Abstract
Background: Huntington's disease (HD) leads to altered gait patterns and reduced daily-living physical activity. Accurate measurement of daily-living walking that takes into account involuntary movements (e.g. chorea) is needed.Objective: To evaluate daily-living gait quantity and quality in HD, taking into account irregular movements.Methods: Forty-two individuals with HD and fourteen age-matched non-HD peers completed clinic-based assessments and a standardized laboratory-based circuit of functional activities, wearing inertial measurement units on the wrists, legs, and trunk. These activities were used to train and test an algorithm for the automated detection of walking. Subsequently, 29 HD participants and 22 age-matched non-HD peers wore a tri-axial accelerometer on their non-dominant wrist for 7 days. Measures included gait quantity (e.g., steps per day), gait quality (e.g., regularity) metrics, and percentage of walking bouts with irregular movements.Results: Measures of daily-living gait quantity including step counts, walking time and bouts per day were similar in HD participants and non-HD peers (p > 0.05). HD participants with higher clinician-rated upper body chorea had a greater percentage of walking bouts with irregular movements compared to those with lower chorea (p = 0.060) and non-HD peers (p < 0.001). Even after accounting for irregular movements, within-bout walking consistency was lower in HD participants compared to non-HD peers (p < 0.001), while across-bout variability of these measures was higher (p < 0.001). Many of the daily-living measures were associated with disease-specific measures of motor function.Conclusions: Results suggest that a wrist-worn accelerometer can be used to evaluate the quantity and quality of daily-living gait in people with HD, while accounting for the influence of irregular (choreic-like) movements, and that gait features related to within- and across-bout consistency markedly differ in individuals with HD and non-HD peers.
Highlights
Huntington’s disease (HD) is an inherited neurodegenerative disease that results in impairments in motor, cognitive, and behavioral domains [1]
HD participants with higher clinician-rated upper body chorea had a greater percentage of walking bouts with irregular movements compared to those with lower chorea (p = 0.060) and non-HD peers (p < 0.001)
Results suggest that a wrist-worn accelerometer can be used to evaluate the quantity and quality of daily-living gait in people with HD, while accounting for the influence of irregular movements, and that gait features related to within- and across-bout consistency markedly differ in individuals with HD and non-HD peers
Summary
Huntington’s disease (HD) is an inherited neurodegenerative disease that results in impairments in motor, cognitive, and behavioral domains [1]. Quantitative, objective measurement of gait and physical activity in dailyliving, ambient settings have the potential to be highly informative; the presence of involuntary movements (e.g., chorea) in people with HD poses a challenge for accurate assessment. There is increasing interest in wearable, remote monitoring sensors to evaluate walking and daily-living physical activity with minimal operator input in a range of neurological disorders including Parkinson’s disease [3,4,5], multiple sclerosis [6,7,8], and HD [9,10,11,12]. No study to date has compared in clinic vs at home accelerometry-based assessments. Huntington’s disease (HD) leads to altered gait patterns and reduced daily-living physical activity. Accurate measurement of daily-living walking that takes into account involuntary movements (e.g. chorea) is needed
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