Dual task gait deteriorates gait performance in cervical dystonia patients: a pilot study

Oscar Crisafulli,Carlo Trompetto,Laura Avanzino,Elisa Pelosin,Luca Puce,Stefania Costi,Lucio Marinelli,Giovanni Abbruzzese

doi:10.1007/s00702-021-02393-1

Abstract

Day-to-day walking-related activities frequently involve the simultaneous performance of two or more tasks (i.e., dual task). Dual task ability is influenced by higher order cognitive and cortical control mechanisms. Recently, it has been shown that the concomitant execution of an attention-demanding task affected postural control in subject with cervical dystonia (CD). However, no study has investigated whether dual tasking might deteriorate gait performance in CD patients. To investigate whether adding a concomitant motor and cognitive tasks could affect walking performance in CD subjects.17 CD patients and 19 healthy subjects (HS) participated in this pilot case–control study. Gait performance was evaluated during four walking tasks: usual, fast, cognitive dual task and obstacle negotiation. Spatiotemporal parameters, dual-task cost and coefficients of variability (CV%) were measured by GaitRite® and were used to detect differences between groups. Balance performance was also assessed with Mini-BEST and Four Step Square tests. In CD participants, correlation analysis was computed between gait parameters and clinical data. Significant differences in complex gait and balance performance were found between groups. CD patients showed lower speed, longer stance time and higher CV% and dual-task cost compared to HS. In CD, altered gait parameters correlated with balance performance and were not associated with clinical features of CD. Our findings suggest that complex walking performance is impaired in patients with CD and that balance and gait deficits might be related

Highlights

Cervical dystonia (CD) is the most common form of adultonset idiopathic focal dystonia and is characterized by involuntary repetitive contractions of neck muscles leading to abnormal postures of the head and neck (Balint et al 2018)
A significant difference was found for gait speed (p = 0.027) and gait speed CV% (p = 0.041), with CD patients showing a slower and more variable gait compared to healthy subjects (HS)
For DT, the analysis showed a significant correlation between Mini Best and stride length CV and between Four-Square Step Test (FSST) and stance time CV and stride length CV

Summary

Introduction

Cervical dystonia (CD) is the most common form of adultonset idiopathic focal dystonia and is characterized by involuntary repetitive contractions of neck muscles leading to abnormal postures of the head and neck (Balint et al 2018). In addition to the distinctive clinical symptoms related to dystonia, CD patients may manifest balance and subtle gait problems that can result in reduced physical activity and fear of falling (Zetterberg et al 2015). Postural instability has been extensively investigated in CD and results demonstrated that postural control and dynamic balance are often impaired. This is supported by the knowledge that the head posture, sensory-motor integration deficits and altered vestibular functions might affect both static and dynamic balance. Results are consistent in reporting differences in gait variability compared to healthy controls.

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Conclusion