Cross-sectional analysis of foot function, functional ability, and health-related quality of life in older people with disabling foot pain

Objective

To determine whether disabling foot pain is associated with foot function characteristics, functional ability, and health‐related quality of life (HRQOL) in older adults.

Methods

The Manchester Foot Pain and Disability Index was used to establish the presence of foot pain in 312 community‐dwelling men and women age >60 years. Ankle dorsiflexion strength and flexibility, foot reaction time, hallux and lesser toe flexor strength, and spatiotemporal gait parameters were measured to characterize foot function. Participants completed postural sway tasks and the Short Form 36 Health Survey (SF‐36) as a measure of HRQOL. Participants with disabling foot pain, classified using both the original and conservative (at least 1 item scored as “most/every day”) definitions, were then compared to those without pain, adjusting for sex and body mass index.

Results

Participants with foot pain scored significantly lower on the total SF‐36 and all subcomponents. Ankle dorsiflexion strength, hallux strength, stride length, step length, and walking speed were significantly reduced in those with foot pain. After applying a more conservative cutoff for disabling foot pain, reduced toe flexor strength, increased foot reaction time, increased postural sway, increased time in double support, and reduced time in single support emerged as additional characteristics of those with disabling foot pain.

Conclusion

Older people with disabling foot pain exhibit reduced HRQOL, functional impairment, and alterations to foot function that may contribute to an increased risk of falling. Providing interventions to older people to reduce foot pain and improve foot function may play a role in improving mobility and quality of life.     

Interaction of age,cognitive function,and gait performance in 50–80-year-olds

The variability of walking gait timing increases with age and is strongly related to fall risk. The purpose of the study was to examine the interaction of age, cognitive function, and gait performance during dual-task walking. Forty-two, healthy men and women, 50–80 years old, completed the Mini-Mental State Exam (MMSE) and Trail Making Test (TMT) to assess cognitive performance and were separated into groups by decade of life. They then performed dual-task walking, at a self-selected pace, on an instrumented treadmill during three cognitive loading conditions: (1) no cognitive load, (2) subtraction from 100 by 1s, and (3) subtraction from 100 by 3s. The treadmill recorded spatiotemporal gait parameters that were used to calculate the mean and coefficient of variation for each variable over ten strides. Time to complete the TMT was positively correlated with age, stride time, double-limb support time, and mediolateral instability and was inversely correlated with single-limb support time. Subjects in their 70s increased their stride time and double-limb support time during the most challenging dual-task condition (subtraction by 3s), whereas subjects in their 50s and 60s did not. Across conditions, the variability of stride length, stride time, and single-limb support time was greatest in the 70s. Mediolateral instability increased only for subjects in their 70s in the subtraction by 3s condition. Reduced cognitive function with age makes it difficult for older adults to maintain a normal, rhythmical gait pattern while performing a cognitive task, which may place them at greater risk for falling.     

Does fear of falling influence spatial and temporal gait parameters in elderly persons beyond changes associated with normal aging?

BACKGROUND: Limited research exists on fear of falling and its affect on gait parameters. Studies have shown a relationship between fear of falling and restriction of activities. The purpose of this study was to determine if a fear of falling in elderly persons was associated with changes in spatial and temporal gait parameters, independent of a history of falls. It was hypothesized that, in elderly persons, gait changes would be associated with a preexisting fear of falling. METHODS: Ninety-five community-dwelling adults, aged 60-97 years (mean age = 74, standard deviation = 8.5) participated in this study. Participant scores on the Modified Falls Efficacy Scale determined an individual's placement into the "fearful" or "fearless" category. Spatial and temporal gait parameters of speed, stride length, step width, and double limb support time were assessed using the GAITRite system, a computerized electronic walkway. RESULTS: The fearful group had a significantly slower gait speed (p <.05) and shorter stride length (p <.05) when compared to the fearless group. Stride width was significantly longer (p =.05) and double limb support time was significantly prolonged (p <.05) in the fearful participants when measured against the fearless participants. CONCLUSIONS: The results of this study support the hypothesis that fear of falling does influence spatial and temporal gait parameter changes in elderly persons. Slower gait speed, shorter stride length, increased stride width, and prolonged double limb support time were found to be associated with a preexisting fear of falling.     

Trunk sway measures of postural stability during clinical balance tests: effects of age.

BACKGROUND: The major disadvantage of current clinical tests that screen for balance disorders is a reliance on an examiner's subjective assessment of equilibrium control. To overcome this disadvantage we investigated, using quantified measures of trunk sway, age-related differences of normal subjects for commonly used clinical balance tests. METHODS: Three age groups were tested: young (15-25 years; n = 48), middle-aged (45-55 years; n = 50) and elderly (65-75 years; n = 49). Each subject performed a series of fourteen tasks similar to those included in the Tinetti and Clinical Test of Sensory Interaction in Balance protocols. The test battery comprised stance and gait tasks performed under normal, altered visual (eyes closed), and altered proprioceptive (foam support surface) conditions. Quantification of trunk sway was performed using a system that measured trunk angular velocity and position in the roll (lateral) and pitch (fore-aft) planes at the level of the lower back. Ranges of sway amplitude and velocity were examined for age-differences with ANOVA techniques. RESULTS: A comparison between age groups showed several differences. Elderly subjects were distinguished from both middle-aged and young subjects by the range of trunk angular sway and angular velocity because both were greater in roll and pitch planes for stance and stance-related tasks (tandem walking). The most significant age group differences (F = 30, p <.0001) were found for standing on one leg on a normal floor or on a foam support surface with eyes open. Next in significance was walking eight tandem steps on a normal floor (F = 13, p <.0001). For gait tasks, such as walking five steps while rotating or pitching the head or with eyes closed, pitch and roll velocity ranges were influenced by age with middle-aged subjects showing the smallest ranges followed by elderly subjects and then young subjects (F = 12, p <.0001). Walking over a set of low barriers also yielded significant differences between age groups for duration and angular sway. In contrast, task duration was the only variable significantly influenced when walking up and down a set of stairs. An interesting finding for all tasks was the different spread of values for each population. Population distributions were skewed for all ages and broadened with age. CONCLUSIONS: Accurate measurement of trunk angular sway during stance and gait tasks provides a simple way of reliably measuring changes in balance stability with age and could prove useful when screening for balance disorders of those prone to fall.     

Muscle mass,muscle strength,functional performance,and physical impairment in women with the hypermobility type of Ehlers‐Danlos syndrome

Objective

To investigate lower extremity muscle mass, muscle strength, functional performance, and physical impairment in women with the Ehlers‐Danlos syndrome hypermobility type (EDS‐HT).

Methods

Forty‐three women with EDS‐HT and 43 sex‐ and age‐matched healthy control subjects participated. Muscle mass was determined by dual x‐ray absorptiometry. Muscle strength and muscle strength endurance were measured with isokinetic dynamometry at angular velocities of 60, 180, and 240°/second. Static muscle endurance during posture maintenance was also assessed. Pain and fatigue were simultaneously evaluated by visual analog scale and the Borg scale, respectively. In addition, the chair rise test for assessment of functional performance and the Arthritis Impact Measurement Scales (AIMS) for physical impairment evaluation were used.

Results

Compared to control subjects, EDS‐HT patients showed substantial lower extremity muscle weakness, reflected by significantly reduced knee extensor and flexor muscle strength and endurance parameters, with differences ranging from ?30% to ?49%; reduced static muscle endurance time; and diminished functional performance. Lower extremity muscle mass was similar in both groups and unlikely to affect the muscle strength results. By contrast, pain and fatigue were omnipresent and increased remarkably due to the tests. Furthermore, the EDS‐HT group was physically impaired, especially in the AIMS domain walking and bending.

Conclusion

This study demonstrates severely reduced quantitative muscle function and impairment in physical function in patients with EDS‐HT compared to age‐ and sex‐matched controls. The muscle weakness may be due to muscle dysfunction rather than reduced muscle mass. Whether muscle strength and endurance can be improved by appropriate exercise programs needs evaluation in further studies.

     

Comparison of biomechanics platform measures of balance and videotaped measures of gait with a clinical mobility scale in elderly women

Performance on the clinical mobility index developed by Tinetti (9) was compared with biomechanics platform measures of sway and videotaped measures of gait in a sample of 43 community-dwelling aged women. Area measures of sway, but not velocity, were associated with performance on the mobility index. When standing on one leg with eyes open, the correlation coefficients for radial area per second with the mobility indices ranged from -0.59 to -0.64 (p less than .001). Knee range of motion and stride length correlated with performance on the mobility index. Knee range of motion correlation coefficients ranged from 0.47 to 0.54 (p less than .001), whereas the range was 0.62 to 0.68 (p less than .001) for stride length. These data demonstrate that biomechanics platform measures of sway and videotaped measures of gait are associated with subject performance on a clinical mobility index and may themselves also be predictive of persons susceptible to falling.     

Age-related differences in walking stability

BACKGROUND: a large proportion of falls in older people occur when walking; however the mechanisms underlying impaired balance during gait are poorly understood. OBJECTIVE: to evaluate acceleration patterns at the head and pelvis in young and older subjects when walking on a level and an irregular walking surface, in order to develop an understanding of how ageing affects postural responses to challenging walking conditions. METHODS: temporo-spatial gait parameters and variables derived from acceleration signals were recorded in 30 young people aged 22-39 years (mean 29.0, SD 4.3), and 30 older people with a low risk of falling aged 75-85 years (mean 79.0, SD 3.0) while walking on a level and an irregular walking surface. Subjects also underwent tests of vision, sensation, strength, reaction time and balance. RESULTS: older subjects exhibited a more conservative gait pattern, characterised by reduced velocity, shorter step length and increased step timing variability. These differences were particularly pronounced when walking on the irregular surface. The magnitude of accelerations at the head and pelvis were generally smaller in older subjects; however the smoothness of the acceleration signals did not differ between the two groups. Older subjects performed worse on tests of vision, peripheral sensation, strength, reaction time and balance. CONCLUSION: the adoption of a more conservative basic gait pattern by older people with a low risk of falling reduces the magnitude of accelerations experienced by the head and pelvis when walking, which is likely to be a compensatory strategy to maintain balance in the presence of age-related deficits in physiological function, particularly reduced lower limb strength.     

Dual-task effects of talking while walking on velocity and balance following a stroke

BACKGROUND: Therapists and nurses often use verbal instruction in the rehabilitation of mobility following stroke. This study aimed to determine whether performing a verbal cognitive task while walking adversely affected patients' balance and velocity. METHODS: There were two counterbalanced conditions: walking only and walking and concurrent cognitive activity. The cognitive activity used was to give one of two verbal responses to two verbal stimuli. An electronic GaitMat measured gait velocity and balance (double support time as a percentage of stride time). RESULTS: 11 people with stroke participated in the study (five women and six men, mean age 72 years, SD 9). They were on average 120 (SD 48) days post-stroke. Velocity decreased (P=0.017) and double-support time as a percentage of stride time increased (P=0.010) when the cognitive activity was added to the test. CONCLUSIONS: Performing a verbal cognitive task while walking adversely affected stroke patients' balance and gait velocity. Susceptibility to disruption varied within the patient group, suggesting clinical heterogeneity. Further research is required before changes to clinical practice are justified.     

Balance,fear of falling,pain and gait aid use by low care older people: pilot study

Objective: To investigate the influence of balance, fear of falling and pain on the type of gait aids used by low care residential older persons. Method: A cross‐sectional design was used. Valid and reliable measures of balance (Berg Balance Test), fear of falling (Falls Efficacy Scale) and pain (Geriatric Pain Measure) were collected. The influence of these clinical factors on the type of gait aid subjects used (no aid, stick or frame, or both) was analysed using one‐way anova for multiple independent groups. Results: Balance and fear of falling were significantly related to the type of gait aid subjects used (P < 0.05), whereas pain had no significant influence (P > 0.05). Conclusions: Balance and fear of falling are significantly associated with the type of gait aid used in this low care population and thus might be important clinical factors to consider when prescribing gait aids. The Berg Balance Test and the Falls Efficacy Scale appear to be useful quantitative tools that might assist this.     

Effect of age on characteristics of forward and backward gait at preferred and accelerated walking speed

BACKGROUND: Backward walking is used increasingly in rehabilitation programs to promote balance, strength, and aerobic conditioning. This study examines the effect of movement direction on the temporal-spatial gait characteristics of old versus young adults when progressing at a comfortable pace and as fast as possible. METHODS: Participants included 40 old (mean age 77.7, standard deviation +/- 6.2) and 30 young volunteers (mean age 24.0, standard deviation +/- 2.3), who were independent walkers. Using a computer-based walkway system, participants were requested to walk forward and backward at a normal pace and as fast as possible. Analyses of variance and Tukey-Kramer tests were conducted to determine effects of age, movement direction, and acceleration of gait speed on various gait parameters. RESULTS: Forward and backward walking of elderly persons is generally characterized by a lower velocity, cadence, stride length, and swing phase, accompanied by an increase in the double-support phase. Reversing from forward to backward walking presents a similar pattern in both age groups, with a decrease in gait velocity, stride length, and swing phase, an increase in the double-support phase, and no change in cadence. However, the decrease in stride length is significantly greater among elderly persons. In young persons, higher gait velocities are achieved by concurrent increases in stride length and cadence, regardless of movement direction. Ability of older persons to increase backward ambulation is limited and relies solely on increasing cadence. CONCLUSIONS: Elderly persons demonstrate difficulties in walking backward, with stride length particularly affected. These difficulties must be considered when using backward ambulation for rehabilitation of elderly persons.     

Increased gait variability in diabetes mellitus patients with neuropathic pain

AimsGait dysfunction in subjects with diabetes mellitus (DM) contributes to falling and subsequent injuries. Using a portable device (GaitMeter^TM), we measured gait parameters in DM patients with and without diabetic peripheral neuropathy (DPN) during flat surface walking. We hypothesized that DM patients with DPN and neuropathic pain (NeP) would have greater gait step variability than those with DPN without NeP.MethodsSubjects with DPN and at least moderate NeP (DPN-P), DPN without NeP (DPN-NoP), DM without DPN, and control subjects without DM were assessed. Our outcome measure was gait variability for step length and velocity. DPN severity was quantified using the Toronto Clinical Scoring System and the Utah Early Neuropathy Score. Falls and their outcomes were retrospectively quantified.ResultsEach cohort contained ≥ 20 subjects. Durations of DM and HbA1C were greatest amongst DPN cohorts. DPN-P participants had greater variability of step length and step velocity, except for DM only participants. DPN-P participants also reported greater risk of hospitalizations for fall-related injuries, and greater fear of falling. Modest negative relationships emerged for step length with step velocity, reported falls and pain severity.ConclusionsNeP contributes to gait variability, potentially contributing to the risk of falling in DM patients.     

Altered gait profile in subjects with peripheral arterial disease

The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects had impaired temporal and spatial gait characteristics compared to non-PAD controls at preferred and rapid self-selected walking paces. A total of 28 PAD subjects with intermittent claudication (age = 71 +/- 1; mean +/- SEM) and 15 non-PAD controls with at least one cardiovascular risk factor but no ambulatory leg pain (age = 71 +/- 1) were recruited. Gait parameters consisting of velocity, cadence, stride length, swing time, stance time, single-support time, double-support time, and base of support were recorded at the preferred and rapid walking paces. At the rapid walking pace, velocity was 22% slower (p < 0.001) in the PAD subjects compared with the non-PAD controls (99.9 +/- 3.3 vs. 117.5 +/- 5.3 cm/s) due to an 8% (p = 0.019) slower cadence (99.9 +/- 1.7 vs. 103.3 +/- 2.4 steps/min) and a 14% (p < 0.001) shorter stride length (119.8 +/- 2.9 vs. 135.8 +/- 4.2 cm/stride). The PAD subjects spent 5% less of the gait cycle in the swing phase (p = 0.006) and 3% more in stance (p = 0.006) than their non-PAD counterparts. During the stance phase, the PAD subjects spent 5% less of the gait cycle in single-stance (p=0.004) and 16% more in double-stance (p = 0.007). Similar results were obtained at the preferred walking pace. In conclusion, compared with the controls, PAD subjects adopted an ambulatory pattern that favored greater gait stability at the expense of greater walking speed at either their preferred or rapid self-selected paces.     

Balance,muscle strength,and fear of falling in older adults

This study examined balance ability, lower-extremity muscle strength, fear of falling and their inter-relationships in 40 community-dwelling older adults (>65 years). Subjects who self-identified either as being fearful of falling or not (no concern) were screened to exclude those with known risk factors for falling. Limits of stability, maximal isometric strength, gait speed, and fear of falling were contrasted between groups (27 control subjects, 13 fearful subjects). Those fearful of falling demonstrated smaller center of pressure (COP) excursions in anterior, left, and right directions (p<.0001) and used a smaller percentage of their base of support during maximal weight shifting in combined anterior-posterior and right-left directions (p<.001) compared to the control group. Strength did not differ between groups, but was associated with the ability to shift the COP in the anterior-posterior direction (p<.05). Fear of falling also related to weight shifting ability (p<.017). Seniors fearful of falling demonstrated limitations in balance ability and balance confidence that could not be explained by muscle weakness.     

Effects of once weekly dual‐task training in older adults: A pilot randomized controlled trial

Aim: To compare single‐task and dual‐task training on obstacle avoidance, gait speed and balance in healthy community‐dwelling older adults. Methods: A total of 17 older adults (65–83 years) participated in a group circuit class, once weekly for 45 min for 4 weeks. The dual‐task group carried out cognitive activities simultaneously with gait and balance exercises. The single‐task training group carried out identical gait and balance activities without cognitive tasks. We assessed time to complete a 6‐m obstacle course under single‐task and three different dual‐task conditions (spontaneous speech, alphabet recitation and coin transfer), 25‐ft gait speed, Timed Up and Go, and the Activities‐specific Balance Confidence Scale. Results: Both groups showed significant improvement in gait speed and Timed Up and Go. In addition, the proportion of participants who achieved gait speed >1.0 m/s increased in both groups. There were no within‐ or between‐subjects differences in obstacle course performance under single or dual‐task conditions after the intervention. Conclusion: Once weekly group circuit training focusing on balance, gait and agility, with or without simultaneous cognitive tasks, resulted in significantly improved walking speed among older adults. Group‐format dual‐task training once per week did not improve walking time or dual‐task cost on an obstacle negotiation task. Geriatr Gerontol Int 2012; ??: ??–??.     

Muscle-tendon tissue properties in the hypermobility type of Ehlers-Danlos syndrome

Objective

To investigate the passive properties of the plantar flexors muscle–tendon tissue in patients with the hypermobility type of Ehlers‐Danlos syndrome (EDS‐HT).

Methods

Twenty‐five women with EDS‐HT and 25 sex‐ and age‐matched healthy control subjects participated in the study. Passive resistive torque (PRT) of the plantar flexors was measured with an isokinetic dynamometer during 2 standardized stretch protocols to obtain the passive muscle tension. Protocol 1 consisted of 4 continuous cycles to a predetermined angle of 10° dorsiflexion. Protocol 2 consisted of a slow stretch to the onset of pain. Torque, angle, and electromyography were simultaneously recorded during the tests. To take muscle thickness into account, muscle cross‐sectional area (MCSA) was obtained with peripheral quantitative computed tomography. Stiffness of the Achilles tendon was assessed using a dynamometer in combination with ultrasonography.

Results

The results demonstrate a significantly larger maximal joint angle in the EDS‐HT patients accompanied by a similar PRT compared to the control subjects (protocol 2), indicating a lower passive muscle tension in the patient group. PRT for the predetermined angle (protocol 1) was the same for both groups and there was no difference in MSCA. Furthermore, a significantly lower Achilles tendon stiffness was seen in the patient group than in the control group.

Conclusion

This study is the first to provide evidence for altered passive properties of the muscle–tendon unit in EDS‐HT patients. These changes are thought to be associated with structural modifications in connective tissue.     

Effects of combined exercise on gait variability in community-dwelling older adults

Training that focuses on strength, balance, and endurance, the so-called combined exercise, can enhance physical function, including gait, according to a literature review. However, the effects of combined exercise on improving gait variability are limited. The objective of this study is to investigate the effects of 12 weeks of combined exercise comprised of resistance, endurance, and balance training on gait performance in older adults. Twenty-nine community-dwelling older adults were recruited and assigned to either the experimental group (n = 17) or the control group (n = 12). The 12-week intervention was a combined exercise program at 1 h per day and 3 days per week. The participants received an assessment for both a 6-min walk and gait during both habitual walking and fast walking conditions at pre-intervention and after 8 and 12 weeks of exercise. The 6-min walk was used to assess gait endurance. GAITRite was used to evaluate gait. An analysis of covariance with the pretest score as the covariate was used to determine the difference in each dependent variable between groups. The level of significance was set as p less than 0.05. Our results showed significant between-group effects in the 6-min walk and velocity, stride time, and stride length in both conditions after 8 weeks of exercise and significant between-group effects in the 6-min walk test and all selected gait parameters in both conditions after 12 weeks of exercise. Our findings demonstrate that a 12-week combined exercise program may positively affect gait endurance and gait performance including gait variability in habitual walking and fast walking conditions among older adults. The current study provides important evidence of short-term combined exercise effects on improvements in gait performance.     

The motor dysfunction of patients with knee osteoarthritis in a Chinese population

OBJECTIVE: To determine the extent of motor dysfunction in people with knee osteoarthritis (OA), as compared with similarly aged subjects without knee OA, in a Chinese population. METHODS: Seventy-six subjects participated in this study. Isometric peak torque of the knee muscles, range of knee motion at rest and during walking, gait velocity, cadence, and stride length were compared. RESULTS: The isometric peak torque of both the quadriceps and the hamstrings of the affected leg of patients with knee OA were weaker than those of the controls (most P < 0.05). The gait velocity was 23.4% slower (P = 0.001), the cadence 33.3% less (P < 0.001), and the stride length 13.4% shorter (P = 0.010) in the patients with OA. The range of knee motion in the patients was reduced by 11.2% at rest (P = 0.003) and by 14.7% during walking (P = 0.001). CONCLUSION: Patients with knee OA exhibited statistically significant deficiencies in the physical performance tested, as compared with similarly aged subjects without knee OA (by 9.6% to 33.3%), in a Chinese population. The indication that this study group seems less severely limited than those reported in Western literature warrants further investigation.     

Spatiotemporal components of the 3‐D gait analysis of community‐dwelling middle‐aged and elderly Japanese: Age‐ and sex‐related differences

Aim: To describe age‐ and sex‐related differences in gait patterns of community‐living men and women using 3‐D gait analysis. Methods: Subjects (n = 2006) aged 40–84 years participated in the National Institute for Longevity Sciences‐Longitudinal Study of Aging (NILS‐LSA). Spatiotemporal components, including velocity, step length, step frequency, and double support time during a gait cycle, were calculated from 3‐D coordinates and vertical force data. Velocity, step length and step frequency were normalized by leg length and acceleration due to gravity, and double support time was normalized to gait cycle duration. Results: Spatiotemporal walking variables of brisk velocity and step length were significantly greater in men than in women, while comfortable velocity and comfortable and brisk step frequencies and double support times were greater in women than in men. Age‐related changes were marked at 70–84 years in most spatiotemporal variables in both sexes during comfortable walking. During brisk walking, age‐related changes were observed from a younger age than during comfortable walking, and there were sex‐related differences. Conclusion: The age‐related gait alteration was obvious among those aged 70 years and older, and it accelerated markedly in women's brisk walking intensity. Geriatr Gerontol Int 2011; 11: 39–49.     

Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer's disease

OBJECTIVES: To evaluate how cognitive function and divided attention affect gait in Alzheimer's disease (AD). DESIGN: Cross-sectional intervention study with subjects serving as their own controls. SETTING: Inpatient unit and outpatient clinic for patients with dementia located at a Veterans Affairs Medical Center. PARTICIPANTS: Twenty-eight patients diagnosed with probable AD. INTERVENTION: Performance of a cognitive task (repeating random digits) while walking. MEASUREMENTS: Neuropsychological measures including clock drawing, verbal fluency, and digit span were obtained along with the Clinical Dementia Rating and Mini-Mental State Examination, the measures of dementia severity. Gait speed and stride-to-stride variability of gait rhythm were measured, once during normal walking and once during dual-task walking. RESULTS: During usual walking, subjects walked slowly and with greater gait variability than older adults without AD. Gait speed was significantly reduced (P<.012) and gait variability increased with dual-task walking (P<.007). The effect on gait variability was larger than the effect on gait speed (P<.015). Executive and neuropsychological function were significantly (P<.02) associated with the increased gait variability that occurred when walking with divided attention but not with gait speed or usual, single-task walking measures of gait. CONCLUSION: Divided attention markedly impairs the ability of patients with AD to regulate the stride-to-stride variations in gait timing. This susceptibility to distraction and its effect on stride time variability, a measure of gait unsteadiness, could partially explain the predilection to falling observed in patients with dementia. The results also support the concept that persons with AD have significant impairments in the cognitive domain of attention and that locomotor function relies upon cognitive, especially executive, function.     

Gait variability while dual-tasking: fall predictor in older inpatients?

BACKGROUND AND AIMS: Increased gait variability is associated with a high risk of falling in older community-dwellers, but no information exists about the relationship between increased gait variability and falls occurring in older hospitalized patients. We therefore sought to determine, in an acute geriatric setting, whether gait variability in single- (i.e., usual walking) or dual-task conditions can predict inpatient falls. METHODS: Stride time variability was calculated in both single-task (i.e., usual walking) and dual-task conditions with a GAITRite-System in 13 male and 44 female patients (mean age=85.0, SD=6.6 yrs) consecutively admitted to the acute care geriatric department of Geneva University Hospitals, Switzerland. All participants were able to walk without assistive devices at day 3 post-admission. Falls during hospital stay were identified through the hospital accident reporting system. RESULTS: Ten fallers and 47 non-fallers were identified. The first fall events were significantly associated with the coefficient of variation of stride time in both walking conditions during hospital stay (OR 13.3, (95% CI 1.6-113.6), p=0.018 for usual walking; OR 8.6, (95% CI 1.9-39.6), p=0.006 for dual- task walking). Furthermore, the time elapsing between the first day of hospitalization and the first fall was significantly shorter when the cut-off value of stride time variability was calculated for dual-tasking compared with usual walking. The Cox regression model revealed that only the coefficient of variation of stride time during dual-task walking was significantly associated with the occurrence of the first fall event (p=0.006). CONCLUSION: Our results suggest that the degree of stride time variability in dual-task walking conditions distinguished fallers from non-fallers in a group of independently walking, older inpatients.