Gait instability associated with ageing

Hylton Menz · Jan 30, 2005

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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.

Hylton Menz · May 19, 2006

More on gait changes with ageing....

A structural equation model relating impaired sensorimotor function, fear of falling and gait patterns in older people

Minimum foot clearance during walking: Strategies for the minimisation of trip-related falls

The circumvention of obstacles during walking in different environmental contexts: A comparison between older and younger adults

NewsBot · Dec 7, 2007

Age-related changes of human balance during quiet stance.
Abrahámov D, Hlavačka F.
Physiol Res. 2007 Nov 30 [Epub ahead of print]

Certain aspects of balance control change with age, resulting in a slight postural instability. We examined healthy subjects between 20-82 years of age during the quiet stance under static conditions: at stance on a firm surface and/or on a compliant surface, with eyes either open or closed. Body sway was evaluated from centre of foot pressure (CoP) positions during a 50 sec interval. The seven CoP parameters were evaluated to assess quiet stance and were analyzed in three age groups: juniors, middle-aged and seniors. The regression analysis showed evident increase of body sway over 60 years of age. We found that CoP parameters were significantly different when comparing juniors and seniors in all static conditions. The most sensitive view on postural steadiness during quiet stance was provided by CoP amplitude and velocity in AP direction and root mean square (RMS) of statokinesigram. New physiological ranges of RMS parameter in each condition for each age group of healthy subjects were determined. Our results showed that CoP data from force platform in quiet stance may indicate small balance impairment due to age. The determined physiological ranges of RMS will be useful for better distinguishing between small postural instability due to aging in contrast to pathological processes in the human postural control.
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NewsBot · Apr 7, 2015

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

Highlights
•The Gait Variability Index is lower in older adults relative to younger adults.
•The Gait Variability Index is lower in older adults with mobility deficits relative to high functioning older adults.
•The Gait Variability Index is valid for assessing age-related decline of mobility function.
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Gait variability, defined as the fluctuation in spatiotemporal characteristics between steps, is suggested to be a sensitive indicator of mobility deficits with aging and pathological processes. A challenge in quantifying gait variability is the decision of which spatiotemporal parameters to assess because gait parameters may exhibit different amounts of variability and may differentially relate to mobility performance. The Gait Variability Index (GVI), a composite measure of variability across several gait parameters, was previously developed to overcome this challenge. The present study seeks to validate the use of GVI in the older adult population. A retrospective analysis of gait and clinical data was conducted using data pooled from five prior studies. The final data set included 105 younger adults (YA, age < 65) and 81 older adults (OA, age ≥ 65). The GVI of OA (91.92 ± 8.75) was significantly lower compared to the GVI of YA (100.79 ± 7.99). Within OA, the GVI was significantly lower (p < 0.0001) in individuals with mobility deficits (84.35 ± 9.03) compared to those with high mobility function (96.35 ± 8.86). Furthermore, GVI was associated with mobility function, including walking speed and performance on the Berg Balance Scale. Our findings imply that the GVI is a valid assessment for gauging spatiotemporal gait variability in older adults, is sensitive to differentiate between high-functioning older adults and those with mild to moderate mobility deficits and is associated with some clinical measures of functional mobility and balance.
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NewsBot · Apr 15, 2015

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

Objective
To investigate the relationships between toe elevation ability in the standing position and dynamic balance and fall risk among community-dwelling older adults.

Design
Cross-sectional survey.

Setting
General community.

Participants
Community-dwelling older adults (N=287).

Interventions
Not applicable.

Main Outcome Measure
Toe elevation angles in the standing position.

Results
Intra-rater and inter-rater reliability of measurements of the toe elevation angle was high (internal coefficient of correlation (ICC (1,2)=0.94 for the former and ICC (2,1)=0.90 for the latter). Significant correlations were found between the toe elevation angle and age (r=-0.20, P<.01), 5 m walking time (r=-0.31, P<.01), Functional Reach Test (r=0.36, P<.01), Timed Up and Go Test (r=-0.36, P<.01), and chair stand test (r=0.26, P<0.01). Subjects who experienced a fall in the previous 6 months had a significantly lower toe elevation angle than those who did not (t=2.19, P<.05 ). Multiple regression analysis revealed that results of the Functional Reach Test (β=.22, P<.001) and Timed Up and Go Test (β=-0.74, P<.001) were significantly associated with the toe elevation angle.

Conclusions
Toe elevation angle was an index of dynamic balance ability and appears to be a simple screening test for fall risk in community-dwelling older adults.
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NewsBot · Sep 9, 2017

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.

Age-related increased hip extensor recruitment during gait is a proposed compensation strategy for reduced ankle power generation and may indicate a distal-to-proximal shift in muscle function with age. Extending beyond joint level analyses, identifying age-related changes at the muscle level could capture more closely the underlying mechanisms responsible for movement. The purpose of this study was to characterize and compare muscle forces and induced accelerations during gait in healthy older adults with those of young adults. Simulations of one gait cycle for ten older (73.9 ± 5.3 years) and six young (21.0 ± 2.1 years) adults walking at their self-selected speed were analyzed. Muscle force and induced acceleration waveforms, along with kinematic, kinetic, and muscle activation waveforms, were compared between age-groups using principal component analysis. Simulations of healthy older adults had greater gluteus maximus force and vertical support contribution, but smaller iliacus force, psoas force, and psoas vertical support contribution. There were no age-group differences in distal muscle force, contribution, or ankle torque magnitudes. Later peak dorsiflexion and peak ankle angular velocity in older adults may have contributed to their greater ankle power absorption during stance. These findings reveal the complex interplay between age-related changes in neuromuscular control, kinematics, and muscle function during gait.
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