PMID: 27427965 PMCID: PMC4948825 DOI: 10.1371/journal.pone.0158956] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 06/25/2016] [Indexed: 11/18/2022] Open
Abstract
Objective We investigated the concurrent validity and test-retest reliability of spatio-temporal gait parameters measured with a single tri-axial accelerometer (TAA), determined the optimal number of steps required for obtaining acceptable levels of reliability, and compared the validity and reliability of the estimated gait parameters across the three reference axes of the TAA. Methods A total of 82 cognitively normal elderly participants walked around a 40-m long round walkway twice wearing a TAA at their center of body mass. Gait parameters such as cadence, gait velocity, step time, step length, step time variability, and step time asymmetry were estimated from the low pass-filtered signal of the TAA. The test-retest reliability and concurrent validity with the GAITRite® system were evaluated for the estimated gait parameters. Results Gait parameters using signals from the vertical axis showed excellent reliability for all gait parameters; the intraclass correlation coefficient (ICC) was 0.79–0.90. A minimum of 26 steps and 14 steps were needed to achieve excellent reliability in step time variability and step time asymmetry, respectively. A strong level of agreement was seen for the basic gait parameters between the TAA and GAITRiteⓇ (ICC = 0.91–0.96). Conclusions The measurement of gait parameters of elderly individuals with normal cognition using a TAA placed on the body’s center of mass was reliable and showed superiority over the GAITRiteⓇ with regard to gait variability and asymmetry. The TAA system was a valid tool for measuring basic gait parameters. Considering its wearability and low price, the TAA system may be a promising alternative to the pressure sensor walkway system for measuring gait parameters.
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Affiliation(s)
- Seonjeong Byun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Ki Woong Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
- * E-mail:
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Kraan CM, Cornish KM, Bui QM, Li X, Slater HR, Godler DE. β-glucuronidase mRNA levels are correlated with gait and working memory in premutation females: understanding the role of FMR1 premutation alleles. Sci Rep 2016; 6:29366. [PMID: 27387142 PMCID: PMC4937393 DOI: 10.1038/srep29366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/17/2016] [Indexed: 12/28/2022] Open
Abstract
Fragile X tremor ataxia syndrome (FXTAS) is a late-onset disorder manifesting in a proportion of FMR1 premutation individuals (PM: 55-199 CGG triplet expansions). FXTAS is associated with elevated levels of FMR1 mRNA which are toxic. In this study, relationships between neurocognitive and intra-step gait variability measures with mRNA levels, measured in blood samples, were examined in 35 PM and 35 matched control females. The real-time PCR assays measured FMR1 mRNA, and previously used internal control genes: β-Glucuronidase (GUS), Succinate Dehydrogenase 1 (SDHA) and Eukaryotic Translation Initiation Factor 4A (EI4A2). Although there was significant correlation of gait variability with FMR1 mRNA levels (p = 0.004) when normalized to GUS (FMR1/GUS), this was lost when FMR1 was normalized to SDHA and EI4A2 (2IC). In contrast, GUS mRNA level normalized to 2IC showed a strong correlation with gait variability measures (p < 0.007), working memory (p = 0.001) and verbal intelligence scores (p = 0.008). PM specific changes in GUS mRNA were not mediated by FMR1 mRNA. These results raise interest in the role of GUS in PM related disorders and emphasise the importance of using appropriate internal control genes, which have no significant association with PM phenotype, to normalize FMR1 mRNA levels.
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Affiliation(s)
- C M Kraan
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, 3800, Australia
| | - K M Cornish
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, 3800, Australia
| | - Q M Bui
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne Carlton, Victoria, 3053, Australia
| | - X Li
- Cyto-molecular Diagnostic Research Laboratory, Victorian Clinical Genetics Services and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, 3052, Australia
| | - H R Slater
- Cyto-molecular Diagnostic Research Laboratory, Victorian Clinical Genetics Services and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - D E Godler
- Cyto-molecular Diagnostic Research Laboratory, Victorian Clinical Genetics Services and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, 3052, Australia
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Characterisation of foot clearance during gait in people with early Parkinson׳s disease: Deficits associated with a dual task. J Biomech 2016; 49:2763-2769. [PMID: 27363617 DOI: 10.1016/j.jbiomech.2016.06.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 05/26/2016] [Accepted: 06/07/2016] [Indexed: 11/21/2022]
Abstract
Tripping is a common cause of falls in older adults and people with Parkinson׳s disease (PD). Foot clearance during gait may be impaired when distracted by a dual task and thus inform trip risk. This study aimed to evaluate whether foot clearance is impaired in PD and is adversely affected by a dual task. 81 older adults and 76 PD walked at a comfortable pace for two minutes under single and dual task conditions (digit recall). Temporal spatial gait was measured using an instrumented walkway. Heel and toe trajectories were obtained bilaterally using 3-dimensional motion capture. Foot clearance was reduced in PD (p<.001) and under dual task (p<.027). The take-off (toe) gradient was reduced under dual task irrespective of group and the landing (heel) gradient was reduced in PD irrespective of task (p<.001). An increased proportion of unimodal toe distributions were observed for PD, particularly under dual task. Group differences were retained when controlling for step length (landing gradient and peak toe clearance in late swing) and gait velocity (landing gradient). Distinct differences in foot clearance were observed even in the early clinical stages of PD. Dual tasking may increase trip risk due to insufficient toe clearance (early swing) for both older adults and PD. Inadequate heel clearance (late swing) may increase falls risk in PD. Clearance deficits in PD are partially related to a reduced gait velocity and step length which may be targeted in tailored therapies. Further work is necessary to understand the mechanisms underlying this pathology-associated deficit.
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143
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König N, Taylor WR, Baumann CR, Wenderoth N, Singh NB. Revealing the quality of movement: A meta-analysis review to quantify the thresholds to pathological variability during standing and walking. Neurosci Biobehav Rev 2016; 68:111-119. [PMID: 27189783 DOI: 10.1016/j.neubiorev.2016.03.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/09/2015] [Accepted: 03/12/2016] [Indexed: 10/21/2022]
Abstract
Neuromotor processes are inherently noisy, which results in variability during movement and fluctuations in motor control. Although controversial, low levels of variability are traditionally considered healthy, while increased levels are thought to be pathological. This systematic review and meta-analysis of the literature investigates the thresholds between healthy and pathological task variability. After examining 13,195 publications, 109 studies were included. Results from over 3000 healthy subjects and 2775 patients revealed an overall positive effect size of pathology on variability of 0.59 for walking and 0.80 for sway. For the coefficient of variation of stride time (ST) and sway area (SA), upper thresholds of 2.6% and 265mm(2) discriminated pathological from asymptomatic performance, while 1.1% and 62mm(2) identified the lower thresholds for pathological variability. This window of healthy performance now provides science based evidence for the discrimination of both extremely low and extremely high levels of variability in the identification as well as standardised monitoring of functional status in neurological cases.
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Affiliation(s)
- N König
- Institute for Biomechanics, ETH Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH Zürich, Switzerland.
| | - C R Baumann
- Department of Neurology, University Hospital Zürich, University of Zurich, Switzerland
| | - N Wenderoth
- Neural Control of Movement Lab, ETH Zürich, Switzerland
| | - N B Singh
- Institute for Biomechanics, ETH Zürich, Switzerland
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144
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Almarwani M, VanSwearingen JM, Perera S, Sparto PJ, Brach JS. Challenging the motor control of walking: Gait variability during slower and faster pace walking conditions in younger and older adults. Arch Gerontol Geriatr 2016; 66:54-61. [PMID: 27255348 DOI: 10.1016/j.archger.2016.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/12/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gait variability is a measure of motor control of gait. Little is known about age-related changes in the motor control of gait (gait variability) during challenging walking conditions, such as slower and faster pace walking. OBJECTIVE The purpose of this study was to examine the impact of challenging walking conditions (slower and faster speeds) on gait variability in younger and older adults. DESIGN This study was a cross-sectional, observational design. METHODS Forty younger (mean age=26.6±6.0years) and 111 community-dwelling older adults (mean age=77.3±6.0years), independent in ambulation, were studied. Gait characteristics were collected using a computerized walkway (GaitMat II™). Step length, step width, step time, swing time, stance time and double support time variability were derived as the standard deviation of all steps across the 4 passes. RESULTS Compared to younger, older adults had a significant change in their gait variability from usual to slower in step width (-0.006±0.003), step time (0.028±0.006), swing time (0.023±0.004), stance time (0.042±0.008), and double support time (0.024±0.005). Changes in gait variability from usual to faster were not significantly different between younger and older adults. LIMITATION Gait variability was examined during self-selected over-ground walking, where subjects directed to walk "slower", "usual" and "faster". CONCLUSIONS Walking slowly is more challenging to the motor control of gait and may be more sensitive to age-related declines in gait than usual and faster speed walks.
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Affiliation(s)
- Maha Almarwani
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA; Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | | | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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145
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Rao AK, Louis ED. Timing control of gait: a study of essential tremor patients vs. age-matched controls. CEREBELLUM & ATAXIAS 2016; 3:5. [PMID: 26937284 PMCID: PMC4774137 DOI: 10.1186/s40673-016-0043-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/23/2016] [Indexed: 11/18/2022]
Abstract
Background Essential tremor (ET) is a common movement disorder characterized by kinetic, postural and intention tremors. Mounting evidence suggests an underlying dysfunction of the cerebellum or cerebellar system. While few recent studies report impairments in timing control of finger movements in ET, timing control of gait has not been examined to date. We compared timing control of gait in ET patients vs. controls, and further assessed the association of these timing impairments with tremor severity among the ET patients. One-hundred-fifty-five ET patients and 60 age-matched controls underwent a comprehensive neurological assessment and gait analysis, which included walking at a criterion step frequency (cadence) with a metronome (timing production) and walking at a criterion step frequency after the metronome was turned off (timing reproduction). Outcomes of interest for both conditions were timing accuracy (measured by cadence error) and timing precision (measured by cadence variability). We also assessed cadence and step time across conditions. Results Cadence was lower in ET patients than controls (p < 0.03), whereas step time was similar for ET patients and controls. Accuracy (cadence error) and precision (cadence variability) were not different in ET patients compared with controls. Cranial tremor score was significantly associated with cadence (timing production condition, p = 0.003 and timing reproduction condition, p = 0.0001) and cadence error (timing production condition, p = 0.01). Kinetic tremor and intention tremor scores were not associated with gait measures. Conclusions ET patients do not demonstrate impairments in timing control of gait as compared with matched controls. Prior work shows that patients with cerebellar dysfunction demonstrate selective impairments in timing of discrete movements (such as finger tapping) but not continuous movements (such as circle drawing). Taken together, these results support the hypothesis that the cerebellum may be important for timing control of discrete rather than continuous movements.
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Affiliation(s)
- Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Physical Therapy), College of Physicians and Surgeons, Columbia University, New York, NY USA ; G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY USA ; Neurological Institute, 8th Floor, 710 West 168th Street, New York, NY 10032 USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT USA ; Department of Chronic Disease Epidemiology, Yale School of Medicine, Yale University, New Haven, CT USA ; Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT USA
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146
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Davis AM, Galna B, Murphy AT, Williams CM, Haines TP. Effect of footwear on minimum foot clearance, heel slippage and spatiotemporal measures of gait in older women. Gait Posture 2016; 44:43-7. [PMID: 27004631 DOI: 10.1016/j.gaitpost.2015.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 02/02/2023]
Abstract
Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls.
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Affiliation(s)
- Annette M Davis
- Monash Health, Podiatry Department, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC 3192, Australia; Monash University, Physiotherapy Department, Clayton Campus, Clayton, VIC 3168, Australia; Monash Health, Allied Health Clinical Research Unit, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC 3192, Australia.
| | - Brook Galna
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC 3192, Australia; Institute of Neuroscience, Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne NE4 5PL United Kingdom.
| | - Anna T Murphy
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC 3192, Australia.
| | - Cylie M Williams
- Monash University, Physiotherapy Department, Clayton Campus, Clayton, VIC 3168, Australia; Monash Health, Allied Health Clinical Research Unit, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC 3192, Australia.
| | - Terry P Haines
- Monash University, Physiotherapy Department, Clayton Campus, Clayton, VIC 3168, Australia; Monash Health, Allied Health Clinical Research Unit, Kingston Centre, 400 Warrigal Road, Cheltenham, VIC 3192, Australia.
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147
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The test-retest reliability and minimal detectable change of spatial and temporal gait variability during usual over-ground walking for younger and older adults. Gait Posture 2016; 44:94-9. [PMID: 27004639 PMCID: PMC4806559 DOI: 10.1016/j.gaitpost.2015.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 02/02/2023]
Abstract
Gait variability is a marker of gait performance and future mobility status in older adults. Reliability of gait variability has been examined mainly in community dwelling older adults who are likely to fluctuate over time. The purpose of this study was to compare test-retest reliability and determine minimal detectable change (MDC) of spatial and temporal gait variability in younger and older adults. Forty younger (mean age=26.6 ± 6.0 years) and 46 older adults (mean age=78.1 ± 6.2 years) were included in the study. Gait characteristics were measured twice, approximately 1 week apart, using a computerized walkway (GaitMat II). Participants completed 4 passes on the GaitMat II at their self-selected walking speed. Test-retest reliability was calculated using Intra-class correlation coefficients (ICCs(2,1)), 95% limits of agreement (95% LoA) in conjunction with Bland-Altman plots, relative limits of agreement (LoA%) and standard error of measurement (SEM). The MDC at 90% and 95% level were also calculated. ICCs of gait variability ranged 0.26-0.65 in younger and 0.28-0.74 in older adults. The LoA% and SEM were consistently higher (i.e. less reliable) for all gait variables in older compared to younger adults except SEM for step width. The MDC was consistently larger for all gait variables in older compared to younger adults except step width. ICCs were of limited utility due to restricted ranges in younger adults. Based on absolute reliability measures and MDC, younger had greater test-retest reliability and smaller MDC of spatial and temporal gait variability compared to older adults.
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148
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Elshehabi M, Maier KS, Hasmann SE, Nussbaum S, Herbst H, Heger T, Berg D, Hobert MA, Maetzler W. Limited Effect of Dopaminergic Medication on Straight Walking and Turning in Early-to-Moderate Parkinson's Disease during Single and Dual Tasking. Front Aging Neurosci 2016; 8:4. [PMID: 26858638 PMCID: PMC4728201 DOI: 10.3389/fnagi.2016.00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background In Parkinson’s disease (PD), the effects of dopaminergic medication on straight walking and turning were mainly investigated under single tasking (ST) conditions. However, multitasking situations are considered more daily relevant. Methods Thirty-nine early-to-moderate PD patients performed the following standardized ST and dual tasks as fast as possible for 1 min during On- and Off-medication while wearing inertial sensors: straight walking and turning, checking boxes, and subtracting serial 7s. Quantitative gait parameters as well as velocity of the secondary tasks were analyzed. Results The following parameters improved significantly in On-medication during ST: gait velocity during straight walking (p = 0.03); step duration (p = 0.048) and peak velocity (p = 0.04) during turning; velocity of checking boxes during ST (p = 0.04) and DT (p = 0.04). Velocity of checking boxes was the only parameter that also improved during DT. Conclusion These results suggest that dopaminergic medication does not relevantly influence straight walking and turning in early-to-moderate PD during DT.
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Affiliation(s)
- Morad Elshehabi
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | - Katrin S Maier
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | - Sandra E Hasmann
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | - Susanne Nussbaum
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | - Heinz Herbst
- Neurozentrum Sophienstrasse , Stuttgart , Germany
| | - Tanja Heger
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | - Markus A Hobert
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology, Hertie Institute for Clinical and Brain Research, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Disease (DZNE), Tuebingen, Germany
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149
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Godfrey A, Del Din S, Barry G, Mathers JC, Rochester L. Within trial validation and reliability of a single tri-axial accelerometer for gait assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:5892-5. [PMID: 25571337 DOI: 10.1109/embc.2014.6944969] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Gait is a sensitive biomarker of decline in both cognitive and physical function. Therefore, the collection of gait data is an important feature of clinical assessments. Accelerometer-based body worn sensors are quickly becoming the preferred tool for assessing gait because they are small, useable in a wide variety of settings, offer more continuous spatio-temporal analysis and are inexpensive when compared with traditional gait assessment methodologies. The purpose of this study was to determine the validity and within test reliability of a low cost body worn movement sensor with associated algorithms to assess gait in a large group of older and younger healthy adults. We collected gait data over intermittent walks on an instrumented walkway for a within trial validation and also used the same accelerometer derived gait data for a within test reliability analysis. ICCs for validation and reliability were >0.756 and >0.965, respectively.
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150
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Reliability of gait variability assessment in older individuals during a six-minute walk test. J Biomech 2015; 48:4185-4189. [DOI: 10.1016/j.jbiomech.2015.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/24/2015] [Accepted: 10/09/2015] [Indexed: 11/21/2022]
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