A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease

Abstract

Locomotion in people with Parkinson’ disease (pwPD) worsens with the progression of disease, affecting independence and quality of life. At present, clinical practice guidelines recommend a basic evaluation of gait, even though the variables (gait speed, cadence, step length) may not be satisfactory for assessing the evolution of locomotion over the course of the disease. Collecting variables into factors of a conceptual model enhances the clinical assessment of disease severity. Our aim is to evaluate if factors highlight gait differences between pwPD and healthy subjects (HS) and do it at earlier stages of disease compared to single variables. Gait characteristics of 298 pwPD and 84 HS able to walk without assistance were assessed using a baropodometric walkway (GAITRite®). According to the structure of a model previously validated in pwPD, eight spatiotemporal variables were grouped in three factors: pace/rhythm, variability and asymmetry. The model, created from the combination of three factor scores, proved to outperform the single variables or the factors in discriminating pwPD from HS. When considering the pwPD split into the different Hoehn and Yahr (H&Y) stages, the spatiotemporal variables, factor scores and the model showed that multiple impairments of gait appear at H&Y stage 2.5, with the greatest difference from HS at stage 4. A contrasting behavior was found for the asymmetry variables and factor, which showed differences from the HS already in the early stages of PD. Our findings support the use of factor scores and of the model with respect to the single variables in gait staging in PD.

Impact of Parkinson’s Disease on Functional Mobility at Different Stages

“…Accordingly, specific assessments to determine PD progression are essential (Marras et al, 2002). Gait analysis has been proved effective to establish PD progression according to recent studies (Godi et al, 2021;Varrecchia et al, 2021;Vila et al, 2021), which have identified several spatiotemporal and kinematic parameters capable of differentiating PD stages. However, functional ability includes other motor skills indicators of static balance, such as sitting down, getting up, or turning around, and the risk of falling in this population (Pelicioni et al, 2019;Muñoz-Bermejo et al, 2021).…”

Machine learning based estimation of dynamic balance and gait adaptability in persons with neurological diseases using inertial sensors

“…In addition, we included a set of clinical and wearable sensor-based features descriptive of gait spatio-temporal aspects (i.e. 6MWT score, duration of stride, step, single support and double support phases) and gait quality (i.e., movement intensity and smoothness, stride/step regularity and variability, gait symmetry, and local dynamic instability) 25 – 27 , which are known to be impaired in PwND 3 , 19 , 28 – 32 . Alterations in gait spatio-temporal parameters have been well-documented in MS 33 , PD 34 and ST 35 .…”

“…Furthermore, for the step and stride times, the respective coefficients of variation were added to the dataset, as measures of step and stride variability, which are usually higher in PwND compared to healthy subjects 75 . Then, a set of 18 metrics was computed, from all trunk acceleration components (antero-posterior, medio-lateral and vertical), to provide information about gait quality domains (i.e., intensity, regularity, symmetry, stability, and smoothness) proposed by previous literature 27 – 32 . Gait intensity was quantified through the root mean squared value of the acceleration 27 .…”

A non-expensive bidimensional assessment can detect subtle alterations in gait performance in people in the early stages of Parkinson’s disease

“…Analyzing gait kinematic variables related to the stages of PD evolution has lately been the object of investigation in several centers around the world, whether to identify different gait patterns between healthy people and people with the disease ( 56 ) or to identify more sensitive gait measures that discriminate stages of PD ( 57 ), or to analyze gait patterns about early (I-II) and intermediate (III-IV) stages, according to the Hoehn and Yahr scale (HY) ( 58 ). Through advanced technological resources such as sensors attached to the body and three-dimensional gait analysis platforms, these studies could distinguish specific critical points of assessment at each stage of PD, such as asymmetry for stage I, gait velocity for stage II and gait times, balance and stride for stage III ( 57 ), reinforcing that the association of spatiotemporal gait variables can better help the understanding of subtle changes between the stages of disease evolution ( 56 ). Postural instability interferes negatively in several gait parameters, as these variables worsen when balance deteriorates ( 58 ).…”