Abstract
Distinct gait characteristics like short steps and shuffling gait are prototypical signs commonly observed in Parkinson’s disease. Routinely assessed by observation through clinicians, gait is rated as part of categorical clinical scores. There is an increasing need to provide quantitative measurements of gait, e.g. to provide detailed information about disease progression. Recently, we developed a wearable sensor-based gait analysis system as diagnostic tool that objectively assesses gait parameter in Parkinson’s disease without the need of having a specialized gait laboratory. This system consists of inertial sensor units attached laterally to both shoes. The computed target of measures are spatiotemporal gait parameters including stride length and time, stance phase time, heel-strike and toe-off angle, toe clearance, and inter-stride variation from gait sequences. To translate this prototype into medical care, we conducted a cross-sectional study including 190 Parkinson’s disease patients and 101 age-matched controls and measured gait characteristics during a 4x10 meter walk at the subjects’ preferred speed. To determine intraindividual changes in gait, we monitored the gait characteristics of 63 patients longitudinally. Cross-sectional analysis revealed distinct spatiotemporal gait parameter differences reflecting typical Parkinson’s disease gait characteristics including short steps, shuffling gait, and postural instability specific for different disease stages and levels of motor impairment. The longitudinal analysis revealed that gait parameters were sensitive to changes by mirroring the progressive nature of Parkinson’s disease and corresponded to physician ratings. Taken together, we successfully show that wearable sensor-based gait analysis reaches clinical applicability providing a high biomechanical resolution for gait impairment in Parkinson’s disease. These data demonstrate the feasibility and applicability of objective wearable sensor-based gait measurement in Parkinson’s disease reaching high technological readiness levels for both, large scale clinical studies and individual patient care.
Highlights
Gait is an important indicator for quality of life [1] and is examined during the clinical diagnostic workup of Parkinson’s disease (PD)
Patients diagnosed with PD according to the consensus criteria of the German Society of Neurology analogue to the National Institute of Neurological Disorders and Stroke (NINDS) diagnostic criteria for PD were recruited during their regular visit in the movement disorder outpatient center at the University Hospital Erlangen from May 3rd, 2010 until July 31st, 2014
Translational neurotechnology is an emerging field with the potential to revolutionize the diagnosis of movement disorders
Summary
Gait is an important indicator for quality of life [1] and is examined during the clinical diagnostic workup of Parkinson’s disease (PD). Introduced in the 1980s to allow a standardized clinical examination, the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRSIII) provides the physician with a valuable standardized clinical examination to rate motor impairment in PD. UPDRS-III includes several gait-associated items, e.g., rigidity and agility of the lower extremities. The evaluation of gait in PD patients uses a single item categorized from “normal,” to “walks slowly, may shuffle with short steps,” “walks with difficulty, little or no assistance, some festination, short steps or propulsion,” and “severe disturbance, frequent assistance,” to “cannot walk” [2]. The UPDRS-III assists the physician to rate general motor impairment in PD, quantitative information on gait impairment is very limited. Being able to implement an objective assessment of gait parameters by mobile means could enable quantification of distinct PD gait patterns, support individual monitoring of disease progression, and help to evaluate response to treatment
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