Sensor-based gait analysis in atypical parkinsonian disorders.

Cecilia Raccagni,Juergen Winkler,Bjoern M Eskofier,Florian Krismer,Sabine Eschlboeck,Sylvia Boesch,Jochen Klucken,Gregor Wenning,Werner Poewe,Klaus Seppi,Heiko Gaßner

doi:10.1002/brb3.977

Abstract

Background and ObjectivesGait impairment and reduced mobility are typical features of idiopathic Parkinson's disease (iPD) and atypical parkinsonian disorders (APD). Quantitative gait assessment may have value in the diagnostic workup of parkinsonian patients and as endpoint in clinical trials. The study aimed to identify quantitative gait parameter differences in iPD and APD patients using sensor‐based gait analysis and to correlate gait parameters with clinical rating scales.Subjects and MethodsPatients with iPD and APD including Parkinson variant multiple system atrophy and progressive supranuclear palsy matched for age, gender, and Hoehn and Yahr (≤3) were recruited at two Movement Disorder Units and assessed using standardized clinical rating scales (MDS‐UPDRS‐3, UMSARS, PSP‐RS). Gait analysis consisted of inertial sensor units laterally attached to shoes, generating as objective targets spatiotemporal gait parameters from 4 × 10 m walk tests.ResultsObjective sensor‐based gait analysis showed that gait speed and stride length were markedly reduced in APD compared to iPD patients. Moreover, clinical ratings significantly correlated with gait speed and stride length in APD patients.ConclusionOur findings suggest that patients with APD had more severely impaired gait parameters than iPD patients despite similar disease severity. Instrumented gait analysis provides complementary rater independent, quantitative parameters that can be exploited for clinical trials and care.

Highlights

Gait impairment is a major motor symptom of idiopathic Parkinson’s disease
Inertial sensor data were processed with a pattern recognition algorithm for calculating clinically relevant spatiotemporal gait parameters (e.g., stride length, FIGURE 1 Spatiotemporal gait parameters (Mean ± SD) in patients with atypical Parkinson disorders (APD), patients with Parkinson’s disease—(matched by age, gender, age of onset, and Hoehn & Yahr disease stage), and healthy controls
Among the different gait parameters, gait speed differentiated between controls and patients, but it was more strongly reduced in atypical parkinsonian disorders (APD) compared to PD patients, despite similar global motor disability according to H&Y scores, indicating a more severe alteration of locomotor abnormality in APD patients

Summary

| INTRODUCTION

Gait impairment is a major motor symptom of idiopathic Parkinson’s disease (iPD). It is even more prominent in patients with atypical parkinsonian disorders (APDs) including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), leading to an impaired quality of life and shorter latency from symptom onset to recurrent falls (Wenning et al, 1999). Inertial sensor data were processed with a pattern recognition algorithm for calculating clinically relevant spatiotemporal gait parameters (e.g., stride length, FIGURE 1 Spatiotemporal gait parameters (Mean ± SD) in patients with atypical Parkinson disorders (APD), patients with Parkinson’s disease (iPD)—(matched by age, gender, age of onset, and Hoehn & Yahr disease stage), and healthy controls (matched by age and gender). According to the item 13 of the UMSARS-2 (body sway), we divided MSA patients into two subgroups, namely patients who recovered unaided (e.g., 0–1 rating points) and patients who would fall if not caught (e.g., 2–4 rating points) and we compared these subgroups in terms of gait speed (p = .013) and stride length (p = .040), observing a statistically relevant difference (Figure 4a). Maximum toe clearance did not correlate with MDS-UPDRS-3 in iPD patients, whereas gait speed and stride length did

| DISCUSSION

Findings

CONFLICT OF INTEREST