Gait Changes Research Articles

Gait Parameters As Early Indicators: Exploring the Diagnostic Potential of Gait Analysis in Rare Diseases – A Preliminary Investigation On Mitochondrial Disorders

Background: Instrumented gait analysis is now increasingly used in clinical decision-making scenarios, as a marker of disease progression, as an early indicator of motor dysfunction, as a differentiating feature for diseases with same phenotype presentation and as an outcome measure for effect of interventions. This is particularly relevant for motor dysfunction in rare inherited neurological disorders which often result in gait impairment. Purpose: Several rare diseases have variable presenting features primarily manifesting as reduced quality of life and impaired function. We aim to investigate the role of gait analysis in the diagnosis of these disorders as it is often difficult and complex. Methods: This is a retrospective observational analysis of quantitative gait parameters of a 15-year-old male presenting with features of mitochondrial dysfunction, and our analysis of gait- related parameters before exercise, post exercise and in recovery phase. Results: The results depicted a few significant changes in gait analysis pattern post exercise which improved in recovery phase hinting at the potential use of gait analysis in such disorders particularly metabolic disorders. This study aims to bridge this gap by presenting three-dimensional gait parameters of a case with mitochondrial disorders and to explore its utility. Conclusions: 3D gait analysis may prove to be an adjunct in the diagnosis, classification and prognosis of rare neuromuscular diseases. It holds potential for diagnosing subtle changes in gait and quantifying the effect of treatment and rehabilitation on gait and hence functional abilities of the patients.

Presumed pituitary apoplexy in 26 dogs: Clinical findings, treatments, and outcomes

Pituitary apoplexy refers to hemorrhage or infarction within the pituitary gland resulting in acute neurological abnormalities. This condition is poorly described in dogs. To document presenting complaints, examination findings, endocrinopathies, magnetic resonance imaging (MRI), treatments, and outcomes of dogs with pituitary apoplexy. Twenty-six client-owned dogs with acute onset of neurological dysfunction. Retrospective case series. Dogs were diagnosed with pituitary apoplexy if MRI or histopathology documented an intrasellar or suprasellar mass with evidence of hemorrhage or infarction in conjunction with acute neurological dysfunction. Clinical information was obtained from medical records and imaging reports. Common presenting complaints included altered mentation (16/26, 62%) and gastrointestinal dysfunction (14/26, 54%). Gait or posture changes (22/26, 85%), mentation changes (18/26, 69%), cranial neuropathies (17/26, 65%), cervical or head hyperpathia (12/26, 46%), and hyperthermia (8/26, 31%) were the most frequent exam findings. Ten dogs (38%) lacked evidence of an endocrinopathy before presentation. Common MRI findings included T1-weighted hypo- to isointensity of the hemorrhagic lesion (21/25, 84%), peripheral enhancement of the pituitary mass lesion (15/25, 60%), brain herniation (14/25, 56%), and obstructive hydrocephalus (13/25, 52%). Fifteen dogs (58%) survived to hospital discharge. Seven of these dogs received medical management alone (median survival 143 days; range, 7-641 days) and 8 received medications and radiation therapy (median survival 973 days; range, 41-1719 days). Dogs with pituitary apoplexy present with a variety of acute signs of neurological disease and inconsistent endocrine dysfunction. Dogs that survive to discharge can have a favorable outcome.

Effect of Fatigue on Movement Patterns During a Loaded Ruck March.

Loaded ruck marching is a common training and operational task for many members of the military. It is known to cause fatigue, affect soldier readiness, and can lead to traumatic and overuse injuries. Quantifying the gait changes that occur over the course of a loaded ruck march may provide a better understanding of injury mechanisms and potentially allow for development of individualized injury-prevention training programs. This study examined the change in soldiers' gait patterns over the course of a loaded ruck march in order to examine the correlation between fatigue and kinematic parameters. Fatigue is a subjective term that may encompass factors such as energy expenditure, muscle exhaustion, and cognitive engagement. Since it can be difficult to quantify, the current study makes the broad assumption that fatigue increases in some (potentially nonlinear) fashion during a loaded ruck march. Three platoons of soldiers participated in a field training exercise with inertial measurement sensors placed on their chests and ankles to record gait parameters throughout a 7-mile ruck march. The effects of fatigue on stride length, stride width, ankle yaw, and torso lean (anterior-posterior [AP] and side-to-side [SS]) were compared using one-way repeated measure analyses of variance. In comparing the first and last quarters of the ruck march, stride length decreased, stride width increased, stride width variability increased, AP torso lean variability increased, and SS torso lean variability increased. Although they do not describe a direct relationship to injury, these results can inform enhanced approaches to quantify and predict soldier fatigue and more reliably prevent future injury.

Effects of a treatment program based on constraint-induced movement therapy for the lower extremities on gait and balance in chronic stroke: a 6-month follow-up pilot study.

Constraint-induced movement therapy (CIMT) for the lower extremities CIMT (LE-CIMT) has been shown feasible and promising but the long-term outcomes remain uncertain. In this pilot study, we recruited eight participants with chronic stroke from our facility for persons with disabilities to determine changes in gait and balance throughout an extended treatment program based on the principles of LE-CIMT. The program consisted of a run-in phase (3 weeks), LE-CIMT phase (3 weeks), and maintenance phase (6 months). In the LE-CIMT phase (3.5 h/day, 5 days/week, 3 weeks), the participants received task-oriented training (3 h) and transfer package training (30 min). The maintenance phase (30 min/day, 2-3 times/week, 6 months) included a transfer package and conventional training. The assessments were performed in the beginning and after each phase using the Fugl-Meyer Assessment, 6-min walk test (6MWT), Berg Balance Scale (BBS), and 10-m walk test from which walking speed, cadence, and stride length were derived. Overall, 6MWT, BBS, walking speed, and cadence improved significantly over time (analysis of variance P < 0.001). When comparing the results from before to after the LE-CIMT phase, 6MWT, BBS, walking speed, and cadence improved significantly ( P = 0.002 to 0.022). At the end of the 6-month maintenance phase, further improvements relative to the after LE-CIMT phase were found for 6MWT, walking speed, and cadence ( P = 0.002 to 0.034). These pilot results suggest that an extended treatment program based on the principles of LE-CIMT can improve balance and more so walking in the chronic phase of stroke.

Motor control complexity can be dynamically simplified during gait pattern exploration using motor control-based biofeedback.

Understanding how the central nervous system coordinates diverse motor outputs has been a topic of extensive investigation. Although it is generally accepted that a small set of synergies underlies many common activities, such as walking, whether synergies are equally robust across a broader array of gait patterns or can be flexibly modified remains unclear. Here, we evaluated the extent to which synergies changed as nondisabled adults (n = 14) explored gait patterns using custom biofeedback. Secondarily, we used Bayesian additive regression trees to identify factors that were associated with synergy modulation. Participants explored 41.1 ± 8.0 gait patterns using biofeedback, during which synergy recruitment changed depending on the type and magnitude of gait pattern modification. Specifically, a consistent set of synergies was recruited to accommodate small deviations from baseline, but additional synergies emerged for larger gait changes. Synergy complexity was similarly modulated; complexity decreased for 82.6% of the attempted gait patterns, but distal gait mechanics were strongly associated with these changes. In particular, greater ankle dorsiflexion moments and knee flexion through stance, as well as greater knee extension moments at initial contact, corresponded to a reduction in synergy complexity. Taken together, these results suggest that the central nervous system preferentially adopts a low-dimensional, largely invariant control strategy but can modify that strategy to produce diverse gait patterns. Beyond improving understanding of how synergies are recruited during gait, study outcomes may also help identify parameters that can be targeted with interventions to alter synergies and improve motor control after neurological injury.NEW & NOTEWORTHY We used a motor control-based biofeedback system and machine learning to characterize the extent to which nondisabled adults can modulate synergies during gait pattern exploration. Results revealed that a small library of synergies underlies an array of gait patterns but that recruitment from this library changes as a function of the imposed biomechanical constraints. Our findings enhance understanding of the neural control of gait and may inform biofeedback strategies to improve synergy recruitment after neurological injury.

Are Age, Self-Selected Walking Speed, or Propulsion Force Predictors of Gait-Related Changes in Older Adults?

There is limited research that directly compares the effect of reduced speed with reduced propulsive force production (PFP) on age-related gait changes. We aimed to determine how changes in the gait of older adults correlate with age, speed, or peak PFP over a 6-year span. We collected kinematics and kinetics of 17 older subjects at 2 time points. We determined which biomechanical variables changed significantly between visits and used linear regressions to determine whether combinations of self-selected walking speed, peak PFP, and age correlated to changes in these variables. We found a suite of gait-related changes that occurred in the 6-year period, in line with previous aging studies. Of the 10 significant changes, we found 2 with significant regressions. Self-selected walking speed was a significant indicator of step length, not peak PFP or age. Peak PFP was a significant indicator for knee flexion. None of the biomechanical changes were correlated to the chronological age of the subjects. Few gait parameters had a correlation to the independent variables, suggesting that changes in gait mechanics were not solely correlated to peak PFP, speed, and/or age. This study improves understanding of changes in ambulation that lead to age-related gait modifications.

Do they Feel Better When they Walk Better? 3D Gait Analysis Study in Total Knee Arthroplasty for Indian Osteoarthritic Knees

Background: Osteoarthritis (OA) is a leading cause of disability in the elderly population. Gait analysis is a widely used tool to measure functional outcomes after total knee arthroplasty (TKA). This study aimed to assess the gait pattern and influence of TKA in patients with osteoarthritic knees. Materials and Methods: Preoperative and postoperative gait analysis was carried out on patients with grade 4 OA knee undergoing TKA. Sequential 33 adults (45 knees) with a mean age of 68.4 ± 5.8 years were studied. Gait analysis was carried out in Jupiter gait lab with 9 Qualisys Oqus cameras system and Qualisys track manager. Kinematic data were processed using Visual 3D C-Motion Software during a minimum of 6 walks across the walkway. Results: A significant difference in temporospatial parameters (gait speed, Cadence, step time, step length, stride width, stride length), joint kinematics in the sagittal plane (pelvis, hip, knee, ankle), coronal plane (pelvis, hip, knee, ankle), transverse plane (hip, knee) and motion analysis profile of knee (flexion/extension), ankle (dorsiflexion/plantarflexion), and hip (adduction/abduction). A significant difference was observed in the oxford knee score (OKS), Short Form 12, and knee society score. Conclusion: 3D gait analysis is a good tool to document and compare gait changes in patients undergoing TKA. Recent advances in surgical techniques and improvements in prosthesis design are important factors for better functional outcomes. Our results may be used by clinicians, physiotherapists, or researchers as a reference for integrated aspects for the development of TKA implant designs and improving functional outcomes.

Exercise therapy guides cortical reorganization after midthoracic spinal contusion to enhance control of lower thoracic muscles, supporting functional recovery

Postural control is critical for locomotion, allowing for gait changes, obstacle avoidance and navigation of rough terrain. A major problem after spinal cord injury (SCI) is regaining the control of balance to prevent falls and further injury. While the circuits for locomotor pattern generation reside in the spinal cord, postural control consists of multiple, complex networks that interact at the spinal, brainstem and cortical levels. After complete SCI, cortical reorganization establishes novel control of trunk musculature that is required for weight-supported stepping. In this study, we examined the impact of exercise therapy on cortical reorganization in the more clinically relevant models of both moderate and severe midthoracic contusion injury in the rat. Results demonstrate that both spontaneous recovery and therapy induced recovery of weight-supported stepping utilize cortical reorganization. Moreover, exercise therapy further improves outcome by enhancing cortical control of lower thoracic muscles enabling improvements in interlimb coordination associated with improved balance that increases weight-supported stepping. The outcome of this study suggest that cortical control of posture is key to functional improvement in locomotion. This information can be used to improve the timing and type of therapy after SCI by considering changes along the entire neural axis.

Effects of age-related changes in trunk and lower limb range of motion on gait

BackgroundThe ability to walk is crucial for maintaining independence and a high quality of life among older adults. Although gait characteristics have been extensively studied in older adults, most studies have investigated muscle activity in the joints of the trunk or the lower limbs without assessing their interactions. Thus, the causes of altered trunk and lower limb movement patterns in older adults remain to explore. Therefore, this study compared the joint kinematic parameters of both trunk and lower limbs between young and older adults to identify kinematic factors associated with changes in gait among older adults.MethodsIn total, 64 older (32 males, aged 68.34 ± 7.38 years; 32 females, aged 67.16 ± 6.66 years) and 64 young (32 males, aged 19.44 ± 0.84 years; 32 females, aged 19.69 ± 0.86 years) healthy adults participated in this study. The range of motion (ROM) of the thorax, pelvis, and trunk in the horizontal plane and of the hip, knee, and ankle joints of the lower limbs in the sagittal plane were measured using a motion capture system with wearable sensors. Two-way analysis of variance assessed differences in ROM by group, sex, and spatio-temporal gait parameters; Pearson correlation analysis assessed the correlation of the trunk and lower limbs.ResultsStep length, gait speed, and stride length were greater in young adults (p < 0.001) than in older adults, but older women displayed the fastest gait speed (p < 0.05). ROM values for the pelvis, thorax, trunk, knee joint, and ankle joint of young adults were greater (p < 0.05) than those in older adults. However, hip ROM in older adults was significantly greater than that in young adults (p < 0.05).ConclusionWith increasing age, ROM of the lower limbs, especially the ankle joint, decreased significantly, resulting in a significant decrease in gait speed. As ROM of the pelvis decreased, stride length decreased significantly in older adults, who compensate through thoracic rotation. Thus, older adults should enhance muscle strength and increase ROM to improve gait patterns.

Neurodegeneration with brain iron accumulation: a differential diagnosis of cerebral palsy

BackgroundBrain iron accumulation neurodegeneration (NBIA) comprises a group of rare diseases characterized by deposits of this metal in brain structures. It presents a great variability of progression, which can be fast enough to lead the patient to death in the first years of life, or slow enough to be confused with non-progressive diseases.Case presentationFemale, 19-year-old patient, cesarean delivery at 38 weeks of gestation. History of multiple sclerosis in a second-degree paternal aunt. Normal neuropsychomotor growth and development up to 11 months, when changes in gait began. After that, it got worse, with decreased muscle strength and falls, but it progressed so slowly that she was diagnosed with cerebral palsy, a non-progressive condition. At the age of 16, she underwent molecular analysis by exome sequencing, being diagnosed with the NBIA Phospholipase A2 (PLAN) variant. Currently doing physical therapy, hydrotherapy, occupational therapy and sertraline.ConclusionsThe report draws attention to the variability of the disease and the possibility of confusion with other diagnoses, which may delay proper management.

Postsurgical Analysis of Gait, Radiological, and Functional Outcomes in Children with Developmental Dysplasia of the Hip.

Children undergoing DDH correction surgery may experience gait abnormalities following soft tissue releases and bony procedures. The purpose of this study was to compare the residual gait changes, radiological outcomes, and functional outcomes in children who underwent DDH surgery with those in healthy controls. Inertial motion sensors were used to record the gait of 14 children with DDH and 14 healthy children. Pelvic X-ray was performed to determine the Severin classification and the presence of femoral head osteonecrosis (Bucholz-Odgen classification). For functional evaluation, the Children's Hospital Oakland Hip Evaluation Scale (CHOHES) was used. There was no difference in spatial parameters between the two groups. In terms of temporal parameters, the DDH-affected limbs had a shorter stance phase (p < 0.001) and a longer swing phase (p < 0.001) than the control group. The kinematic study showed that the affected limb group had smaller hip adduction angle (p = 0.002) and increased internal rotation (p = 0.006) with reduced upward pelvic tilt (p = 0.020). Osteonecrosis was graded II, III, and IV in five, three, and one patients, respectively. Five patients had no AVN changes. The Severin classification was grade I, II, and III for six, three, and five patients, respectively. Most patients had good functional outcomes on the CHOHES, with a mean total score of 96.64 ± 5.719. Multivariate regression analysis revealed that weight, height, and femoral osteotomy were independent predictors for gait, radiological and functional outcome. Despite good functional scores overall, some children had poor radiological outcomes and gait abnormalities. Our results identified the risk factors for poor outcomes, and we recommend specified rehabilitative strategies for long-term management.

Investigation of gait and balance function in cervical spondylotic myelopathy patients using wearable sensors

Background ContextCervical spondylotic myelopathy (CSM) is a degenerative disease caused by cervical cord compression and can lead to the significant impairment of motor function including gait and balance disturbances and changes in lower extremity muscle activity. PurposeThis study aimed to characterize gait, balance and lower extremity muscle activity in patients with CSM compared to age-matched healthy controls (HCs) using wearable sensors in the clinical setting. Study DesignNonrandomized, prospective cohort study. Patient SampleTen CSM patients and 10 age-matched HCs were recruited for this study. Outcome MeasuresGait and balance function parameters contained spatial temporal parameters, step regularity (SR1), stride regularity (SR2) and harmonic ratio (HR). EMG muscle activity parameters included time to peak and peak value during loading, stance, and swing phase. MethodsIn this study, parameters of gait and balance function were extracted using triaxial accelerometer attached to the spinous processes of Lumbar 5 while participants performed an overground walking at a self-preferred speed. Moreover, muscular activity was simultaneously recorded via sEMG sensors attached to tibialis anterior (TA), rectus femoris (RF), bicep femoris (BF), and gastrocnemius lateral (GL). Independent sample t test was used to find the differences between CSM patients and HCs. ResultsGait analysis showed cadence, step length and walking speed were statistically significantly lower in CSM patients than HCs. Stride time was significantly higher for CSM patients in comparison to HCs. Lower root mean square ratio (RMSR) of acceleration in the mediolateral (ML) direction, HR in the anteroposterior (AP) direction, SR1 in the AP direction and SR2 in all three directions were observed in CSM patients. For muscle activity analysis, EMG RMS for TA and RF during loading phase and RMS for GL during midstance phase was significantly lower for CSM patients, while significantly higher value was observed for RF RMS during midstance phase and GL RMS during swing phase in CSM patients. ConclusionOur pilot study shows that wearable sensors are able to detect the changes of gait, balance and lower extremity muscle activities of CSM patients in the clinical setting. This pilot study sets the stage for future researches on the diagnosis and monitor progression of CSM disease using wearable technology.

Changes in biomechanics, strength, physical function, and daily steps after extended-release corticosteroid injections in knee osteoarthritis: a responder analysis.

To determine changes in gait biomechanics, quadricep strength, physical function, and daily steps after an extended-release corticosteroid knee injection at 4 and 8weeks post-injection in individuals with knee osteoarthritis as well as between responders and non-responders based on changes in self-reported knee function. The single-arm, clinical trial included three study visits (baseline, 4weeks, and 8weeks post-injection), where participants received an extended-release corticosteroid injection following the baseline visit. Time-normalized vertical ground reaction force (vGRF), knee flexion angle (KFA), knee abduction moment (KAM), and knee extension moment (KEM) waveforms throughout stance were collected during gait biomechanical assessments. Participants also completed quadricep strength, physical function (chair-stand, stair-climb, 20-m fast-paced walk) testing, and free-living daily step assessment for 7days following each visit. All participants demonstrated increased KFA excursion (i.e., greater knee extension angle at heel strike and KFA at toe-off), increased KEM during early stance, improved physical function (all p < 0.001), and increased quadricep strength at 4 and 8weeks. KAM increased throughout most of stance at 4 and 8weeks post-injection (p < 0.001) but appears to be driven by gait changes in non-responders. Non-responders demonstrated lesser vGRF during late stance and lesser KEM and KFA throughout stance compared to responders at baseline. Extended-release corticosteroid injections demonstrated short-term improvements in gait biomechanics, quadricep strength, and physical function for up to 4weeks. However, non-responders demonstrated gait biomechanics associated with osteoarthritis progression prior to the corticosteroid injection, suggesting that non-responders demonstrate more deleterious gait biomechanics prior to corticosteroid injection. Key Points • Individuals with knee osteoarthritis who were treated with extended-release corticosteroid injections demonstrated improvements in gait biomechanics and physical function for 8weeks. • Individuals with knee osteoarthritis, who walked with aberrant walking biomechanics before treatment, failed to respond to extended-release corticosteroid treatment. • Future research should determine the mechanisms contributing to the short-term changes in gait biomechanics and physical function such as reduced inflammation.

Exercise Therapy in Nonspecific Low Back Pain among Individuals with Lower-Limb Amputation: A Systematic Review.

Low back pain is very common condition that often becomes a long-lasting problem in prostheses users after lower limb amputation. The presented study aims to decide the potential benefits of exercise therapy on low back pain among lower limb amputees by using a systematic review. The PICO technique was used to answer the primary issue of this review: Does exercise treatment lessen the prevalence of low back pain in the population of lower limb amputees? Systematic review was conducted in the following databases: Medline-PubMed, EMBASE, Scopus, and Web of Science. Studies up to September 2010 published in English are included. Aim, target population, development and execution strategies, and treatment suggestions were among the data gathered. The primary outcomes of interest were exercise interventions as a therapy for low back pain but only two articles met including criteria. The search was broadened and 21 studies describing biomechanical changes in gait and pelvic-spine posture were analysed. This review indicates that movement therapy is a potential treatment strategy in low back pain among amputees. The major limitation of the study is the very heterogenous group of subjects in terms of amputation level, baseline activity level and comorbidities. We used a procedure that was registered in PROSPERO (CRD42022345556) to perform this systematic review of systematic reviews. There is a necessity of good quality research for concluding a consensus of exercise intervention.

Functional Implications of Flat-Topped Talus Following Treatment of Idiopathic Clubfoot Deformity.

Though flatness of the talar dome (TD) is a potential consequence of operative and nonoperative clubfoot management, the functional impact of this deformity is not well understood. This study analyzes the relationship between TD morphology and ankle function at skeletal maturity in patients treated for idiopathic clubfoot during infancy. 33 skeletally mature patients (average age 17.9 years) with 48 idiopathic clubfeet were identified. Weightbearing radiographs, gait analysis, and patient-reported outcomes using the Pediatric Orthopaedic Data Collection Instrument (PODCI) were obtained. Radius of curvature (ROC) of the TD and tibial plafond were measured along with other parameters of talar and calcaneal morphology. All measurements were correlated to PODCI scores and gait analysis data. Patients demonstrated marked variability in ROC of the TD (mean 30.8 mm, SD 13.6 mm), TD radius to talar length (R/L) ratio (mean 0.56, SD 0.28), opening angle of the TD (alpha angle) (mean 89.6°, SD 28.4°), and tibiotalar incongruity index (mean 0.18, SD 0.16). Increased tibiotalar incongruity index correlated with decreased maximum plantar flexion (r = ‒0.325, P = .02). A less acute alpha angle of the talar dome correlated with increased maximum ankle power generation (r = 0.321, P = .03) as did increased length of the talar neck (r = 0.358, P = .013). Increased tibiotalar incongruity index correlated negatively with PODCI global function domain scores (r = ‒0.490, P = .04; r = ‒0.381, P = .03, respectively), whereas length of the talar body correlated with higher global function scores (r = 0.376, P = .03) and lower pain scores (r = 0.350, P = .046). At skeletal maturity, flattening of the talar dome and tibiotalar incongruity on plain radiographs correlate modestly with gait changes, whereas tibiotalar incongruity and length of the talar body, not flatness of the talar dome, correlate with decreased patient-reported outcome scores. Level III, prognostic.

Effects of visual restoration on gait performance and kinematics of lower extremities in patients with age-related cataract.

Visual inputs are critical for locomotor navigation and sensorimotor integration in the elderly; however, the mechanism needs to be explored intensively. The present study assessed the gait pattern after cataract surgery to investigate the effects of visual restoration on locomotion. The prospective study recruited 32 patients (70.1 ± 5.2 years) with bilateral age-related cataracts in the Department of Ophthalmology at Peking University Third Hospital from October 2016 to December 2019. The temporal-spatial gait parameters and kinematic parameters were measured by the Footscan system and inertial measurement units. Paired t -test was employed to compare data normally distributed and Wilcoxon rank-sum test for non-normally distributed. After visual restoration, the walking speed increased by 9.3% (1.19 ± 0.40 m/s vs. 1.09 ± 0.34 m/s, P =0.008) and exhibited an efficient gait pattern with significant decrease in gait cycle (1.02 ± 0.08 s vs. 1.04 ± 0.07 s, P =0.012), stance time (0.66 ± 0.06 s vs. 0.68 ± 0.06 s, P =0.045), and single support time (0.36 ± 0.03 s vs. 0.37 ± 0.02 s, P =0.011). High amplitude of joint motion was detected in the sagittal plane in the left hip (37.6° ± 5.3° vs. 35.5° ± 6.2°, P =0.014), left thigh (38.0° ± 5.2° vs. 36.4° ± 5.8°, P =0.026), left shank (71.9° ± 5.7° vs. 70.1° ± 5.6°, P =0.031), and right knee (59.1° ± 4.8° vs. 56.4° ± 4.8°, P =0.001). The motor symmetry of thigh improved from 8.35 ± 5.30% to 6.30 ± 4.73% ( P =0.042). The accelerated gait in response to visual restoration is characterized by decreased stance time and increased range of joint motion. Training programs for improving muscle strength of lower extremities might be helpful to facilitate the adaptation to these changes in gait.

Relationship between Cognitive Decline and Daily Life Gait among Elderly People Living in the Community: A Preliminary Report

Introduction: Early detection and intervention are important to prevent dementia. Gait parameters have been recognized as a potentially easy screening tool for mild cognitive impairment (MCI); however, differences in gait parameters between cognitive healthy individuals (CHI) and MCI are small. Daily life gait change may be used to detect cognitive decline earlier. In the present study, we aimed to clarify the relationship between cognitive decline and daily life gait. Methods: We performed 5-Cog function tests and daily life and laboratory-based gait assessments on 155 community-dwelling elderly people (75.5 ± 5.4 years old). Daily life gait was measured for 6 days using an iPod-touch with an accelerometer. Laboratory-based 10-m gait (fast pace) was measured using an electronic portable walkway. Results: The subjects consisted of 98 CHI (63.2%) and 57 cognitive decline individuals (CDI; 36.8%). Daily life maximum gait velocity in the CDI group (113.7 [97.0–128.5] cm/s) was significantly slower than that in the CHI group (121.2 [105.8–134.3] cm/s) (p = 0.032). In the laboratory-based gait, the stride length variability in the CDI group (2.6 [1.8–4.1]) was significantly higher than that in the CHI group (1.8 [1.2–2.7]) (p < 0.001). The maximum gait velocity in daily life gait was weakly but significantly correlated with stride length variability in laboratory-based gait (ρ = −0.260, p = 0.001). Conclusion: We found an association between cognitive decline and slower daily life gait velocity among community-dwelling elderly people.

Abstract P305: Peripheral Neuropathy is Associated With Slow Gait Speed in Older Adults in the Atherosclerosis Risk in Communities Study

Introduction: Peripheral neuropathy (PN) (decreased sensation in the foot) is associated with falls and mortality. Small studies have found an association between slow gait speed and PN, primarily in adults with diabetes, but evidence is limited in adults without diabetes. Hypothesis: We hypothesized that PN is associated with slow gait speed in older adults. Methods: We performed a non-concurrent cross-sectional analysis of 360 participants in the Atherosclerosis Risk in Communities (ARIC) Study who completed standardized monofilament testing for PN at visit 6 (2016-2017) and Zeno Walkway mat-sensor gait testing at visit 8 (2019-2020). Gait speed was assessed categorically (normal (≥1.0m/s) or slow (&lt;1.0m/s)) and continuously. Logistic and linear regression were used to examine the association between PN and slow gait speed overall and stratified by diabetes status after adjusting for traditional risk factors. Results: The prevalence of PN was 32.2% (34% in adults with diabetes and 30% in adults without diabetes). Slow gait speed was observed in 53% of patients with PN compared to 40% of patients without PN (p=0.022). In adjusted models, PN was significantly associated with slow (categorical) and slower (continuous) gait speed in the overall sample, and these associations were particularly robust among adults without diabetes ( Table ). Conclusions: PN was associated with slow gait speed in a community-dwelling cohort of older adults. The specific association of PN and slow gait speed in persons without diabetes is novel. Despite a relatively small sample size, the difference between PN and non-PN participants’ continuous gait speeds exceeded the accepted threshold for clinically meaningful differences (generally &gt;0.05m/s). A better understanding of additional PN-specific gait changes may help elucidate mechanisms underlying the association of PN with slow gait, falls, and mortality.

Wearable sensors for assessing disease severity and progression in Progressive Supranuclear Palsy

IntroductionProgressive supranuclear palsy (PSP) is an atypical parkinsonism characterized by prominent gait and postural impairment. The PSP rating scale (PSPrs) is a clinician-administered tool to evaluate disease severity and progression. More recently, digital technologies have been used to investigate gait parameters. Therefore, object of this study was to implement a protocol using wearable sensors evaluating disease severity and progression in PSP. MethodsPatients were evaluated with the PSPrs as well as with three wearable sensors located on the feet and lumbar area. Spearman coefficient was used to assess the relationship between PSPrs and quantitative measurements. Furthermore, sensor parameters were included in a multiple linear regression model to assess their ability in predicting the PSPrs total score and sub-scores. Finally, differences between baseline and three-month follow-up were calculated for PSPrs and each quantitative variable. The significance level in all analyses was set at ≤ 0.05. ResultsFifty-eight evaluations from thirty-five patients were analyzed. Quantitative measurements showed multiple significant correlations with the PSPrs scores (r between 0.3 and 0.7; p < 0.05). Linear regression models confirmed the relationships. After three months visit, significant worsening from baseline was observed for cadence, cycle duration and PSPrs item 25, while PSPrs item 10 showed a significant improvement. ConclusionWe propose wearable sensors can provide an objective, sensitive quantitative evaluation and immediate notification of gait changes in PSP. Our protocol can be easily introduced in outpatient and research settings as a complementary tool to clinical measures as well as an informative tool on disease severity and progression in PSP.

Effect of disturbance stimulation using a split-belt treadmill on a patient with cerebellar ataxia: a case report

PurposeWe present the case of a patient with cerebellar ataxia who was treated with walking practice using a split-belt treadmill with disturbance stimulation. The treatment effects were evaluated for improvements in standing postural balance and walking ability.Case presentationThe patient was a 60-year-old Japanese male who developed ataxia after cerebellar hemorrhage. Assessment was performed using the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and Timed Up-and-Go tests. A 10 m walking speed and walking rate were also assessed longitudinally. The obtained values were fit into a linear equation (y = ax + b), and the slope was calculated. This slope was then used as the predicted value for each period relative to the pre-intervention value. After removing the trend of the value for each period relative to the pre-intervention value, the amount of pre- to post-intervention change for each period was calculated to verify the intervention effect. Furthermore, to verify the changes in gait over time, a three-dimensional motion analyzer was used to analyze the pre- and post-intervention gait five times, and the results were kinematically compared.ResultsNo significant pre- to post-intervention changes were observed in the Scale for the Assessment and Rating of Ataxia scores. Conversely, the Berg Balance Scale score, walking rate, and 10 m walking speed increased, and the Timed Up-and-Go score decreased in the B1 period, indicating a marked improvement from the predicted results based on the linear equation. For changes in gait determined using three-dimensional motion analysis, an increase in stride length was observed in each period.ConclusionThe present case findings suggest that walking practice with disturbance stimulation using a split-belt treadmill does not improve inter-limb coordination, but contributes to improving standing posture balance, 10 m walking speed, and walking rate.