362 Enhanced Measures to Quantify Gait and Balance Impairment in Degenerative Cervical Myelopathy: A Prospective Cohort Study

Abstract

INTRODUCTION: Gait and balance impairment are among the cardinal symptoms of Degenerative Cervical Myelopathy, however, utilizing objective measurements of these functions is highly challenging. METHODS: A prospective cross-sectional cohort study with manual and quantitative gait/balance testing using a Protokinetics Zeno Walkway electronic pressure mat (self/fast-paced, tandem gait/stance, Romberg, one foot standing). RESULTS: 95 DCM and 78 healthy subjects were included. For quantitave gait assesment, Velocity (p = 4.56x 10-8, 3.39x10-7), Gait Variability Index (p = 1.788x10-8, p = 0.00169), and stability ratio, single stance time/ double stance time, (p = 4.167x10^-7, p = 1.438x10^-5) were significantly different between groups for both self and fast-paced gait assessments, respectively. Balance was assessed by the variability of the center of pressure (COP). The standard deviation variability of COP in both the X (p = 0.00171) and Y directions (p = 0.000104) and cadence (p = 0.00175) were significant for tandem gait, walking heel-to-toe. Standing on either the Left or Right foot also showed a difference in the variability of COP in both directions X (p = 4.21x10^-7 Left Foot, p = 8.27x10^-7 Right Foot) and Y (p = 6.64x10^-4 Left Foot, p = 1.32x10^-4 Right Foot). On, manual assesment, DCM patients scored significantly worse in all parameters such as self-paced (p = 5.54x10^-2), fast-paced (p = 6.28x10^-2), tandem gait (p = 3.60x10^-8), Romberg eyes open (p = 1.58x10^-2), Romberg eyes closed (p = 1.90x10^-2), L foot stance (p = 6.78x10^-6), R foot stance (2.1x10^-6), and tandem stance (p = 8.83x10^-5). CONCLUSIONS: Quantitative parameters from an electronic pressure mat can be used to assess gait and balance impairment with high sensitivity and strong correlation with subjective measures. Manual scoring of tandem gait, standing on one foot, and tandem stance also provided robust differences and can be easily adopted into routine assessment of DCM patients.