An emerging body of literature has examined cortical activity during walking and balance tasks in older adults and in people with Parkinson's disease, specifically using functional near infrared spectroscopy (fNIRS) or electroencephalography (EEG). This review provides an overview of this developing area, and examines the disease-specific mechanisms underlying walking or balance deficits. Medline, PubMed, PsychInfo and Scopus databases were searched. Articles that described cortical activity during walking and balance tasks in older adults and in those with PD were screened by the reviewers. Thirty-seven full-text articles were included for review, following an initial yield of 566 studies. This review summarizes study findings, where increased cortical activity appears to be required for older adults and further for participants with PD to perform walking and balance tasks, but specific activation patterns vary with the demands of the particular task. Studies attributed cortical activation to compensatory mechanisms for underlying age- or PD-related deficits in automatic movement control. However, a lack of standardization within the reviewed studies was evident from the wide range of study protocols, instruments, regions of interest, outcomes and interpretation of outcomes that were reported. Unstandardized data collection, processing and reporting limited the clinical relevance and interpretation of study findings. Future work to standardize approaches to the measurement of cortical activity during walking and balance tasks in older adults and people with PD with fNIRS and EEG systems is needed, which will allow direct comparison of results and ensure robust data collection/reporting. Based on the reviewed articles we provide clinical and future research recommendations.

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Objective: Gait provides a sensitive measurement for signs of aging and neurodegenerative conditions. Measurement of gait is transitioning from the laboratory environment to the clinic with the use of inertial measurement units, providing a simple and cost-effective assessment tool. However, such assessments first need validation against reference systems. The aim of this study was to validate the APDM Mobility Lab (ML) system (version 2) against a pressure sensor walkway in younger adults (n = 18), older adults (n = 18) and people with mild Parkinson's disease (n = 21) in the laboratory. Approach: Participants completed a two-minute walk over a pressure sensor walkway whilst wearing three sensors (strapped to the lumbar spine and both feet). Comparison of output from the systems was then performed. Main results: Overall, we identified that ML provided good to excellent agreement (ICC > 0.75) for gait velocity, stride length, stride length SD, cadence, stride time and stride time SD. Measures of double support time, single support time and swing time had moderate to poor agreement (ICC 0.213-0.725), particularly for younger adults and PD. Significance: Overall, Mobility Lab provides a valid system for gait data collection for clinical and research application.

Concussed individuals commonly exhibit locomotor deficits during dual-task gait that can last substantially longer than clinical signs and symptoms. Previous studies have examined traditional stability measures, but nonlinear stability may offer further information about the health of the motor control system post-concussion. For up to one year post-concussion, this study longitudinally examined the local dynamic stability of five concussed athletes and four matched healthy controls during single- and dual-task gait. Local dynamic stability (LDS) was estimated using short-term, finite-time maximum Lyapunov exponents calculated from tri-axial accelerometers placed on the trunk and head. No main effects of group or task were found for LDS or stride time variability, but significant group*task interactions were apparent for trunk stability and stride time variability. Concussed individuals exhibited decreased trunk LDS and increased stride time variability during dual-task walking compared to matched controls despite similar single-task stability and variability. These preliminary results reinforce previous reports that concussions persistently affect dual-task processes even when single-tasks may be unaffected. Furthermore, the decreased local dynamic stability during dual-task gait indicates the concussed group attenuated local disturbances less than their healthy teammates. The decreased dynamic stability during dual-task activities was present after the athletes were cleared for competition and may be a contributing factor in the higher rates of musculoskeletal injuries in athletes post-concussion.