Assessment of gait in subcortical vascular encephalopathy by computerized analysis: a cross-sectional and longitudinal study

Abstract

In subcortical vascular encephalopathy (SVE) gait disturbance is a common and early clinical sign which might be used to monitor disease progression. In the absence of reliable scales and with regard to the equivocal results of highly complex gait imaging devices we assessed the natural course of SVE in a prospective study, using a new straight forward technique to quantify and compare sequential gait studies. We report the results of 300 computerized gait analyses in 119 patients with SVE and 63 age-matched controls. Thirty-nine SVE patients were re-evaluated to monitor the natural course of the disease and to study the correlation of gait disturbances with MRI changes and neuropsychological findings. The system consists of a set of shoes containing 16 load sensors and a measuring-unit reading each sensor at 20-ms intervals. By off-line analysis we graded each recording on a Gait Disorder Score (GDS) with six variables indicating gait steadiness: step frequency, length of gait lines (which represent the movement of the centre of gravity during heel to toe movement), length of single support lines, variability of single and of double support lines, and double support time. In cross-sectional analysis, patients with SVE showed cadence (steps/min) to be reduced at 87.3 +/- 19.5 (96.4 +/- 7.8 in controls, P < 0.05). Length of gait lines was significantly less: 0.70 +/- 0.13 vs. 0.80 +/- 0.05 in controls, with length of single support gait lines reduced at 0.42 +/- 0.14 in SVE (0.58 +/- 0.06 in controls, P < 0.05). Variability of both single support lines (5.69 +/- 1.90%; 4.24 +/- 1.07% in controls, P < 0.05) and double support lines was elevated (3.59 +/- 1.62% vs. 2.54 +/- 0.59%), while duration of double support phases was increased (0.19 +/- 0.10 s vs. 0.13 +/- 0.02 s in controls, P < 0.05). The progressive character of the disease was demonstrated by increasing GDS values in 39 SVE patients with a frontal gait disorder who were re-investigated after a mean interval of 26 months (5.4 +/- 4.5 vs. 8.4 +/- 5.5, P < 0.05). This study shows the value of a new and practicable gait analysis system for the evaluation of gait disorders and it quantifies the deterioration of gait in SVE patients.

Impact of White Matter Lesions on Physical Functioning and Fall Risk in Older People

“…8,19,23,32,35 Two studies also reported a threshold effect of WMLs on mobility 7,31 with larger volumes of WMLs at baseline found to predict greater declines in mobility over time in longitudinal studies. 27,28,30,38 Finally, it has been reported that a significant increase in WML volumes occurs more frequently in mobility impaired people compared with people without such impairment. 37…”

“…Even so, the associations between WMLs and impaired physical performance reported in several studies remained significant after controlling for vascular risk factors such as heart disease, hypertension, diabetes, homocysteine levels, and physical activity. 17,20,21,23,27 This suggests that vascular risk factors explain only a small component of the variance in the relationship between WMLs and physical performance.…”

“…Nine cross-sectional 10,12,19,20,23,[32][33][34][35][36] and 5 longitudinal studies 27,28,30,37,38 have assessed the relationship between WMLs and mobility (Supplemental Table VI and Results). All studies found an association between mobility impairment and overall increased WML volumes as well as increased regional WML volumes in periventricular, frontal, parietaloccipital, and frontal periventricular areas.…”

Fluctuation and synchronization of gait intervals and gait force profiles distinguish stages of Parkinson's disease

“…The subjects wore force-sensitive insoles [14] that recorded with a sampling frequency of 100 Hz the normal force exerted by the floor while stepping during a period of 2 min of comfortable walking. Subjects walked along a 25 m long corridor, turned when they reached an end, and continued walking.…”

Diffusion Tensor Imaging and Gait in Elderly Persons With Cerebral Small Vessel Disease

“…3 Although we demonstrated that the different severity of WML and lacunar infarcts could partially account for this discrepancy, 1 even subjects with a similar degree of WML may have a different degree of gait impairment. 4 Because identical-appearing WML on conventional MRI are actually histopathologically heterogeneous, 5 it could be that only WML with the highest loss of microstructural integrity are related to gait disturbances. Moreover, MRI is not sensitive to early loss of microstructural integrity of the normal-appearing white matter (NAWM).…”