Abstract
The aim of this study was to establish a comprehensive and yet parsimonious model of daily mobility activity in patients with neurological gait disorders. Patients (N = 240) with early-stage neurological (peripheral vestibular, cerebellar, hypokinetic, vascular or functional) gait disorders and healthy controls (N = 35) were clinically assessed with standardized scores related to functional mobility, balance confidence, quality of life, cognitive function, and fall history. Subsequently, daily mobility was recorded for 14 days by means of a body-worn inertial sensor (ActivPAL®). Fourteen mobility measures derived from ActivPAL recordings were submitted to principle component analysis (PCA). Group differences within each factor obtained from PCA were analyzed and hierarchical regression analysis was performed to identify predictive characteristics from clinical assessment for each factor. PCA yielded five significant orthogonal factors (i.e., mobility domains) accounting for 92.3% of the total variance from inertial-sensor-recordings: ambulatory volume (38.7%), ambulatory pattern (22.3%), postural transitions (13.3%), sedentary volume (10.8%), and sedentary pattern (7.2%). Patients' mobility performance only exhibited reduced scores in the ambulatory volume domain but near-to-normal scores in all remaining domains. Demographic characteristics, clinical scores, and fall history were differentially associated with each domain explaining 19.2–10.2% of their total variance. This study supports a low-dimensional five-domain model for daily mobility behavior in patients with neurological gait disorders that may facilitate monitoring the course of disease or therapeutic intervention effects in ecologically valid and clinically relevant contexts. Further studies are required to explore the determinants that may explain performance differences of patients within each of these domains and to examine the consequences of altered mobility behavior with respect to patients' risk of falling and quality of life.
Highlights
Disorders of gait and balance and associated mobility impairments are a common complication in neurological diseases and affect around 60% of patients [41]
Patients and healthy controls did not differ in basic demographics parameters
Retrospective fall assessment revealed that patients had considerably more often fallen in the past with significantly more severe consequences of falling
Summary
Disorders of gait and balance and associated mobility impairments are a common complication in neurological diseases and affect around 60% of patients [41]. Highest prevalence for gait and mobility impairments have been reported for patients with Parkinson’s disease, followed by vascular encephalopathy, cerebellar ataxia, and sensory. Functional mobility tests (e.g., the Timed Up and Go test [29]) and instrument-based measures of gait stability have been shown to more adequately capture mobility impairments and to more reliably identify a risk of falling. A drawback of these approaches lies in the fact that they are primarily performed within the laboratory or a specialized clinical setting. They may miss or underestimate the challenges of real-life mobility during which patients fall
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