The gait disorder in primary orthostatic tremor

Abstract Objective To uncover possible impairments of walking and dynamic postural stability in patients with primary orthostatic tremor (OT). Methods Spatiotemporal gait characteristics were quantified in 18 patients with primary OT (mean age 70.5 ± 5.9 years, 10 females) and 18 age-matched healthy controls. One-third of patients reported disease-related fall events. Walking performance was assessed on a pressure-sensitive carpet under seven conditions: walking at preferred, slow, and maximal speed, with head reclination or eyes closed, and while performing a cognitive or motor dual-task paradigm. Results Patients exhibited a significant gait impairment characterized by a broadened base of support (p = 0.018) with increased spatiotemporal gait variability (p = 0.010). Walking speed was moderately reduced (p = 0.026) with shortened stride length (p = 0.001) and increased periods of double support (p = 0.001). Gait dysfunction became more pronounced during slow walking (p < 0.001); this was not present during fast walking. Walking with eyes closed aggravated gait disability as did walking during cognitive dual task (p < 0.001). Conclusion OT is associated with a specific gait disorder with a staggering wide-based walking pattern indicative of a sensory and/or a cerebellar ataxic gait. The aggravation of gait instability during visual withdrawal and the normalization of walking with faster speeds further suggest a proprioceptive or vestibulo-cerebellar deficit as the primary source of gait disturbance in OT. In addition, the gait decline during cognitive dual task may imply cognitive processing deficits. In the end, OT is presumably a complex network disorder resulting in a specific spino-cerebello-frontocortical gait disorder that goes beyond mere tremor networks.

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Evaluation of Standing Balance Performance in Indian Classical Dancers

Journal of Dance Medicine & Science ◽

10.12678/1089-313x.24.1.19 ◽

2020 ◽

Vol 24 (1) ◽

pp. 19-23

Author(s):

Juhi K. Bharnuke ◽

Rajani P. Mullerpatan ◽

Claire Hiller

Keyword(s):

Dual Task ◽

Center Of Pressure ◽

Standing Balance ◽

Balance Performance ◽

Classical Dance ◽

Eyes Closed ◽

Eyes Open ◽

Second Dual ◽

Indian Classical Dance ◽

Base Of Support

Indian classical dance involves a constant change of the base of support from stance to low jumps and spins along with intricate footwork. Graceful movement of the torso, shifting from side to side and turning around the axis of the spine, challenges balance. Yet, balance performance remains unexplored in Indian classical dancers. Therefore, the present study aimed to compare the standing balance of 36 active female dancers (18 to 25 years of age) who had performed Indian classical dance for a minimum of 10 years with 36 healthy age-matched women not involved in regular physical activity. Balance was evaluated in static and dynamic conditions of single and dual-limb stance on a force plate using center-of-pressure trajectory and the Star Excursion Balance Test (SEBT). Dancers demonstrated better balance on both instrumented and non-instrumented outcome variables: wide base of support with eyes open and with eyes closed; for 30-second single limb stance with eyes open and with eyes closed; for 13-second dual task in single limb stance; and for 22-second dual task in wide base of support. The SEBT revealed significantly better balance performance of dancers in the three directions tested: anterior, posteromedial, and posterolateral. There was also a strength component of the study on which the dancers achieved significantly higher scores than controls for the three muscle groups tested (gastrocsoleus, gluteus medius, and quadriceps), which can be attributed to their training. These findings can be used to recommend classical dance training to achieve the dual purpose of deriving better balance and stronger bodies and maintaining the Indian dance heritage.

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Frontal vs. Posterior cognitive dysfunction: Does greater risk of dementia lead to a differential gait in Parkinson’s disease?

Brazilian Journal of Motor Behavior ◽

10.20338/bjmb.v13i1.124 ◽

2019 ◽

Vol 13 (1) ◽

pp. 1-10

Author(s):

Carolina R. A. Silveira ◽

Eric A. Roy ◽

Quincy J. Almeida

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Deficits ◽

Dual Task ◽

Brain Areas ◽

Dual Task Condition ◽

Double Support ◽

Task Conditions ◽

Base Of Support ◽

Normal Cognition

Background: Gait impairment is suggested to predict the onset of dementia in Parkinson’s disease (PD). Interestingly, studies have shown that PD patients with cognitive deficits mediated by posterior brain areas are at greater risk of developing dementia than those with frontal deficits. Yet, it remains unknown whether PD patients with posterior cognitive deficits show differences in gait when compared to those with frontal deficits. Aim: This study aimed to compare gait of individuals with PD showing “posterior”, “frontal”, or no cognitive impairment (NCI). Methods: Based on a sample of 64 individuals with PD, median scores were calculated for three neuropsychological tests relying on “frontal” and three relying on “posterior” brain areas. Individuals assigned into the Frontal or Posterior groups showed at least 2 out of 3 scores lower than the median in frontal or posterior tests, respectively. Those with 0 or 1 score lower than the median were classified as NCI. Participants walked under single and dual task conditions. Results: All groups walked slower, with greater variability, wider base of support, and longer double support in the dual task condition. Interpretation: PD patients with posterior cognitive deficits walk similarly to those with frontal deficits and those with normal cognition.

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Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽

10.1159/000515939 ◽

2021 ◽

pp. 1-10

Author(s):

He Zhou ◽

Catherine Park ◽

Mohammad Shahbazi ◽

Michele K. York ◽

Mark E. Kunik ◽

...

Keyword(s):

Older Adults ◽

Steady State ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Cognitive Frailty ◽

Single Task ◽

Double Support ◽

Gait Parameters ◽

Digital Biomarkers

Background: Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Methods: Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Results: Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d = 0.42–0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. Conclusions: This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

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Concussion History and Balance Performance in Adolescent Rugby Union Players

The American Journal of Sports Medicine ◽

10.1177/0363546521998709 ◽

2021 ◽

pp. 036354652199870

Author(s):

Mark Matthews ◽

William Johnston ◽

Chris M. Bleakley ◽

Richard J. Davies ◽

Alan T. Rankin ◽

...

Keyword(s):

Dual Task ◽

Inertial Sensor ◽

Dynamic Balance ◽

Rugby Union ◽

Static Balance ◽

Balance Performance ◽

Eyes Closed ◽

History Of ◽

Concussion History ◽

Rugby Players

Background: Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players. Hypothesis: Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes ( x, y, and z). Results: Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; P = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; P = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- ( P = .47) and dual-task ( P = .67) conditions. Conclusion: Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.

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Effect of Temporal Arrangement on Multimedia Learning

Inquiry@Queen's Undergraduate Research Conference Proceedings ◽

10.24908/iqurcp.8565 ◽

2018 ◽

Author(s):

Victoria Chen

Keyword(s):

Prior Knowledge ◽

Cognitive Processing ◽

Teaching And Learning ◽

Multimedia Learning ◽

Primary Source ◽

Sources Of Information ◽

Multimedia Teaching ◽

Text Information ◽

Source Of Information

The purpose of this study is to examine whether Multimedia learning theory (Mayer, 1997; Schnotz & Kürschner, 2007) holds true when images are the primary source of information and text information is secondary. I will test how temporal arrangement of audio and image presentations affects quality of learning in this situation. I hypothesize that when audio is played before or after the image participants will require increased cognitive processing to mentally integrate the two sources of information resulting in deeper learning and transfer of learning. On the other hand when audio is played while the image is shown, I hypothesize that participants with high prior knowledge of the subject will score lower than participants with low prior knowledge, because prior knowledge will interfere with knowledge from the two sources causing a redundancy effect. This experiment will lead to greater understanding of multimedia teaching and learning in classrooms as well as how it affects deeper learning.

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Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Multiple Sclerosis International ◽

10.1155/2020/6707414 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Erin M. Edwards ◽

Deborah A. Kegelmeyer ◽

Anne D. Kloos ◽

Manon Nitta ◽

Danya Raza ◽

...

Keyword(s):

Cognitive Function ◽

Dual Task ◽

Mixed Model ◽

Walking Ability ◽

Healthy Controls ◽

Backward Walking ◽

Double Support ◽

Task Conditions ◽

Future Work ◽

Age And Sex

Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2×2×2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p=0.015) and dual-task (p=0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p=0.023; p=0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p=0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p<0.001) and forward (p=0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r=−0.490; p=0.046) and slower velocity (r=−0.483; p=0.050). Conclusion. Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.

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Dual-task and electrophysiological markers of executive cognitive processing in older adult gait and fall-risk

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2015.00200 ◽

2015 ◽

Vol 9 ◽

Cited By ~ 20

Author(s):

Elizabeth A. Walshe ◽

Matthew R. Patterson ◽

SeÃ¡n Commins ◽

Richard A. P. Roche

Keyword(s):

Older Adult ◽

Cognitive Processing ◽

Dual Task ◽

Fall Risk

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Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter?

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0331 ◽

2020 ◽

pp. 1-12

Author(s):

Emily L. Messerschmidt ◽

Eric E. Hall ◽

Caroline J. Ketcham ◽

Kirtida Patel ◽

Srikant Vallabhajosula

Keyword(s):

Dual Task ◽

Gait Speed ◽

College Athletes ◽

Step Length ◽

Swing Phase ◽

Testing Time ◽

Contact Sports ◽

Double Support ◽

Concussion History ◽

Support Phase

Context: Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. Objective: To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. Design: Exploratory cross-sectional study. Setting: Laboratory. Participants: In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. Interventions: Not applicable. Main Outcome Measures: Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). Results: Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, −0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). Conclusions: Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete’s gait upon analysis.

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Angelman Syndrome

10.1093/med/9780199937837.003.0055 ◽

2017 ◽

Author(s):

Kristin W. Barañano

Keyword(s):

Angelman Syndrome ◽

Expressive Language ◽

Neurodevelopmental Disorder ◽

Synaptic Function ◽

Gait Disorder ◽

Ataxic Gait ◽

Synaptic Circuits ◽

Ubiquitin E3 Ligase ◽

Time Treatment

Angelman syndrome (AS) is a severe neurodevelopmental disorder caused by maternal deficiency of the epigenetically imprinted gene UBE3A. It is characterized by severe developmental delay, an ataxic gait disorder, an apparent happy demeanor with frequent smiling or laughing, and severe expressive language impairments. Understanding the neurobiology of AS has focused on understanding how UBE3A is regulated by neuronal activity, as well as the targets of its ubiquitin E3 ligase activity. This has led to a model of the role of UBE3A in the regulation of experience-dependent sculpting of synaptic circuits. At this time, treatment is largely supportive, but efforts directed toward reversing the epigenetic silencing machinery may lead to improved synaptic function in AS patients.

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Age-related gait standards for healthy children and young people: the GOS-ICH paediatric gait centiles

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-316311 ◽

2019 ◽

Vol 104 (8) ◽

pp. 755-760 ◽

Cited By ~ 3

Author(s):

Lucy M. Alderson ◽

Sandra X Joksaite ◽

Jennifer Kemp ◽

Eleanor Main ◽

Tim Watson ◽

...

Keyword(s):

Young People ◽

Step Length ◽

Additive Models ◽

Healthy Children ◽

Children And Young People ◽

Double Support ◽

Age Related ◽

History Of ◽

Characteristic Features ◽

Base Of Support

ObjectiveTo develop paediatric gait standards in healthy children and young people.MethodsThis observational study aims to address the lack of population standards for gait measurements in children. Analysing gait in children affected by neurological or musculoskeletal conditions is an important component of paediatric assessment but is often confounded by developmental changes. The standards presented here do not require clinician expertise to interpret and offer an alternative to developmental tables of normalised gait data. Healthy children aged 1–19 years were recruited from community settings in London and Hertfordshire, UK. The GAITRite walkway was used to record measurements for each child for velocity, cadence, step length, base of support and stance, single and double support (as percentage of gait cycle). We fitted generalised linear additive models for location, scale and shape (gamlss).ResultsWe constructed percentile charts for seven gait variables measured on 624 (321 males) contemporary healthy children using a gamlss package in R. A clinical application of gait standards was explored.ConclusionAge-related, gender-specific standards for seven gait variables were developed and are presented here. They have a familiar format and can be used clinically to aid diagnoses and to monitor change over time for both medical therapy and natural history of the condition. The clinical example demonstrates the potential of the Great Ormond Street Institute of Child Health Paediatric Gait Centiles to enable meaningful interpretation of change in an individual’s performance and describes characteristic features of gait from a specific population throughout childhood.

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