Abstract
Cerebellar stroke typically results in increased variability during walking. Previous research has suggested that auditory cueing reduces excessive variability in conditions such as Parkinson’s disease and post-stroke hemiparesis. The aim of this case report was to investigate whether the use of a metronome cue during walking could reduce excessive variability in gait parameters after a cerebellar stroke. An elderly female with a history of cerebellar stroke and recurrent falling undertook three standard gait trials and three gait trials with an auditory metronome. A Vicon system was used to collect 3-D marker trajectory data. The coefficient of variation was calculated for temporal and spatial gait parameters. SDs of the joint angles were calculated and used to give a measure of joint kinematic variability. Step time, stance time, and double support time variability were reduced with metronome cueing. Variability in the sagittal hip, knee, and ankle angles were reduced to normal values when walking to the metronome. In summary, metronome cueing resulted in a decrease in variability for step, stance, and double support times and joint kinematics. Further research is needed to establish whether a metronome may be useful in gait rehabilitation after cerebellar stroke and whether this leads to a decreased risk of falling.
Highlights
Cerebellar infarction accounts for ~3% of strokes, resulting in an incidence of ~20,000 cases per year in the USA [1]
Gait ataxia is associated with increased variability in both step time and step length [3], and similar range of motion patterns were observed at the hip, knee, and ankle, the variability of these patterns were significantly higher for hip and knee motion compared to controls [4]
The coefficient of variation (CoV) was reduced from 9.9 to 3.8% and 10.9 to 3.3% for left and right step times, respectively, from 7.2 to 4.5% and from 8.0 to 6.8% for stance times and from 18.7 to 14.8% and from 18.8 to 14.2% for double support times when walking in the metronome-cued condition compared to baseline
Summary
Cerebellar infarction accounts for ~3% of strokes, resulting in an incidence of ~20,000 cases per year in the USA [1]. Gait ataxia is associated with increased variability in both step time and step length [3], and similar range of motion patterns were observed at the hip, knee, and ankle, the variability of these patterns were significantly higher for hip and knee motion compared to controls [4] These increases in variability are likely to be caused by the interaction between the stroke-induced deficits in balance control, limb control and coordination, and the resultant adjustments needed to respond to these deficits [5]. Greater variability in step length and double support time is linearly associated with increased risk of multiple falls in older adults, with a non-linear association for step time variability [9] Both increased stride time and length variability are associated with falls in cerebellar ataxia [10]. Reducing excessive gait variability resulting from a cerebellar stroke is an important concern for health-care professionals
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