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PubMed2005

The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis.

It is difficult to identify objective parameters for assessing the joint function when evaluating the outcome of orthopaedic procedures, especially endoprosthetic replacement. Spatial and temporal parameters of gait have clinical relevance in the assessment of motor pathologies, particularly in orthopaedics. However, the influence of gait speed on these biomechanical parameters has been difficult to be taken into consideration so far. The objective of the present study was to analyse the impact of gait speed on gait parameters and to set a standard walking speed for patients with osteoarthritis by means of a special treadmill control mechanism. The second objective is to compare the gait patterns in patients with unilateral osteoarthritis of the hip joint or of the knee joint to the gait pattern of healthy control subjects. A total of 20 patients with severe unilateral osteoarthritis of the hip, 20 patients with severe unilateral osteoarthritis of the knee and 20 healthy elderly subjects without any history of lower extremity joint pathology were investigated at four different gait speeds. The gait analysis equipment used consisted of an infinitely adjustable force-instrumented treadmill and an ultrasound-based motion analyser system with electromyography. Our data suggest that most of the biomechanical parameters depend on gait speed. The highest gait speed that all our patients with severe osteoarthritis were suitable with, without pain and loss of coordination, was 2.00 km/h. Our findings indicate that the changes in gait parameters may occur in patients with unilateral osteoarthritis of the hip joint or the knee joint compared to the gait pattern of healthy control subjects. Hip joint or knee joint degeneration was compensated for in part by the pelvis and other joints in the lower limb. Reduced motion of the hip joint or knee joint leads to an increased pelvic motion, which should affect the natural mobility of the lumbar spine and cause pain in the lumbar region of the spine because of their kinematic interaction.

Adaptation, Physiological↗
PubMed1999

A mechanical energy analysis of gait initiation.

The analysis of gait initiation (the transient state between standing and walking) is an important diagnostic tool to study pathologic gait and to evaluate prosthetic devices. While past studies have quantified mechanical energy of the body during steady-state gait, to date no one has computed the mechanical energy of the body during gait initiation. In this study, gait initiation in seven normal male subjects was studied using a mechanical energy analysis to compute total body energy. The data showed three separate states: quiet standing, gait initiation, and steady-state gait. During gait initiation, the trends in the energy data for the individual segments were similar to those seen during steady-state gait (and in Winter DA, Quanbury AO, Reimer GD. Analysis of instantaneous energy of normal gait. J Biochem 1976;9:253-257), but diminished in amplitude. However, these amplitudes increased to those seen in steady-state during the gait initiation event (GIE), with the greatest increase occurring in the second step due to the push-off of the foundation leg. The baseline level of mechanical energy was due to the potential energy of the individual segments, while the cyclic nature of the data was indicative of the kinetic energy of the particular leg in swing phase during that step. The data presented showed differences in energy trends during gait initiation from those of steady state, thereby demonstrating the importance of this event in the study of locomotion.

Adult↗
PubMedDate not supplied

Spatial parameters of walking gait and footedness.

OBJECTIVE: The present study was undertaken to assess whether footedness has effects on selected spatial and angular parameters of able-bodied gait by evaluating footprints of young adults. SUBJECTS AND METHODS: A total of 112 males and 93 females were selected from among students and staff members of the University of Malawi using a simple random sampling method. Footedness of subjects was assessed by the Waterloo Footedness Questionnaire Revised. Gait at natural speed was recorded using the footprint method. The following spatial parameters of gait were derived from the inked footprint sequences of subjects: step and stride lengths, gait angle and base of gait. The anthropometric measurements taken were weight, height, leg and foot length, foot breadth, shoulder width, and hip and waist circumferences. RESULTS: The prevalence of right-, left- and mix-footedness in the whole sample of young Malawian adults was 81%, 8.3% and 10.7%, respectively. One-way analysis of variance did not reveal a statistically significant difference between footedness categories in the mean values of anthropometric measurements (p > 0.05 for all variables). Gender differences in step and stride length values were not statistically significant. Correction of these variables for stature did not change the trend. Males had significantly broader steps than females. Normalized values of base of gait had similar gender difference. The group means of step length and normalized step length of the right and left feet were similar, for males and females. There was a significant side difference in the gait angle in both gender groups of volunteers with higher mean values on the left side compared to the right one (t = 2.64, p < 0.05 for males, and t = 2.78, p < 0.05 for females). One-way analysis of variance did not demonstrate significant difference between footedness categories in the mean values of step length, gait angle, bilateral differences in step length and gait angle, stride length, gait base and normalized gait variables of male and female volunteers (p > 0.05 for all variables). CONCLUSIONS: The present study demonstrated that footedness does not affect spatial and angular parameters of walking gait.

Adult↗
PubMed2004

Gait analysis in children and adolescents with spinal cord injuries.

BACKGROUND/OBJECTIVE: Improving ambulation in patients with spinal cord injuries (SCIs) is a major challenge for the clinician. Physical examination can be supplemented with biomechanic information from the gait laboratory to comprehensively evaluate and improve walking. Gait analysis is an effective method to evaluate 3-dimensional dynamic joint range of motion (kinematics) and forces (kinetics) occurring at the hip, knee, and ankle/foot. Clinical gait analysis has proved to be essential for surgical and rehabilitative planning and posttreatment assessment in many neuromuscular disorders. Benefits of gait analysis also may apply to walking patients with SCIs. The goal of this study was to demonstrate the utility of gait analysis in children and adolescents with SCIs. METHODS: Motion analysis evaluations and physical examinations were performed on 33 children and adolescents with SCIs (16 males, 17 females). Mean age at time of gait analysis was 11.7 years, with an age range of 2.5 to 21 years. RESULTS: Abnormal kinematic patterns, which were repeatable over several years, were demonstrated in the patients with SCI. Gait analysis was beneficial in making educated treatment decisions about orthotic prescription, surgery, postsurgical evaluation, prescription of new therapy, evaluation of spasticity medications, and experimental treatments. Another advantage of gait analysis is recording and reviewing changes in gait over time. In our study, 22 of the 33 patients received a 1-year follow-up gait analysis. Patients followed over multiyear intervals have demonstrated characteristic changes in mobility patterns, resulting in changes in prescription of mobility aids. The benefits of gait analysis are demonstrated by case presentation. CONCLUSION: Improved ambulation for patients with SCI can be accomplished with physical therapy, orthotics, spasticity management, and surgery. These treatments, as well as innovative new areas such as functional electrical stimulation and robotic-assisted therapy, rely on gait analysis to provide a template of normal walking patterns and to measure function and document improvements.

Adolescent↗
PubMedDate not supplied

Biomechanics and physiology of gait selection in flying birds.

Two wing-beat gaits, distinguished by the presence or absence of lift production during the upstroke, are currently used to describe avian flight. Vortex-visualization studies indicate that lift is produced only during the downstroke in the vortex-ring gait and that lift is produced continuously in the continuous-vortex gait. Tip-reversal and feathered upstrokes represent different forms of vortex-ring gait distinguished by wing kinematics. Useful aerodynamic forces may be produced during tip-reversal upstroke in slow flight and during a feathered upstroke in fast flight, but it is probable that downstroke forces are much greater in magnitude. Uncertainty about the function of these types of upstroke may be resolved when more data are available on wake structure in different flight speeds and modes. Inferring from wing kinematics and available data on wake structure, birds with long wings or wings of high aspect ratio use a vortex-ring gait with tip-reversal upstroke at slow speeds, a vortex-ring gait with a feathered upstroke at intermediate speeds, and a continuous-vortex gait at fast speeds. Birds with short wings or wings of low aspect ratio use a vortex-ring gait with a feathered upstroke at all speeds. Regardless of wing shape, species tend to use a vortex-ring gait for acceleration and a continuous-vortex gait for deceleration. Some correlations may exist between gait selection and the function of the muscular and respiratory system. However, overall variation in wing kinematics, muscle activity, and respiratory activity is continuous rather than categorical. To further our understanding of gait selection in flying birds, it is important to test whether upstroke function varies in a similar manner. Transitions between lifting and nonlifting upstrokes may be more subtle and gradual than implied by a binomial scheme of classification.

Animals↗
PubMed2000

Idiopathic senile gait disorders are signs of subclinical disease.

OBJECTIVES: To evaluate survival and causes of death in subjects with idiopathic senile gait disorders. DESIGN: A population-based longitudinal study. SETTING: Survival analysis of the oldest old within the Leiden 85-plus Study. PARTICIPANTS: We distinguished three different groups according to their gait: subjects with a normal gait (n = 25), subjects with senile gait disorders (n = 14), and subjects with gait disorders due to known disease (n = 87). The mean age was 90 years in all groups (range 87 to 97 years). MEASUREMENTS: The risk of all cause mortality and cardiovascular mortality was estimated over 5 years of follow-up in a Cox-proportional hazards model, adjusted for age and sex. RESULTS: Eighty-nine of 126 subjects died during follow-up. Mean survival differed among the three groups (P log-rank = .01). All cause mortality risk was increased in subjects with senile gait disorders compared with subjects with a normal gait (RR = 2.8; 95% CI, 1.1-7.3, P = .03) and was similar to subjects with gait disorders caused by known disease (RR = 1.2; 95% CI: .6-2.5, P = .6). Mortality caused by cardiovascular disease also differed among the three groups (P log-rank = .03). The risk of cardiovascular death in subjects with senile gait disorders was twofold greater than in subjects with a normal gait (RR = 2.1; 95% CI, 0.4-10.3). CONCLUSIONS: Senile gait disorders are related to subclinical, perhaps cardiovascular, disease. Senile gait disorders should not be accepted as an inevitable, benign concomitant of the normal aging process.

Aged↗
PubMedDate not supplied

Improvements in trunk sway observed for stance and gait tasks during recovery from an acute unilateral peripheral vestibular deficit.

OBJECTIVES: Our aim was to track improvements in postural control during recovery from an acute unilateral peripheral vestibular deficit (UVL), presumably due to vestibular neuritis, and to determine if recovery rates were different for stance and gait tasks. Postural control was quantified using simple measurements of trunk sway: amplitudes of trunk sway angle and angular velocity, in the roll and pitch directions as well as task duration, were examined for a battery of stance and gait tasks. These measures were collected at the onset of the deficit and then 3 weeks and 3 months later. STUDY DESIGN: A repeated-measures design was used for UVL subjects and age-matched healthy controls. Stance tasks involved standing on 1 or 2 legs with eyes open or closed. Gait tasks consisted of tandem gait, walking normally with eyes closed, or with the head rotating or head pitching, walking up and down stairs and walking over a series of low barriers. Stance and tandem gait tasks were repeated using a foam support surface instead of a normal floor. PATIENTS: Twenty-eight patients with acute UVL were examined. MAIN OUTCOME MEASURES: The range of trunk sway angular displacement and angular velocity in the pitch and roll directions was measured for each task in addition to task duration. The measures were compared with those of normal subjects. RESULTS: The amplitudes of pitch trunk sway for 2-legged stance tasks with eyes closed underwent the greatest reduction 3 weeks after UVL onset. At 3 months, trunk sway was almost normal for all 2-legged stance tasks. One-legged stance tasks with eyes open showed a similar but slower improvement. Stance time without a fall showed a very rapid improvement for 1-legged tasks but was still shorter than that of normal subjects at 3 months. Trunk sway for the simple gait tasks was within normal range at 3 months; however, task duration was still longer than normal. More complex gait tasks, such as walking 8 tandem steps on foam or walking up and down stairs, showed no improvement in trunk roll sway at 3 months. A mix of variables from mainly gait tasks best identified a balance deficit due to UVL, with complex gait tasks becoming more important for identification purposes as compensation progressed. The accuracy of UVL identification with durations alone was 75% of the accuracy with combined trunk sway and duration measures. CONCLUSIONS: These data suggest that recovery of normal trunk control during the compensation process for unilateral vestibular hypofunction is more rapid for stance tasks than gait tasks. Even at 3 months, trunk sway for complex gait tasks was not normal. Thus, trunk sway for gait tasks provides a better insight into remaining deficits in balance control of vestibular-loss patients than the sway of stance tasks.

Acute Disease↗
PubMed2002

Estimates of circulation and gait change based on a three-dimensional kinematic analysis of flight in cockatiels (Nymphicus hollandicus) and ringed turtle-doves (Streptopelia risoria).

Birds and bats are known to employ two different gaits in flapping flight, a vortex-ring gait in slow flight and a continuous-vortex gait in fast flight. We studied the use of these gaits over a wide range of speeds (1-17 ms(-1)) and transitions between gaits in cockatiels (Nymphicus hollandicus) and ringed turtle-doves (Streptopelia risoria) trained to fly in a recently built, variable-speed wind tunnel. Gait use was investigated via a combination of three-dimensional kinematics and quasi-steady aerodynamic modeling of bound circulation on the distal and proximal portions of the wing. Estimates of lift from our circulation model were sufficient to support body weight at all but the slowest speeds (1 and 3 ms(-1)). From comparisons of aerodynamic impulse derived from our circulation analysis with the impulse estimated from whole-body acceleration, it appeared that our quasi-steady aerodynamic analysis was most accurate at intermediate speeds (5-11 ms(-1)). Despite differences in wing shape and wing loading, both species shifted from a vortex-ring to a continuous-vortex gait at 7 ms(-1). We found that the shift from a vortex-ring to a continuous-vortex gait (i) was associated with a phase delay in the peak angle of attack of the proximal wing section from downstroke into upstroke and (ii) depended on sufficient forward velocity to provide airflow over the wing during the upstroke similar to that during the downstroke. Our kinematic estimates indicated significant variation in the magnitude of circulation over the course the wingbeat cycle when either species used a continuous-vortex gait. This variation was great enough to suggest that both species shifted to a ladder-wake gait as they approached the maximum flight speed (cockatiels 15 ms(-1), doves 17 ms(-1)) that they would sustain in the wind tunnel. This shift in flight gait appeared to reflect the need to minimize drag and produce forward thrust in order to fly at high speed. The ladder-wake gait was also employed in forward and vertical acceleration at medium and fast flight speeds.

Animals↗
PubMed2005

[Gait analysis--a new diagnostic tool].

Three-dimensional gait analysis is a systematic measurement, description, and assessment of human gait. Gait analysis is established as a useful diagnostic tool in patients with gait problems, as it is not possible to obtain an adequate and detailed understanding of such a complex mechanism as gait in a conventional clinical examination. The method has provided a better understanding of both normal gait and abnormal gait patterns; it is a suitable instrument for evaluation of treatment results as well as for scientific work. The first gait laboratory for clinical use in Norway was established in 2002 in the Section for child neurology at Rikshospitalet University Hospital in Oslo, Norway. In this article the procedure for gait analysis is described and the clinical value is indicated by a case record of a child with cerebral palsy. Gait analysis has entailed a change of policy with regard to surgical treatment in this patient group. Previously, operative intervention at a single level was usual, whereas current practice involves simultaneous interventions at several levels of both lower extremities. After three years' experience we recommend gait analysis in routine diagnostics, particularly as a preoperative evaluation, in all children with gait problems and in the follow up after surgery or other treatment.

Adolescent↗
PubMed1990

Kinematics of high-heeled gait.

High-heeled shoes cause postural changes, a loss in foot function, and increased shock loadings during gait, which must be compensated by accommodations in the kinematics of body segments proximal to the feet. The hypothesis tested in this study was that there are differences in the three-dimensional kinematics of the tibia, knee, hip, pelvis, trunk, and upper trunk between low-heeled and high-heeled gait. Gait analysis of 14 subjects showed that during high-heeled gait subjects walked more slowly (p less than .001), had shorter stride lengths (p less than .001), and had higher stance time percentages (p less than .05). Kinematically, high-heeled gait compared to low-heeled gait, was characterized by significantly increased knee flexion at heelstrike (5.4 degrees vs 2.1 degrees, p less than .05) and during stance phase (22.6 degrees vs 19.2 degrees, p less than .05). During swing phase, high-heeled gait, compared to low-heeled gait, resulted in significantly lower knee flexion (66.1 degrees vs 72.1 degrees, p less than .05) and hip flexion (33.5 degrees vs 34.8 degrees, p less than .05). The range of motion of the pelvis in the sagittal plane was slightly lower in high-heeled gait than in low-heeled gait (7.0 degrees vs 7.9 degrees, p less than .05). No significant differences between low-heeled and high-heeled gait were found in the motions of the pelvis and trunk in the frontal and transverse planes. Statistical tests of intrasubject variability of angles of gait showed that five repeated trials were adequate for analysis of the tibia and knee in all planes of motion and for the hip in frontal and transverse planes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Gait quality assessment using self-organising artificial neural networks.

In this study, the challenge to maximise the potential of gait analysis by employing advanced methods was addressed by using self-organising neural networks to quantify the deviation of patients' gait from normal. Data including three-dimensional joint angles, moments and powers of the two lower limbs and the pelvis were used to train Kohonen artificial neural networks to learn an abstract definition of normal gait. Subsequently, data from patients with gait problems were presented to the network which quantified the quality of gait in the form of a single curve by calculating the quantisation error during the gait cycle. A sensitivity analysis involving the manipulation of gait variables' weighting was able to highlight specific causes of the deviation including the anatomical location and the timing of wrong gait patterns. Use of the quantisation error can be regarded as an extension of previously described gait indices because it measures the goodness of gait and additionally provides information related to the causes underlying gait deviations.

Biomechanical Phenomena↗
PubMed2005

Quantitative measures of gait characteristics indicate prevalence of underlying subclinical structural brain abnormalities in high-functioning older adults.

Abnormal gait in high-functioning older adults may indicate underlying subtle structural brain abnormalities. We tested the hypothesis that temporal and spatial parameters of gait, including speed, stride length and double support time, are cross-sectionally associated with white matter hyperintensity, subcortical infarcts or brain atrophy on brain MRI. We examined 321 men and women (mean age = 78.3) participating to the Cardiovascular Health Study who were free of dementia or stroke at the time of the gait assessment. Analyses were set with gait as independent variable and brain MRIs as dependent variables. Gait measures were determined from the footfalls recorded on a 4-meter-long instrumented walking surface, the GaitMat II. Brain MRIs were examined for the presence of white matter hyperintensity (WMG, graded from 0 to 9), brain infarcts (predominantly subcortical) and ventricular enlargement (graded from 0 to 9). Slower gait, shorter stride length and longer double support times were associated with greater prevalence of white matter grade > or =3 (p = 0.02), and at least 1 brain infarct (p = 0.04) independent of age. In multivariate logistic regression models adjusted for demographics and clinical cardiovascular diseases, those with gait speed <1.02 m/s were more likely to have WMG > or =3 and at least 1 brain infarct, compared with those with faster gait - odds ratio (OR): 2.85, 95% confidence interval (95% CI): 1.35, 6.02, and OR: 2.09, 95% CI: 1.04, 4.19. Shorter stride length was also associated with greater probability of having at least 1 brain infarct (gait stride <0.88 vs. >1.10 m: OR: 3.20, 95% CI: 1.49, 6.88), while longer double support times were associated with a greater probability of having WMG > or =3 (double support time >0.19 vs. <0.14 s: OR: 2.3, 95% CI: 1.1, 4.7) independent of demographics and clinical cardiovascular diseases. Gait parameters were not significantly associated with ventricular grade. In summary, in this group of high-functioning older adults, poorer gait speed, shorter stride and longer double support time are associated with high white matter disease and subclinical strokes.

Aged↗
PubMed1999

Velocity modulation and rhythmic synchronization of gait in Huntington's disease.

This study analyzed the ability of patients with Huntington's disease (HD) to modulate gait velocity without external sensory cues and in response to an auditory rhythmic cue within a frequency entrainment design. Uncued gait patterns of 27 patients were first assessed during normal, slower, and faster self-paced walking. During rhythmic trials, metronome and musical beat patterns were delivered at rates 10% slower and 10-20% faster than baseline cadence to cue gait patterns. After the rhythmic trials, patients were retested at normal gait speed without rhythm. Gait velocities in the patients with HD were below normal reference values in all ranges. Patients were able to significantly (p <0.05) modulate their gait velocity during self-paced and rhythmic metronome cueing but not during music. The ability to modulate gait velocity was retained regardless of the severity of the disease. Gait velocity declined with an increase in disability and chorea score. The disability score differentiated better between gait velocity of moderately and severe patients than chorea score. Slowness of gait was significantly correlated only with disability score and not with chorea. Patients had more difficulty producing adequate step rates than stride lengths during normal and fast walking speeds. After the rhythmic trials, unpaced gait velocity remained significantly (p <0.05) higher than baseline. This carry-over effect was not seen after the uncued trials. Synchronization ability was deficient in all patients, deteriorated with severity of disease, and was already compromised in patients with soft disease signs. Rhythmic tracking of music declined more with severity of disease than metronome tracking. In summary, patients were able to modulate velocity with and without external cues. Velocity adaptations to the external rhythm in music and metronome were achieved without exact synchronization between step cadence and rhythmic stimulus.

Acoustic Stimulation↗
PubMed1994

Gait abnormality in essential tremor.

Essential tremor (ET) has been described as a monosymptomatic disorder. In reports describing large series of patients with ET, there are rare patients who exhibit a noticeable gait disorder. However, we have observed that patients with ET and normal gait often exhibit an abnormality of tandem gait. To investigate this observation, we examined whether a gait disorder was present in 36 consecutive patients (mean age 69) with ET. We employed a tremor rating scale that scored tremor amplitude, location, and disability. In all patients, gait and tandem gait were separately evaluated. Eighteen of 36 patients (50%) exhibited tandem gait abnormalities in the presence of a normal narrow-based gait compared to 11 of 40 age-matched controls (28%) (p < 0.05). Abnormality of tandem gait was more frequently present in older ET patients and those with > 5 years of disease duration. No relationship was found between presence of tandem gait abnormality and gender, tremor severity, head involvement, or positive family history. The finding of a tandem gait abnormality in 50% of ET patients suggests that cerebellar dysfunction may be important in its pathophysiology.

Aged↗
PubMed2006

An evaluation of accuracy and repeatability of a novel gait analysis device.

INTRODUCTION: Restoration of gait is a particularly important patient-based functional outcome following lower extremity trauma. A new portable device which measures gait parameters, the IDEEA, may be particularly useful in evaluating post-traumatic gait parameters in the office setting, but the accuracy and repeatability of this device relative to standard gait laboratory footswitches are unknown. MATERIAL AND METHODS: Twelve healthy subjects were tested simultaneously using the IDEEA device and standard gait laboratory footswitches, at slow, medium, and fast speeds. Parameters evaluated were single-limb support time (SLS), double-limb support time (DLS), swing phase duration (SPD), cycle duration, and cadence. RESULTS: The repeatability between right and left measurements tended to be better for the IDEEA, and was at least as good as the foot switches. The absolute differences of the timed gait parameters between the two devices were all in the range of 0.03 s, which is within the data sampling resolution of the gait laboratory foot switches (0.04 s). Furthermore, assuming a 1-s gait cycle, these differences account for only 3% of the gait cycle, which is also well within the clinical parameters for evaluating and differentiating between treatments. CONCLUSION: This device is accurate and repeatable, and may facilitate the evaluation of gait function in post-traumatic patients in settings outside of the traditional gait laboratory.

Adult↗
PubMed2004

Gait analysis of sporadic and hereditary spastic paraplegia.

OBJECTIVES: Sporadic (SSP) and hereditary spastic paraplegias (HSP) are clinically and genetically heterogeneous disorders, which are characterised by a slowly progressive spastic paraparesis. Initial symptoms and the rate of progression are variable even among members of the same family. Spastic paraparesis is the major and most disabling clinical symptom and was assessed with gait analysis using a three-dimensional infrared movement analysis system. METHODS AND RESULTS: 22 patients with clinically and/or genetically confirmed SSP/HSP were compared with age-matched control subjects. Significantly lower values were found for gait velocity, stride length, step height and the range of motion of the knee-angle. The gait pattern is characterised by a severe spasticity of both legs with only mild paresis. The balance-related gait parameters show a broad-based gait without inwardly rotated feet. No correlation was found between disease duration and the severity of the gait disorder and the central motor conduction time to the leg muscles and the abnormal gait parameters. The gait pattern did not differ between the 7 SSP cases and the 15 HSP cases. CONCLUSIONS: We conclude that three-dimensional gait analysis can uncover specific features of such rare gait disorders, and may be used as an objective tool to quantify the impairment of gait parameters in patients with SSP/HSP and thus can be used to monitor disease progression and the effect of therapeutic interventions.

Adult↗
PubMed2005

Role of hypokinesia and bradykinesia in gait disturbances in Huntington's disease: a biomechanical study.

OBJECTIVE: To evaluate specific patterns of locomotion in Huntington's disease (HD) and notably the respective roles of hypokinesia (i. e. a decrease in the amplitude of movement) and bradykinesia (i. e. difficulty in executing a movement, slowness) in gait disturbance. METHODS: Kinematic, spatial (stride length, speed), temporal (cadence, speed, and stride time) and angular gait parameters (joint ankle range) were recorded in 15 early-stage HD patients by means of a video motion analysis system and then compared with 15 controls and 15 Parkinson's disease (PD) patients. Hypokinesia was studied in terms of both spatial (decrease in stride length) and angular gait parameters (decrease in joint ankle range), whereas hyperkinesia was characterized by an increase in joint ankle range. Bradykinesia (defined by a decrease in gait velocity) was also assessed in terms of temporal parameters (cadence, stride time). We studied the influence of clinical symptoms (motor dysfunction, chorea, overall disability and cognitive impairment) and the CAG repeat number on gait abnormalities. RESULTS: we observed a clear decrease in gait speed, a decrease in cadence and an increase in stride time (i. e. bradykinesia) for HD, with significant intra-individual variability. Cadence remained normal in PD. In HD, there was no evidence for a clear decrease in stride length, although the latter is a characteristic feature of hypokinetic gait (such as that observed in PD). Angle analysis revealed the coexistence of hyperkinesia and hypokinesia in HD, which thus participate in gait abnormalities. Gait speed in HD was correlated to the motor part of the UHDRS. CONCLUSION: Gait in HD is mainly characterized by a timing disorder: bradykinesia was present, with severe intra-individual variability in temporal gait parameters.

Adult↗
PubMed2006

Gait characteristics in nondisabled community-residing nonagenarians.

OBJECTIVE: To determine gait performance in community-residing nonagenarians. DESIGN: Nested case-control study. SETTING: Community. PARTICIPANTS: Thirty-one nondisabled nonagenarians (17 women) and 170 young-old controls (age range, 70-85y) participating in a longitudinal study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Systematic clinical and quantitative gait assessments. We also examined the association of gait velocity with death over a 1-year period. RESULTS: Nonagenarian men had better performance on all quantitative gait parameters examined compared with women. Male sex (beta=.58; 95% confidence interval [CI], 9.95-38.89) and depressive symptoms (beta=-.34; 95% CI, -6.73 to -0.04) were independently associated with gait velocity in multivariate linear regression models. The 6 hypertensive nonagenarians on angiotensin-converting enzyme (ACE) inhibitors had faster gait velocity (median, 103.1cm/s) compared with the 8 hypertensive nonagenarians not on ACE inhibitors (median, 77.5cm/s; P=.029). Nonagenarians had worse quantitative gait parameters compared with the young-old controls, although the differences were less marked when subjects with clinically normal gaits in both groups were compared. Gait velocity did not predict survival over 1-year follow-up. CONCLUSIONS: Gait characteristics in nondisabled community-residing nonagenarians are associated with male sex, depressive symptoms, and medications. The quantitative gait measures in this sample of nondisabled nonagenarians provide a yardstick to compare younger-age groups.

Aged↗