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Gait instability associated with ageing

Discussion in 'Gerontology' started by Hylton Menz, Jan 30, 2005.

  1. Hylton Menz

    Hylton Menz Guest


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    Two interesting papers from the latest Gait & Posture which assess gait stability in older people:

    Moe-Nilssen R, Helbostad J. Interstride trunk acceleration variability but not step width variability can differentiate between fit and frail older adults. Gait & Posture 2005;21:164-170.

    Variability of gait may be regarded as a sign of adaptability and thus a requirement for successful locomotion, or as a sign of impaired balance control. In this study we examined the role of step width variability (SWV) and interstride trunk acceleration variability in two groups of fit and frail old people. We investigated the association of these measures and how they differentiated the two groups. We examined 33 fit older adults (mean age 73 years, S.D. 3.3 years) and 32 frail old people (mean age 80 years, S.D. 4.0 years). Subjects performed timed walking at different speeds ranging from very slow to very fast. SWV was measured from footprints. Trunk accelerations were registered by a triaxial accelerometer and interstride trunk acceleration variability assessed by an unbiased autocorrelation procedure. All measures were normalized to a walking speed of 0.9 m/s to avoid the confounding effect of gait speed on speed dependent gait parameters. SWV demonstrated low association with the trunk variability measures, and did not differ between groups. The frail group had lower mediolateral (P=0.015), but higher vertical (P=0.015) and anteroposterior (P<0.02) trunk variability than the fit group. Trunk variability classified 80% of the subjects correctly into their respective group (sensitivity=0.75, specificity=0.85). The findings are compatible with a notion that mediolateral interstride trunk variability represents a different aspect of motor control than variability in the direction of propulsion.​

    Hermana T, Giladia N, Gurevicha T, Hausdorff JM. Gait instability and fractal dynamics of older adults with a "cautious" gait: why do certain older adults walk fearfully? Gait & Posture 2005;21:178-185.

    Many older adults walk with a cautious and impaired gait of unknown origin, however, the relationship between fear of falling and the observed gait changes is not well understood. To better understand the "cautious" gait of the elderly, we tested the hypothesis that temporal gait variability, putatively a marker of intrinsic walking unsteadiness, is increased among older adults with a cautious gait and a higher-level gait disorder (HLGD), an altered gait that cannot be attributed to a well-defined cause. Twenty-five older adults (mean age: 78 years) with a HLGD were compared to healthy controls of similar age and sex (n=28). The clinical characteristics (e.g., neurological status, fear of falling), the magnitude of the stride-to-stride variations in gait cycle timing (a measure of temporal gait variability), and a fractal index of gait (a measure of the stride dynamics independent of the magnitude of the variability) were studied in both groups. Gait variability was significantly increased (P<0.0001) in HLGD subjects (52±26 ms) compared to controls (27±9 ms). Changes in frontal lobe and extra-pyramidal function were also found in the patient group. Among HLGD subjects, gait variability was not associated (P>0.05) with age, gender, MMSE score, muscle strength, # of co-morbidities, balance, cerebellar signs, or pyramidal signs, but was significantly associated with scores on the Geriatric Depression Scale (r=0.46, P<0.02) and fear of falling (r=0.69, P<0.0001). Among HLGD subjects, only a fractal index was significantly different in fallers and non-fallers. These findings underscore the idea that the gait changes in older adults who walk with fear may be an appropriate response to unsteadiness, are likely a marker of underlying pathology, and are not simply a physiological or psychological consequence of normal aging. ​
     
  2. Hylton Menz

    Hylton Menz Guest

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    Articles:
    1
    Age-related changes of human balance during quiet stance.
    Abrahámov D, Hlavačka F.
    Physiol Res. 2007 Nov 30 [Epub ahead of print]
     
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    Articles:
    1
    VALIDITY OF THE GAIT VARIABILITY INDEX IN OLDER ADULTS: EFFECT OF AGING AND MOBILITY IMPAIRMENTS
    Chitralakshmi K. Balasubramania, David J. Clark, Arnaud Gouelle
    Gait and Posture; Article in Press
     
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    Articles:
    1
    Relationships Between Simple Toe Elevation Angle in the Standing Position and Dynamic Balance and Fall Risk among Community-dwelling Older Adults
    Katsuhiko Takatori, PhD, RPT, Daisuke Matsumoto, MS, RPT
    PM & R: Article in Press
     
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    Articles:
    1
    Age-Related Differences in Gait Kinematics, Kinetics, and Muscle Function: A Principal Component Analysis.
    Schloemer SA et al
    Ann Biomed Eng. 2017 Mar;45(3):695-710. doi: 10.1007/s10439-016-1713-4.
     
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