Neurological update: emerging issues in gait disorders

The relationship between sleep quality and gait in people with multiple sclerosis: A pilot study

Background

Gait deficits are common among people with multiple sclerosis (PwMS). Therefore, investigating factors that may influence walking in PwMS is important. Previous studies in older adults and other neurological populations demonstrated the relationship between sleep quality and gait performance. Despite the fact that the prevalence of poor sleep quality is very high among PwMS, little is known about the effect of sleep quality on gait among PwMS.

Objective

This study aimed to explore the relationship between sleep quality and gait performance in PwMS.

Methods

Forty-one PwMS participated in the study between February 2019 and December 2019. Participants were asked to walk at a self-selected speed over 10 m with an inertial measurement unit (IMU) attached over the back. Walking speed, step length (left and right), and step time were calculated. Sleep was estimated objectively using a wrist-worn triaxle-accelerometer; the derived parameters were sleep efficiency (SE) and the number of awakening after sleep onset (NASO).

Results

SE significantly correlated with step length (p = 0 . 02 ). Furthermore, the NASO significantly correlated with gait speed (p = 0 . 03 ), and step-time (p = 0 . 02 ). These correlations remained significant even after adjusting for age and disease duration.

Conclusion

We observed that when corrected for disease duration and age there were relationships between NASO and SE to gait parameters; these observations warrant further investigations.

The Association Between Gait Speed and Sleep Problems Among Chinese Adults Aged 50 and Greater

Objective

The relationship between sleep problems and walking speed has been less explored. The present cross-sectional study was to investigate the association between sleep quality and sleep duration and gait speed in Chinese adults.

Methods

A total of 13,367 participants were recruited in this cross-sectional study, retrieving the data from the Global Aging and Adult Health Survey (SAGE). Gait speed was measured using the 4-m walking test. Age, sex, education years, smoking status, alcohol consumption, physical activity, chronic disease, sleep problems were self-reported by participants. To explore the association between sleep problems and gait speed, multivariate linear regression models were employed.

Results

In the adjusted model, poor sleep quality and longer sleep duration were significantly associated with slower normal walking speed in Chinese adults (p < 0.001). Moreover, there were negatively significant associations between normal gait speed and sleep quality in male adults (p < 0.01).

Conclusion

The findings suggest that slower normal walking speed was associated with poor sleep quality and longer sleep duration (>8 h) in Chinese male adults.

Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study

STUDY OBJECTIVES

To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia.

METHODS

Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann-Whitney U-tests.

RESULTS

Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p<0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p<0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48-30.93 vs 7.81% IQR: 4.43-14.82, p<0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: -0.89-38.84 vs 15%, IQR: -0.89-38.84%, p=0.599).

CONCLUSION

Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.

The Associations Between Objectively Measured Gait Speed and Subjective Sleep Quality in First-Year University Students, According to Gender

PURPOSE

To examine the associations between gait speed and sleep quality in first-year university students, according to gender.

METHODS

In this cross-sectional study, we recruited 193 first-year university students [mean age±standard deviation (SD): 19.6±1.1 years; mean height: 178.0±10.5 cm; mean weight: 74.0±11.0 kg; 26.9% women). Sleep quality was assessed using the Pittsburgh Sleep Quality questionnaire, with a lower score indicating "better" sleep quality. Gait speed was measured using the Zebris pressure platform. The associations were examined with generalized linear models and multiple regression analysis.

RESULTS

In the unadjusted model, faster participants had significantly "better" sleep quality (β=-3.15, 95% CI -3.82 to -2.47, p<0.001). When the model was adjusted for sex, age, body-mass index, self-rated health, smoking status, and psychological distress, faster participants remained having "better" sleep quality (β=-2.88, 95% CI -3.53 to -2.22, p<0.001).

CONCLUSION

This study shows that sleep quality can be predicted by gait speed in the first-year university students.

Association between Gait Variability and Gait-Ability Decline in Elderly Women with Subthreshold Insomnia Stage

This study investigates the gait characteristics of elderly women, aged more than 65 years, with subthreshold insomnia stage at various walking speeds. A total of 392 participants (insomnia: 202 and controls: 190) wearing shoe-type inertial measurement units completed walking tests on a treadmill for a duration of 1 min at slower, preferred, and faster speeds. The insomnia group indicated lower pace parameters (range of Cohen's d: 0.283-0.499) and the single support phase (Cohen's d: 0.237), greater gait variability (range of Cohen's d: 0.217-0.506), and bilateral coordination (range of Cohen's d: 0.254-0.319), compared with their age-matched controls; the coefficient of variance (CV) of the stance phase at the faster speed condition was a crucial variable for distinguishing between insomnia and control groups. In addition, the insomnia group demonstrated insufficient gait adaptation at the slower and preferred speeds, as indicated by the CVs of the stride length, stride time, and step time. In particular, participants with worsened insomnia symptoms or sleep problems showed that these worse gait patterns may increase the potential risk of falling in elderly women. Thus, elderly women with subthreshold insomnia stage need to improve their sleep quality to enhance their physical functions.

Corticomuscular control of walking in older people and people with Parkinson's disease

Changes in human gait resulting from ageing or neurodegenerative diseases are multifactorial. Here we assess the effects of age and Parkinson’s disease (PD) on corticospinal activity recorded during treadmill and overground walking. Electroencephalography (EEG) from 10 electrodes and electromyography (EMG) from bilateral tibialis anterior muscles were acquired from 22 healthy young, 24 healthy older and 20 adults with PD. Event-related power, corticomuscular coherence (CMC) and inter-trial coherence were assessed for EEG from bilateral sensorimotor cortices and EMG during the double-support phase of the gait cycle. CMC and EMG power at low beta frequencies (13–21 Hz) was significantly decreased in older and PD participants compared to young people, but there was no difference between older and PD groups. Older and PD participants spent shorter time in the swing phase than young individuals. These findings indicate age-related changes in the temporal coordination of gait. The decrease in low-beta CMC suggests reduced cortical input to spinal motor neurons in older people during the double-support phase. We also observed multiple changes in electrophysiological measures at low-gamma frequencies during treadmill compared to overground walking, indicating task-dependent differences in corticospinal locomotor control. These findings may be affected by artefacts and should be interpreted with caution.

The role of gender in the association between personality and task priority in older adults' dual-tasking while walking

BACKGROUND

Falls are a major problem for older adults. Many falls occur when a person's attention is divided between two tasks, such as a dual task (DT) involving walking. Most recently, the role of personality in walking performance was addressed; however, its association with DT performance remains to be determined.

METHODS

This cross-sectional study of 73 older, community-dwelling adults explores the association between personality and DT walking and the role of gender in this relationship. Personality was evaluated using the five-factor model. Single-task (ST) and DT assessment of walking-cognitive DT performance comprised a 1-min walking task and an arithmetic task performed separately (ST) and concurrently (DT). Dual-task costs (DTCs), reflecting the proportional difference between ST and DT performance, were also calculated.

RESULTS

Gender plays a role in the relationship between personality and DT. Extraversion was negatively associated with DTC-motor for men (ΔR² = 0.06, p < 0.05). Conscientiousness was positively associated with DTC-cognition for women (ΔR² = 0.08, p < 0.01).

CONCLUSION

These findings may lead to effective personality-based early detection and intervention for fall prevention.