Self-reported gait unsteadiness in mildly impaired neurological patients: an objective assessment through statistical gait analysis

Maria Benedetti,Marco Boschi,Roberto Piperno,Verusca Gasparroni,Valentina Agostini,Marco Knaflitz

doi:10.1186/1743-0003-9-64

Abstract

BackgroundSelf-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function. However, in the literature there are only a few papers that address this disorder. The aim of this study is to identify objectively subclinical abnormal gait strategies in these patients.MethodsEleven patients affected by self-reported unsteadiness during gait (4 TBI and 7 MS) and ten healthy subjects underwent gait analysis while walking back and forth on a 15-m long corridor. Time-distance parameters, ankle sagittal motion, and muscular activity during gait were acquired by a wearable gait analysis system (Step32, DemItalia, Italy) on a high number of successive strides in the same walk and statistically processed. Both self-selected gait speed and high speed were tested under relatively unconstrained conditions. Non-parametric statistical analysis (Mann–Whitney, Wilcoxon tests) was carried out on the means of the data of the two examined groups.ResultsThe main findings, with data adjusted for velocity of progression, show that increased double support and reduced velocity of progression are the main parameters to discriminate patients with self-reported unsteadiness from healthy controls. Muscular intervals of activation showed a significant increase in the activity duration of the Rectus Femoris and Tibialis Anterior in patients with respect to the control group at high speed.ConclusionsPatients with a subjective sensation of instability, not clinically documented, walk with altered strategies, especially at high gait speed. This is thought to depend on the mechanisms of postural control and coordination. The gait anomalies detected might explain the symptoms reported by the patients and allow for a more focused treatment design. The wearable gait analysis system used for long distance statistical walking assessment was able to detect subtle differences in functional performance monitoring, otherwise not detectable by common clinical examinations.

Highlights

Self-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function
Gait and balance disorders cause severe impairments for patients affected by cerebellar ataxia, who are at risk of accidental falls and disability in daily life activities [1,2]
We have focused our attention on a group of patients with no functional limitations in normal daily activities that are frequently addressed to our rehabilitation facilities for subjective unsteadiness and/or dizziness while walking

Summary

Introduction

Self-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function. The diagnosis of ataxia or postural imbalance is often not substantiated in these patients, and subjective unsteadiness during gait is the only symptom patients complain about. We have focused our attention on a group of patients with no functional limitations in normal daily activities that are frequently addressed to our rehabilitation facilities for subjective unsteadiness and/or dizziness while walking. This group of patients can be classified as highly-functioning because they can walk independently at home and in moderate community activities, can accept uneven terrain and can negotiate a crowded shopping center (“community walker”) [13]

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