The Impact of Different Types of Assistive Devices on Gait Measures and Safety in Huntington's Disease

Abstract

BackgroundGait and balance impairments lead to frequent falls and injuries in individuals with Huntington's disease (HD). Assistive devices (ADs) such as canes and walkers are often prescribed to prevent falls, but their efficacy is unknown. We systematically examined the effects of different types of ADs on quantitative gait measures during walking in a straight path and around obstacles.MethodsSpatial and temporal gait parameters were measured in 21 subjects with HD as they walked across a GAITRite walkway under 7 conditions (i.e., using no AD and 6 commonly prescribed ADs: a cane, a weighted cane, a standard walker, and a 2, 3 or 4 wheeled walker). Subjects also were timed and observed for number of stumbles and falls while walking around two obstacles in a figure-of-eight pattern.ResultsGait measure variability (i.e., coefficient of variation), an indicator of fall risk, was consistently better when using the 4WW compared to other ADs. Subjects also walked the fastest and had the fewest number of stumbles and falls when using the 4WW in the figure-of-eight course. Subjects walked significantly slower using ADs compared to no AD both across the GAITRite and in the figure-of-eight. Measures reflecting gait stability and safety improved with the 4WW but were made worse by some other ADs.

Video game play (Dance Dance Revolution) as a potential exercise therapy in Huntington’s disease: a controlled clinical trial

“…3 These deficits include greater postural sway, delayed balance reactions, slower gait, shortened stride length, widened support base, and increased stance and double support time. 3,4 Individuals with Huntington's disease also have increased gait parameter variability that may increase fall risk. 3,4 Falls frequently occur when maneuvering around or stepping over obstacles.…”

“…3,4 Individuals with Huntington's disease also have increased gait parameter variability that may increase fall risk. 3,4 Falls frequently occur when maneuvering around or stepping over obstacles. Thus, interventions that help prevent or ameliorate balance and gait impairments would benefit this population.…”

Evaluation of gait performance of knee osteoarthritis patients after total knee arthroplasty with different assistive devices

“…The highest percentage in the swing phase may be due to the forearms supports, which provide greater support, decreasing knee pain to patients (Tereso et al, 2014). It is known that an unsecure gait results in an increased stance phase (Kloos et al, 2012). Thus, it is possible that RFS provided an extra support and stability, increasing the sense of security, compared with the other ADs.…”

“…This AD also causes a lower variability in gait and it is easy to use (Kloos et al, 2012;Vogt et al, 2010;Wellmon et al, 2006). On the other hand, there are Volume 31, Number 3, p. 208-217, 2015 several authors indicating that this AD causes changes in posture and, an increased risk of fall (Kegelmeyer et al, 2013;Liu et al, 2009;Vogt et al, 2010).…”

“…On the other hand, standard walker (SW) is known as the more stable device, supporting a greater percentage of body weight (Melis et al, 1999). Still, it provides a slow and varied gait, less mobility with higher metabolic cost due to reduced speed and repetitive motion for lifting it while moving forward (Kegelmeyer et al, 2013;Kloos et al, 2012;Melis et al, 1999;Priebe and Kram, 2011;Roomi et al, 1998). Crutches have upper limbs support and enable an easy climbing of the stairs (Van Hook et al, 2003).…”