Increased gait variability is associated with the history of falls in patients with cerebellar ataxia

Abstract

Falls are common in patients with cerebellar ataxia (CA). Identification of gait variables associated with a higher risk of falls allows us to detect fallers and initiate protective procedures early. Gait variability, which is increased in CA patients, is a good predictor of falls in elderly subjects and patients with neurodegenerative diseases. The relationship between gait variability and fall risk in patients with different cerebellar disorders was systematically investigated. A total of 48 patients with different cerebellar ataxia entities [adult-onset cerebellar atrophy (SAOA) (n = 23), unknown entity (n = 7), vascular (n = 5), post-cerebellitis (n = 6), congenital (n = 2), Louis-Bar syndrome (n = 2), ethyltoxic (n = 2) posttraumatic (n = 1)] were examined using a GAITRite® sensor mat. Spatial and temporal variability parameters were used for ANOVA testing and logistic regression models with categorized fall events as dependent variables. Gait variability in the fore-aft direction showed significant differences between the fall groups (p < 0.05-0.01). Model effects were highest for walking with slow speed (correct prediction 0.50-0.72). The speed-dependent integral of gait variability markers showed a higher discriminatory power (correct prediction 0.74-0.94). Gait variability is linked to the fall risk of patients with CA, slow walking and temporal gait variability being most relevant. The use of speed-dependent integrals of gait variability improves the accuracy of fall prediction. To predict fall risks in cerebellar ataxia, gait variability measurements made during slow walking should be included in a gait analysis procedure. The effects of speed-adjusted physiotherapeutic interventions have to be further investigated.

Gait and balance in adults with Friedreich's ataxia

“…The authors reported that gait variability was significantly higher in the FA group compared with healthy subjects. Another study reported a significant relationship between gait variability and fall risk, particularly with slow walking, in people with a variety of cerebellar disorders [27]. The results are comparable to our findings of a significant correlation between stride length variability during both comfortable and fast walking and balance as assessed using the BBS and the LOS test.…”

“…Gait variability is well documented in people with cerebellar ataxia and is related to walking impairment [6,7], gait speed [26] and falls [27]. Subjects with a variety of cerebellar ataxias exhibited significant variability in step and stride length, cadence, step time and stance time [6].…”

Accuracy and repeatability of two methods of gait analysis – GaitRite™ und Mobility Lab™ – in subjects with cerebellar ataxia

“…As a main finding, cerebellar ataxic gait disorder did not compromise the measurement accuracy estimated by betweenmethod comparison and measurement precision estimated from repeated testing. Increased spatiotemporal variability of stepping movements as the most consistently reported finding in ataxia [2,3] was also shown in our SCA14 cohort. However, measures of gait variability showed lowest consistency between methods in CTR as well as low agreement in retest in both groups.…”

“…It is characterized by a broad-based and more variable stepping as the most consistent finding that results in slowness of gait and falls [1][2][3]. The clinical assessment of walking ability forms part of commonly used rating scales for this disorder [4].…”

The Rotterdam study: why fall in COPD?

“…Gait variability is a well-established risk factor for falls in elderly subjects and patients with neurodegenerative diseases [4]. In persons with COPD, lower limb muscle weakness and impaired activities of daily living predict falls, though little was known on the influence of gait deficits [5].…”