Gait disorders in the elderly and dual task gait analysis: a new approach for identifying motor phenotypes
Identifieur interne : 000033 ( Main/Exploration ); précédent : 000032; suivant : 000034Gait disorders in the elderly and dual task gait analysis: a new approach for identifying motor phenotypes
Auteurs : Bernard Auvinet [France] ; Claude Touzard [France] ; François Montestruc [France] ; Arnaud Delafond [France] ; Vincent Goeb [France]Source :
- Journal of NeuroEngineering and Rehabilitation [ 1743-0003 ] ; 2017.
Abstract
Gait disorders and gait analysis under single and dual-task conditions are topics of great interest, but very few studies have looked for the relevance of gait analysis under dual-task conditions in elderly people on the basis of a clinical approach.
An observational study including 103 patients (mean age 76.3 ± 7.2, women 56%) suffering from gait disorders or memory impairment was conducted. Gait analysis under dual-task conditions was carried out for all patients. Brain MRI was performed in the absence of contra-indications. Three main gait variables were measured: walking speed, stride frequency, and stride regularity. For each gait variable, the dual task cost was computed and a quartile analysis was obtained. Nonparametric tests were used for all the comparisons (Wilcoxon, Kruskal-Wallis, Fisher or Chi2 tests).
Four clinical subgroups were identified: gait instability (45%), recurrent falls (29%), memory impairment (18%), and cautious gait (8%). The biomechanical severity of these subgroups was ordered according to walking speed and stride regularity under both conditions, from least to most serious as follows: memory impairment, gait instability, recurrent falls, cautious gait (
Gait analysis under dual-task conditions in elderly people suffering from gait disorders or memory impairment is of great value in assessing the severity of gait disorders, differentiating between peripheral pathologies and central nervous system pathologies, and identifying motor phenotypes. Correlations between motor phenotypes and brain imaging require further studies.
The online version of this article (doi:10.1186/s12984-017-0218-1) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12984-017-0218-1
PubMed: 28143497
PubMed Central: 5282774
Affiliations:
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Claude" uniqKey="Touzard C" first="Claude" last="Touzard">Claude Touzard</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Geontology Unit, Centre Hospitalier de LAVAL, Rue du haut rocher, F 53000 Laval, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Geontology Unit, Centre Hospitalier de LAVAL, Rue du haut rocher, F 53000 Laval</wicri:regionArea><placeName><region type="region" nuts="2">Pays de la Loire</region><settlement type="city">Laval</settlement></placeName></affiliation></author><author><name sortKey="Montestruc, Francois" sort="Montestruc, Francois" uniqKey="Montestruc F" first="François" last="Montestruc">François Montestruc</name><affiliation wicri:level="3"><nlm:aff id="Aff3">eXYSTAT SAS, 34 rue Victor Hugo, F 92240 Malakoff, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>eXYSTAT SAS, 34 rue Victor Hugo, F 92240 Malakoff</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Malakoff</settlement></placeName></affiliation></author><author><name sortKey="Delafond, Arnaud" sort="Delafond, Arnaud" uniqKey="Delafond A" first="Arnaud" last="Delafond">Arnaud Delafond</name><affiliation wicri:level="3"><nlm:aff id="Aff4">Radiology Unit, Polyclinique du Maine, 4 Avenue des Français Libres, F 53000 Laval, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Radiology Unit, Polyclinique du Maine, 4 Avenue des Français Libres, F 53000 Laval</wicri:regionArea><placeName><region type="region" nuts="2">Pays de la Loire</region><settlement type="city">Laval</settlement></placeName></affiliation></author><author><name sortKey="Goeb, Vincent" sort="Goeb, Vincent" uniqKey="Goeb V" first="Vincent" last="Goeb">Vincent Goeb</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0593 702X</institution-id><institution-id institution-id-type="GRID">grid.134996.0</institution-id><institution>Rheumatology Department,</institution><institution>University Hospital,</institution></institution-wrap>F 80054 Amiens, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>F 80054 Amiens</wicri:regionArea></affiliation></author></analytic><series><title level="j">Journal of NeuroEngineering and Rehabilitation</title><idno type="eISSN">1743-0003</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Gait disorders and gait analysis under single and dual-task conditions are topics of great interest, but very few studies have looked for the relevance of gait analysis under dual-task conditions in elderly people on the basis of a clinical approach.</p></sec><sec><title>Methods</title><p>An observational study including 103 patients (mean age 76.3 ± 7.2, women 56%) suffering from gait disorders or memory impairment was conducted. Gait analysis under dual-task conditions was carried out for all patients. Brain MRI was performed in the absence of contra-indications. Three main gait variables were measured: walking speed, stride frequency, and stride regularity. For each gait variable, the dual task cost was computed and a quartile analysis was obtained. Nonparametric tests were used for all the comparisons (Wilcoxon, Kruskal-Wallis, Fisher or Chi<sup>2</sup> tests).</p></sec><sec><title>Results</title><p>Four clinical subgroups were identified: gait instability (45%), recurrent falls (29%), memory impairment (18%), and cautious gait (8%). The biomechanical severity of these subgroups was ordered according to walking speed and stride regularity under both conditions, from least to most serious as follows: memory impairment, gait instability, recurrent falls, cautious gait (<italic>p</italic> < 0.01 for walking speed, <italic>p</italic> = 0.05 for stride regularity). According to the established diagnoses of gait disorders, 5 main pathological subgroups were identified (musculoskeletal diseases (<italic>n</italic> = 11), vestibular diseases (<italic>n</italic> = 6), mild cognitive impairment (<italic>n</italic> = 24), central nervous system pathologies, (<italic>n</italic> = 51), and without diagnosis (<italic>n</italic> = 8)). The dual task cost for walking speed, stride frequency and stride regularity were different among these subgroups (<italic>p</italic> < 0.01). The subgroups mild cognitive impairment and central nervous system pathologies both showed together a higher dual task cost for each variable compared to the other subgroups combined (<italic>p</italic> = 0.01). The quartile analysis of dual task cost for stride frequency and stride regularity allowed the identification of 3 motor phenotypes (<italic>p</italic> < 0.01), without any difference for white matter hyperintensities, but with an increased Scheltens score from the first to the third motor phenotype (<italic>p</italic> = 0.05).</p></sec><sec><title>Conclusions</title><p>Gait analysis under dual-task conditions in elderly people suffering from gait disorders or memory impairment is of great value in assessing the severity of gait disorders, differentiating between peripheral pathologies and central nervous system pathologies, and identifying motor phenotypes. Correlations between motor phenotypes and brain imaging require further studies.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12984-017-0218-1) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Montero Odasso, M" uniqKey="Montero Odasso M">M Montero-Odasso</name></author><author><name sortKey="Verghese, J" uniqKey="Verghese J">J Verghese</name></author><author><name sortKey="Beauchet, O" uniqKey="Beauchet O">O Beauchet</name></author><author><name sortKey="Hausdorff, Jm" uniqKey="Hausdorff J">JM Hausdorff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Verghese, J" uniqKey="Verghese J">J Verghese</name></author><author><name sortKey="Le Valley, A" uniqKey="Le Valley A">A Le Valley</name></author><author><name sortKey="Hall, Cb" uniqKey="Hall C">CB 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Drew</name></author><author><name sortKey="Prentice, S" uniqKey="Prentice S">S Prentice</name></author><author><name sortKey="Schepens, B" uniqKey="Schepens B">B Schepens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wright, Sl" uniqKey="Wright S">SL Wright</name></author><author><name sortKey="Kay, Re" uniqKey="Kay R">RE Kay</name></author><author><name sortKey="Avery, Et" uniqKey="Avery E">ET Avery</name></author><author><name sortKey="Giordani, B" uniqKey="Giordani B">B Giordani</name></author><author><name sortKey="Alexander, Nb" uniqKey="Alexander N">NB Alexander</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kelly, Ve" uniqKey="Kelly V">VE Kelly</name></author><author><name sortKey="Janke, Aa" uniqKey="Janke A">AA Janke</name></author><author><name sortKey="Shumway Cook, A" uniqKey="Shumway Cook A">A Shumway-Cook</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kelly, Ve" uniqKey="Kelly V">VE Kelly</name></author><author><name sortKey="Eusterbrock, Aj" uniqKey="Eusterbrock A">AJ Eusterbrock</name></author><author><name sortKey="Shumway Cook, A" uniqKey="Shumway Cook A">A Shumway-Cook</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>France</li></country><region><li>Pays de la Loire</li><li>Île-de-France</li></region><settlement><li>Laval</li><li>Malakoff</li></settlement></list><tree><country name="France"><region name="Pays de la Loire"><name sortKey="Auvinet, Bernard" sort="Auvinet, Bernard" uniqKey="Auvinet B" first="Bernard" last="Auvinet">Bernard Auvinet</name></region><name sortKey="Delafond, Arnaud" sort="Delafond, Arnaud" uniqKey="Delafond A" first="Arnaud" last="Delafond">Arnaud Delafond</name><name sortKey="Goeb, Vincent" sort="Goeb, Vincent" uniqKey="Goeb V" first="Vincent" last="Goeb">Vincent Goeb</name><name sortKey="Montestruc, Francois" sort="Montestruc, Francois" uniqKey="Montestruc F" first="François" last="Montestruc">François Montestruc</name><name sortKey="Touzard, Claude" sort="Touzard, Claude" uniqKey="Touzard C" first="Claude" last="Touzard">Claude Touzard</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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