Gait dynamics in Parkinson’s disease: Common and distinct behavior among stride length, gait variability, and fractal-like scaling

Abstract Background Gait impairment is a pivotal feature of parkinsonian syndromes and increased gait variability is associated with postural instability and a higher risk of falls. Objectives We compared gait variability at different walking velocities between and within groups of patients with Parkinson-variant multiple system atrophy, idiopathic Parkinson’s disease, and a control group of older adults. Methods Gait metrics were recorded in 11 multiple system atrophy, 12 Parkinson’s disease patients, and 18 controls using sensor-based gait analysis. Gait variability was analyzed for stride, swing and stance time, stride length and gait velocity. Values were compared between and within the groups at self-paced comfortable, fast and slow walking speed. Results Multiple system atrophy patients displayed higher gait variability except for stride time at all velocities compared with controls, while Parkinson’s patients did not. Compared with Parkinson’s disease, multiple system atrophy patients displayed higher variability of swing time, stride length and gait velocity at comfortable speed and at slow speed for swing and stance time, stride length and gait velocity (all P < 0.05). Stride time variability was significantly higher in slow compared to comfortable walking in patients with multiple system atrophy (P = 0.014). Variability parameters significantly correlated with the postural instability/gait difficulty subscore in both disease groups. Conversely, significant correlations between variability parameters and MDS-UPDRS III score was observed only for multiple system atrophy patients. Conclusion This analysis suggests that gait variability parameters reflect the major axial impairment and postural instability displayed by multiple system atrophy patients compared with Parkinson’s disease patients and controls.

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Self-paced treadmills do not allow for valid observation of linear and non-linear gait variability outcomes in patients with Parkinson’s disease

10.1101/2020.03.16.993899 ◽

2020 ◽

Author(s):

Maryam Rohafza ◽

Rahul Soangra ◽

Jo Armour Smith ◽

Niklas König Ignasiak

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Healthy Subjects ◽

Stride Length ◽

Correlation Coefficients ◽

Gait Variability ◽

Treadmill Walking ◽

The Self ◽

Constant Speed ◽

Belt Speed

AbstractBackgroundDue to the imposed constant belt speed, motorized treadmills are known to change linear and non-linear gait variability outcomes. This is particularly true of patients with Parkinson’s disease where the treadmill can act as an external pacemaker. Therefore, the use of treadmills is generally not recommended when quantifying gait variability. Self-paced treadmills allow for updating the belt speed relative to the walking speed of the subject and might, therefore, be a useful tool for the collection of long consecutive walking trials, necessary for gait variability observations.Research questionTo validate gait variability measures collected on a self-paced treadmill as compared to overground walking.MethodsThirteen healthy subjects and thirteen patients with Parkinson’s disease performed 5 – 8 minute long walking trials: overground, on a treadmill at a constant speed, as well as in three different self-paced treadmill modes. Stride times and stride lengths were recorded using a validated IMU-system and variability was quantified using the coefficient of variation, sample entropy, and detrended fluctuation analysis. Overground and treadmill trials were compared using Pearson’s correlation coefficient, method error, and Bland and Altman analysis.ResultsFor healthy subjects, the self-paced treadmill resulted in increased correlation coefficients of 0.57 – 0.74 as compared to a constant speed treadmill. Correlation coefficients for stride length variability between overground and treadmill walking were not significant. For patients, generally, large errors of 33-40% of stride time variability were observed between overground and treadmill walking. Stride length variability is most similar at a constant belt speed and shows errors of 14-39%.SignificanceDespite an improvement of temporal gait variability validity in the self-paced mode for healthy subjects, the large systematic and random errors between overground and self-paced treadmill walking prohibit meaningful gait variability observations in patients with Parkinson’s disease using self-paced treadmills.

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Do Upper and Lower Camptocormias Affect Gait and Postural Control in Patients with Parkinson’s Disease? An Observational Cross-Sectional Study

Parkinson s Disease ◽

10.1155/2019/9026890 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Christian Geroin ◽

Marialuisa Gandolfi ◽

Isacco Maddalena ◽

Nicola Smania ◽

Michele Tinazzi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Postural Control ◽

Gait Speed ◽

Stride Length ◽

Cross Sectional Study ◽

Gait Variability ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional

Gait impairments and camptocormia (CC) are common and debilitating in patients with Parkinson’s disease (PD). Two types of CC affect patients with PD, but no studies investigated their relative contribution in worsening gait and postural control. Therefore, we investigated spatiotemporal gait parameters, gait variability, and asymmetry and postural control in PD patients (Hoehn & Yahr ≤4) with upper CC and lower CC and patients without CC. This observational cross-sectional study involving patients with PD and upper CC (n=16) and lower CC (n=14) and without CC (n=16). The primary outcome measure was gait speed assessed by the GAITRite System. The secondary outcome measures were other spatiotemporal parameters, gait variability, and asymmetry. Postural control and balance were assessed with posturography and the Mini-BESTest. Patients with lower CC showed a higher H&Y stage (p=0.003), a worse PDQ8 (p=0.042), and a lower Mini-BESTest score (p=0.006) than patients with PD without CC. Patients with lower CC showed a reduced gait speed (p=0.012), stride length, and velocity than patients with PD without CC. Upper CC patients showed a higher stride length than lower CC ones (p=0.007). In the eyes open and closed condition, patients with lower CC showed a higher (worse) velocity of CoP displacement in mediolateral direction and length of CoP than patients with PD without CC. No significant between-group differences were measured in gait variability and asymmetry. In conclusion, lower CC was associated with more severe gait and postural control impairment than patients with upper CC and without CC. Categorizing CC based on the bending fulcrum is compulsory to identify patients with the worst performance and to implement specific rehabilitation programs.

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Faculty Opinions recommendation of Gait variability in Parkinson's disease: an indicator of non-dopaminergic contributors to gait dysfunction?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10438957.11270055 ◽

2011 ◽

Author(s):

Veronique VanderHorst ◽

Kathrin Czarnecki

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Gait Variability ◽

Gait Dysfunction

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Quantitative assessment of gait parameters in people with Parkinson's disease in laboratory and clinical setting: Are the measures interchangeable?

Neurology International ◽

10.4081/ni.2018.7729 ◽

2018 ◽

Vol 10 (2) ◽

Cited By ~ 4

Author(s):

Massimiliano Pau ◽

Federica Corona ◽

Roberta Pili ◽

Carlo Casula ◽

Marco Guicciardi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Clinical Setting ◽

Stride Length ◽

Experimental Setting ◽

Optoelectronic System ◽

Double Support ◽

Gait Parameters ◽

Spatio Temporal ◽

Wearable Accelerometers

This study aimed to investigate possible differences in spatio-temporal gait parameters of people with Parkinson’s Disease (pwPD) when they are tested either in laboratory using 3D Gait Analysis or in a clinical setting using wearable accelerometers. The main spatio-temporal gait parameters (speed, cadence, stride length, stance, swing and double support duration) of 31 pwPD were acquired: i) using a wearable accelerometer in a clinical setting while wearing shoes (ISS); ii) same as condition 1, but barefoot (ISB); iii) using an optoelectronic system (OES) undressed and barefoot. While no significant differences were found for cadence, stance, swing and double support duration, the experimental setting affected speed and stride length that decreased (by 17% and 12% respectively, P<0.005) when passing from the clinical (ISS) to the laboratory (OES) setting. These results suggest that gait assessment should be always performed in the same conditions to avoid errors, which may lead to inaccurate patient’s evaluations.

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