A comparison of two walking while talking paradigms in aging

BackgroundOur study aimed to [1] compare dual-task costs in gait and cognitive performance during two dual-task paradigms: walking while reciting alternate letters of the alphabet (WWR) and walking while counting backward by sevens (WWC); [2] examine the relationship between the gait and cognitive interference tasks when performed concurrently.ScopeGait and cognitive performance were tested in 217 non-demented older adults (mean age 76 ± 8.8 years; 56.2% female) under single and dual-task conditions. Velocity (cm/s) was obtained using an instrumented walkway. Cognitive performance was assessed using accuracy ratio: [correct responses]/[total responses]. Linear mixed effects models revealed significant dual-task costs, with slower velocity (p < .01) and decreased accuracy ratio (p < .01) in WWR and WWC compared to their respective single task conditions. Greater dual-task costs in velocity (p < .01) were observed in WWC compared to WWR. Pearson correlations revealed significant and positive relationships between gait and cognitive performance in WWR and WWC (p < .01); increased accuracy ratio was associated with faster velocity.ConclusionsOur findings suggested that dual-task costs in gait increase as the complexity of the cognitive task increases. Furthermore, the positive association between the gait and cognitive tasks suggest that dual-task performance was not influenced by task prioritization strategies in this sample.     

Residual standard deviation: Validation of a new measure of dual-task cost in below-knee prosthesis users

We developed and evaluated properties of a new measure of variability in stride length and cadence, termed residual standard deviation (RSD). To calculate RSD, stride length and cadence are regressed against velocity to derive the best fit line from which the variability (SD) of the distance between the actual and predicted data points is calculated. We examined construct, concurrent, and discriminative validity of RSD using dual-task paradigm in 14 below-knee prosthesis users and 13 age- and education-matched controls. Subjects walked first over an electronic walkway while performing separately a serial subtraction and backwards spelling task, and then at self-selected slow, normal, and fast speeds used to derive the best fit line for stride length and cadence against velocity. Construct validity was demonstrated by significantly greater increase in RSD during dual-task gait in prosthesis users than controls (group-by-condition interaction, stride length p = 0.0006, cadence p = 0.009). Concurrent validity was established against coefficient of variation (CV) by moderate-to-high correlations (r = 0.50–0.87) between dual-task cost RSD and dual-task cost CV for both stride length and cadence in prosthesis users and controls. Discriminative validity was documented by the ability of dual-task cost calculated from RSD to effectively differentiate prosthesis users from controls (area under the receiver operating characteristic curve, stride length 0.863, p = 0.001, cadence 0.808, p = 0.007), which was better than the ability of dual-task cost CV (0.692, 0.648, respectively, not significant). These results validate RSD as a new measure of variability in below-knee prosthesis users. Future studies should include larger cohorts and other populations to ascertain its generalizability.     

Biomechanical effects following footstrike pattern modification using wearable sensors

ObjectivesThis study sought to examine the biomechanical effects of an in-field sensor-based gait retraining program targeting footstrike pattern modification during level running, uphill running and downhill running.DesignQuasi-experimental design.MethodsSixteen habitual rearfoot strikers were recruited. All participants underwent a baseline evaluation on an instrumented treadmill at their preferred running speeds on three slope settings. Participants were then instructed to modify their footstrike pattern from rearfoot to non-rearfoot strike with real-time audio biofeedback in an 8-session in-field gait retraining program. A reassessment was conducted to evaluate the post-training biomechanical effects. Footstrike pattern, footstrike angle, vertical instantaneous loading rate (VILR), stride length, cadence, and knee flexion angle at initial contact were measured and compared.ResultsNo significant interaction was found between training and slope conditions for all tested variables. Significant main effects were observed for gait retraining (p-values ≤ 0.02) and slopes (p-values ≤ 0.01). After gait retraining, 75% of the participants modified their footstrike pattern during level running, but effects of footstrike pattern modification were inconsistent between slopes. During level running, participants exhibited a smaller footstrike angle (p ≤ 0.01), reduced VILR (p ≤ 0.01) and a larger knee flexion angle (p = 0.01). Similar effects were found during uphill running, together with a shorter stride length (p = 0.01) and an increased cadence (p ≤ 0.01). However, during downhill running, no significant change in VILR was found (p = 0.16), despite differences found in other biomechanical measurements (p-values = 0.02–0.05).ConclusionAn 8-session in-field gait retraining program was effective in modifying footstrike pattern among runners, but discrepancies in VILR, stride length and cadence were found between slope conditions.     

Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study

ObjectivesTo examine gait parameters in people with gout during different walking speeds while adjusting for body mass index (BMI) and foot-pain, and to determine the relationship between gait parameters and foot-pain and disability.MethodGait parameters were measured using the GAITRite™ walkway in 20 gout participants and 20 age- and sex-matched controls during self-selected and fast walking speeds. Foot-pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI) which contains four domains relating to function, physical appearance, pain and work/leisure.ResultsAt the self-selected speed, gout participants demonstrated increased step time (p = 0.017), and stance time (p = 0.012), and reduced velocity (p = 0.031) and cadence (p = 0.013). At the fast speed, gout participants demonstrated increased step time (p = 0.007), swing time (p = 0.005) and stance time (p = 0.019) and reduced velocity (p = 0.036) and cadence (p = 0.009). For participants with gout, step length was correlated with total MFPDI (r = −0.62, p = 0.008), function (r = −0.65, p = 0.005) and physical appearance (r = −0.50, p = 0.041); stride length was correlated with total MFPDI (r = −0.62, p = 0.008), function (r = −0.65, p = 0.005) and physical appearance (r = −0.50, p = 0.041); and velocity was correlated with total MFPDI (r = −0.60, p = 0.011), function (r = −0.63, p = 0.007) and work/leisure (r = −0.53, p = 0.030).ConclusionGait patterns exhibited by people with gout are different from controls during both self-selected and fast walking speeds, even after adjusting for BMI and foot-pain. Additionally, gait parameters were strongly correlated with patient-reported functional limitation, physical appearance and work/leisure difficulties, while pain did not significantly influence gait in people with gout.     

Sleep quality is associated with walking under dual-task,but not single-task performance

ObjectivesThe objective of this study was to assess the relationship between sleep behavior and gait performance under single-task (ST) and dual-task (DT) walking conditions in community- dwelling older adults.MethodsWalking under ST and DT conditions was evaluated in 34 community-dwelling older adults, 64.7% women, mean age 71.5 (SD ± 5.8). Gait-speed and gait-variability data were collected using the OPAL wearable sensors of the Mobility Lab. Sleep behavior (sleep efficiency [SE] and sleep latency [SL]) was assessed using actigraphy, over 5 consecutive nights.ResultsLower SE was associated with decreased gait speed and increased stride-length variability during DT (rs = 0.35; p = 0.04; rs = −0.36; p = 0.03, respectively), whereas longer SL was associated with increased stride-length variability during DT (rs = 0.38; p = .03). After controlling for age and cognition, SE accounted for 24% and 33% of the variability in stride length and stride time. No associations were found between sleep and gait measures under ST walking.ConclusionsLower SE is associated with decreased gait speed and increased gait variability under DT conditions that are indicative of an increased risk for falls in older adults. Our findings support clinical recommendations to incorporate the evaluation of sleep quality in the context of risk assessment for falls.     

Attentional requirements of walking according to the gait phase and onset of auditory stimuli

A dual-task paradigm was used to examine the influence of an attention demanding cognitive task on each phase of gait. Twenty-three participants (aged 18–27) walked on a treadmill at a 20% increase of their self-selected speed, either alone or while performing a cognitive task. Muscle activity was measured with electromyography (iEMG) for eight muscles of the dominant leg. The cognitive task consisted of subtracting one (EASY) or seven (HARD) from aurally presented numbers. Reaction time (RT) and accuracy were recorded. iEMG events were selected according to stimulus onset (0–150 ms, 150–300 ms and 300–450 ms) prior to phases of gait (double-leg stance, single-leg stance and swing). There was a decrease in iEMG amplitude of fibularis longus (p = .013) and a trend in the same direction for vastus lateralis (p = .065) while walking and performing the cognitive task. When stimulus onset was considered, iEMG of medial gastrocnemius (p = .021) and lateral gastrocnemius (p = .004) were reduced during single-leg stance, when stimuli occurred between 300 and 450 ms prior to this phase. Cognitive performance was affected by task difficulty (RT, accuracy) and by dual-task load (RT). Dual-task costs were observed in both the motor and the cognitive tasks, suggesting that walking requires attention. There was a specific moment (300 ms after stimulus onset) during single-leg stance when dual-task costs were most pronounced, corroborating supraspinal involvement in the control of normal walking. Time-based approaches should be considered when analyzing attentional demands of a dynamic task such as gait.     

Accelerometer-based determination of gait variability in older adults with knee osteoarthritis

Knee osteoarthritis (KOA) can affect the spatiotemporal (ST) aspects of gait as well as the variability of select ST parameters based on standard linear measures of variability (e.g., standard deviation (SD) and coefficient of variation). Non-linear measures (e.g., fractal scaling index (FSI) and sample entropy) can be more sensitive to changes in gait variability, and have been used to quantify differences in the stride patterns of patients with Parkinson’s disease and the motion of ACL-deficient knees. However, the effect of KOA on the dynamic complexity of the stride pattern has not been investigated. Therefore, the purpose of this study was to investigate the effect of KOA on gait variability (linear and non-linear measures) in a group of older adults, and to compare these results to a healthy control group. Participants walked for 10 min with a tri-axial accelerometer placed at the lower back. Mean and SDs of stride time and step time as well as the FSI for the entire series of stride times were calculated for each participant. Participants with KOA had significantly greater mean stride time (p = 0.031) and step time (p = 0.024) than control group participants. While stride and step time variability (SD) were greater in the KOA group, the differences were not significant, nor was the difference in the FSI. Low statistical power (β = 0.40 and 0.30 for stride and step time SD, respectively) combined with the confounding effects of walking speed and heterogeneous KOA severity likely prevented significant differences from being found.     

The association between fear of falling and gait variability in both leg and trunk movements

The aim of this study was to explore whether FoF was associated with variability in both leg and trunk movements during gait in community-dwelling elderly. Ninety-three elderly people participated in this study. Each participant was categorized into either Fear or No-Fear group on the basis of having FoF. The participants walked 15 m at their preferred speed. The wireless motion recording sensor units were attached to L3 spinous process and right posterior surface of heel during gait. Gait velocity, stride time and stride length were calculated. Variability in lower limb movements was represented by coefficient of variation (CV) of stride time. Trunk variability was represented by autocorrelation coefficients (AC) in three directions (vertical: VT, mediolateral: ML and anteroposterior: AP), respectively. Gait parameters were compared between groups, and further analyses were performed using generalized linear regression models after adjustment of age, sex, fall experience, height, weight, and gait velocity. Although gait velocity, mean stride time and stride length did not differ significantly between groups, stride time CV and all ACs were significantly worse in the Fear group after adjustment for variables, even including gait velocity (stride time CV: p = 0.003, β = −0.793; AC-VT: p = 0.011, β = 0.053; AC-ML: p = 0.044, β = 0.075; AC-AP: p = 0.002, β = 0.078). Our results suggest that fear of falling is associated with variability in both leg and trunk movements during gait in community-dwelling elderly. Further studies are needed to prove a causal relationship.     

Using a dual-task protocol to investigate motor and cognitive performance in healthy children and youth

ObjectivesMild traumatic brain injury (or concussion) is a prevalent yet understudied health concern in children and youth. This injury can cause dysfunction in both motor and cognitive domains; however, most literature focuses on single-task neuropsychological tests which only assess cognition. Although dual-task research on concussed children and youth is needed as many daily activities require both motor and cognitive domains, we must first investigate whether performing simultaneous motor and cognitive tasks of varied complexity impact these domains in healthy children and youth.Participants and designData collected from 106 healthy children and youth (5–18 years) created a normative dataset. Participants performed motor (postural stability) and cognitive (visual attention) tasks under single- and dual-task conditions. The cognitive task difficulty remained constant while the motor task had four conditions of increasing difficulty. The relationship between the number of correct responses (cognitive performance) and sway index (motor performance) was determined using two repeated measures ANOVAs (p < 0.05).ResultsDual-task conditions resulted in reduced postural stability, with greater differences on the foam surface (F_2,206 = 16.070, p < 0.0005). No statistically significant differences were observed in attention (F_4,101 = 0.713, p = 0.584).ConclusionsPostural stability decreased under dual-task conditions, but attention was maintained or improved. Consequently, attention took precedence over postural control when performing tasks concurrently, demonstrating the ability for dual-task methodology to isolate specific processes. This study provides a normative dataset to be used during clinical management to identify functional deficits following concussion and acts as a starting point to explore dual-task protocols in children and youth following concussion.     

Balance and cognitive performance during a dual-task: Preliminary implications for use in concussion assessment

ObjectivesTo determine the reliability and effects of a dual-task paradigm on balance and cognitive function compared to a single-task paradigm.DesignRepeated measures.MethodsHealthy participants (n = 23) completed a variation of the Sensory Organization Test and the incongruent Stroop test individually (single-task) and concurrently (dual-task) during two testing sessions.ResultsThe Sensory Organization Test and incongruent Stroop test had moderate to high reliability (1.00 > ICC_2,k > 0.60) under the dual-task conditions. Reaction time was significantly longer (t₂₁ = ?2.54, p = 0.019) under the dual-task conditions, while balance scores under one of the four conditions of the Sensory Organization Test (sway floor/fixed wall) were statistically better (t₂₂ = ?3.03, p = 0.006) under the dual-task conditions. However, this difference in balance scores may not be clinically meaningful.ConclusionsThese findings illustrate that the Sensory Organization Test and incongruent Stroop task can be reliably incorporated into a dual-task assessment paradigm. The slowed reaction time under the dual-task paradigm indicates that the dual-task provided an additional cost to cognitive function. Dual-task concussion assessment paradigms involving these two tasks are psychometrically appropriate as well as more representative of actual sporting situations. However, more research should be conducted in a concussed population to further validate this claim.     

Comparison of temporal and stride characteristics in myotonic dystrophies type 1 and 2 during dual-task walking

ObjectiveWe analyzed temporal and stride characteristics in patients with myotonic dystrophy type 1 (DM1) and type 2 (DM2) while performing dual mental and motor tasks, and investigated correlations between gait parameters and cognitive impairments.MethodDual-task walking was performed by 37 patients (20 DM1 and 17 DM2) and 48 healthy subjects divided into two groups, age- and gender-matched control group for DM1 (HC1) and age- and gender-matched control group for DM2 (HC2). The subjects performed a basic walking task, dual-motor task, dual-mental task, and combined motor and mental task.ResultsDM1 and DM2 patients differed significantly in temporal and stride characteristics compared to HC. Main differences in DM1 were slower gait and shorter stride length, while both DM1 and DM2 patients had a higher degree of variation of the swing time during dual-task gait, a parameter that reflects posture and balance. Impact of the cognitive dual task on gait pattern changes was also observed. Visuospatial ability correlated with gait changes in DM1, while executive functions had stronger influence in DM2 (p < 0.01). Both patient groups had leg muscle weakness.ConclusionGait pattern was impaired in both patient groups concerning temporal and stride characteristics. Dual-task walking paradigm may discover mild initial gait changes and could provide early identification of fall risks and predict possible falls in DM patients.     

Different cognitive functions discriminate gait performance in younger and older women: A pilot study

AimCognitive dysfunction is associated with slower gait speed in older women, but whether cognitive function affects gait performance earlier in life has yet to be investigated. Thus, the objective of this study was to test the hypothesis that cognitive function will discriminate gait performance in healthy younger women.MethodsFast-pace and dual-task gait speed were measured in 30 young to middle-aged (30–45 y) and 26 older (61–80 y) women without mild cognitive impairment. Visuoperceptual ability, working memory, executive function, and learning ability were assessed using neuropsychological tests. Within each age group, women were divided by the median into lower and higher cognitive function groups to compare gait performance.ResultsYounger women with higher visuoperceptual ability had faster fast-pace (2.25 ± 0.30 vs. 1.98 ± 0.18 m/s, p ≤ 0.01) and dual-task gait speed (2.02 ± 0.27 vs. 1.69 ± 0.25 m/s, p ≤ 0.01) than women with lower visuoperceptual ability. The difference in dual-task gait speed remained significant (p = 0.02) after adjusting for age, years of education, and other covariates. Dividing younger women based on other cognitive domains showed no difference in gait performance. In contrast, working memory and executive function discriminated dual-task gait speed (p < 0.05) in older women after adjusting for age and education.ConclusionTo our knowledge, this is the first study to show that poorer cognitive function even at a relatively young age can negatively impact mobility. Different cognitive functions discriminated gait performance based on age, highlighting a possible influence of aging in the relationship between cognitive function and mobility in women.     

Dual-task gait differences in female and male adolescents following sport-related concussion

Concussion may affect females and males differentially. Identification of gender-related differences after concussion, therefore, may help clinicians with individualized evaluations. We examined potential differences in dual-task gait between females and males after concussion. Thirty-five participants diagnosed with a concussion (49% female, mean age = 15.0 ± 2.1 years, 7.5 ± 3.0 days post-injury) and 51 controls (51% female, mean age = 14.4 ± 2.1 years) completed a symptom inventory and single/dual-task gait assessment. The primary outcome variable, the dual-task cost, was calculated as the percent change between single-task and dual-task conditions to account for individual differences in spatio-temporal gait variables. No significant differences in symptom severity measured by the post-concussion symptom scale were observed between females (32.0 ± 18.0) and males (27.8 ± 18.2). Compared with males, adolescent females walked with significantly decreased cadence dual-task costs after concussion (−19.7% ± 10.0% vs. −11.3% ± 9.2%, p = 0.007) when adjusted for age, height, and prior concussion history. No significant differences were found between female and male control groups on other dual-task cost gait measures. Females and males with concussion also walked with significantly shorter stride lengths than controls during single-task (females: 1.13 ± 0.11 m vs. 1.26 ± 0.11 m, p = 0.001; males: 1.14 ± 0.14 m vs. 1.22 ± 0.15 m, p = 0.04) and dual-task gait (females: 0.99 ± 0.10 m vs. 1.10 ± 0.11 m, p = 0.001; males: 1.00 ± 0.13 m vs. 1.08 ± 0.14 m, p = 0.04). Females demonstrated a significantly greater amount of cadence change between single-task and dual-task gait than males after a sport-related concussion. Thus, differential alterations may exist during gait among those with a concussion; gender may be one prominent factor affecting dual-task gait.     

The effect of a dual task on gait speed in community dwelling older adults: A systematic review and meta-analysis

Background and purposeReduced walking speed in older adults is associated with adverse health outcomes. This review aims to examine the effect of a cognitive dual-task on the gait speed of community-dwelling older adults with no significant pathology affecting gait.Data sources and study selectionElectronic database searches were performed in, Web of Science, PubMed, SCOPUS, Embase and psychINFO. Eligibility and methodological quality was assessed by two independent reviewers. The effect size on gait speed was measured as the raw mean difference (95% confidence interval) between single and dual-task performance. Pooled estimates of the overall effect were computed using a random effects method and forest plots generated.Data extraction and data synthesis22 studies (27 data sets) with a population of 3728 were reviewed and pooled for meta-analysis. The mean walking speed of participants included in all studies was >1.0 m/s and all studies reported the effect of a cognitive dual-task on gait speed. Sub-analysis examined the effect of type of cognitive task (mental-tracking vs. verbal-fluency). Mean single-task gait speed was 1.21 (0.13) m/s, the addition of a dual-task reduced speed by 0.19 m/s to 1.02 (0.16) m/s (p < 0.00001), both mental-tracking and verbal-fluency tasks resulted in significant reduction in gait speed.Limitations and conclusionThe cross-sectional design of the studies made quality assessment difficult. Despite efforts, high heterogeneity remained, possibly due to participant characteristics and testing protocols. This meta-analysis shows that in community-dwelling older adults, the addition of a dual-task significantly reduces gait speed and may indicate the value of including dual-task walking as part of the standard clinical assessment of older people.     

Variability of gait,bilateral coordination,and asymmetry in women with fibromyalgia

PurposeTo analyze how fibromyalgia affected the variability, asymmetry, and bilateral coordination of gait walking at comfortable and fast speeds.Methods65 fibromyalgia (FM) patients and 50 healthy women were analyzed. Gait analysis was performed using an instrumented walkway (GAITRite system). Average walking speed, coefficient of variation (CV) of stride length, swing time, and step width data were obtained and bilateral coordination and gait asymmetry were analyzed.ResultsFM patients presented significantly lower speeds than the healthy group. FM patients obtained significantly higher values of CV_StrideLength (p = 0.04; p < 0.001), CV_SwingTime (p < 0.001; p < 0.001), CV_StepWidth (p = 0.004; p < 0.001), phase coordination index (p = 0.01; p = 0.03), and p_CV (p < 0.001; p = 0.001) than the control group, walking at comfortable or fast speeds. Gait asymmetry only showed significant differences in the fast condition.ConclusionFM patients walked more slowly and presented a greater variability of gait and worse bilateral coordination than healthy subjects. Gait asymmetry only showed differences in the fast condition. The variability and the bilateral coordination were particularly affected by FM in women. Therefore, variability and bilateral coordination of gait could be analyzed to complement the gait evaluation of FM patients.     

Home-based interventions improve trained,but not novel,dual-task balance performance in older adults: A randomized controlled trial

The purpose of this study was to compare the efficacy of four different home-based interventions on dual-task balance performance and to determine the generalizability of the four trainings to untrained tasks. Sixty older adults, aged 65 and older, were randomly assigned to one of four home-based interventions: single-task motor training, single-task cognitive training, dual-task motor-cognitive training, and dual-task cognitive–cognitive training. Participants received 60-min individualized training sessions, 3 times a week for 4 weeks. Prior to and following the training program, participants were asked to walk under two single-task conditions (i.e. narrow walking and obstacle crossing) and two dual-task conditions (i.e. a trained narrow walking while performing verbal fluency task and an untrained obstacle crossing while counting backward by 3 s task). A nine-camera motion capture system was used to collect the trajectories of 32 reflective markers placed on bony landmarks of participants. Three-dimensional kinematics of the whole body center of mass and base of support were computed. Results from the extrapolated center of mass displacement indicated that motor-cognitive training was more effective than the single-task motor training to improve dual-task balance performance (p = 0.04, ES = 0.11). Interestingly, balance performance under both single-task and dual-task conditions can also be improved through a non-motor, single-task cognitive training program (p = 0.01, ES = 0.13, and p = 0.01, ES = 0.11, respectively). However, improved dual-task processing skills during training were not transferred to the novel dual task (p = 0.15, ES = 0.09). This is the first study demonstrating that home-based dual-task training can be effectively implemented to improve balance performance during gait in older adults.     

Gait deficits in people with multiple sclerosis: A systematic review and meta-analysis

BackgroundMultiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.ObjectiveThis systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.MethodsA systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.ResultsForty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD = 1.27, 95% CI{0.93, 1.61}), velocity (SMD = 1.12, 95% CI{0.85, 1.39}), double support duration (SMD = 0.85, 95% CI{0.51, 1.2}), step length (SMD = 1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD = 1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD = 0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD = 1.15, 95% CI{0.42, 1.88}).ConclusionsMS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.     

The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: A systematic review and meta-analysis

ObjectivesThe purpose of this systematic review was to determine the viability of the dual-task paradigm in the evaluation of a sports-related concussion.DesignSystematic review and meta-analysis.MethodsEight electronic databases were searched from their inception until the 11^th of April 2011. Studies were grouped according to their reported gait performance variables and their time(s) of assessment(s). Raw mean differences (MD) and 95% confidence intervals (CI) were calculated based on raw means and standard deviations for gait performance measures in both single- and dual-task conditions. Dual-task deficits were pooled using a random effects model and heterogeneity (I²) between studies was assessed.ResultsTen studies representing a total sample of 168 concussed and 167 matched (age and gender) non-concussed participants met the inclusion criteria. Meta-analysis demonstrated that dual-task performance deficits were detected (p < 0.05) in the concussed group for gait velocity (GV) (MD = ?0.133; 95% CI ?0.197, ?0.069) and range of motion of the centre of mass in the coronal plane (ML-ROM) (MD = 0.007; 95% CI 0.002, 0.011), but not in the non-concussed group; GV (MD = ?0.048; 95% CI ?0.101, 0.006), ML-ROM (MD = 0.002; 95% CI ?0.001, 0.005).ConclusionsThe results of this study indicate that GV and ML-ROM are sensitive measures of dual-task related changes in concussed patients and should be considered as part of a comprehensive assessment for a sports-related concussion.     

Age-related decline of gait variability in children with attention-deficit/hyperactivity disorder: Support for the maturational delay hypothesis in gait

BackgroundPrevious findings showed a tendency toward higher gait variability in children with attention-deficit/hyperactivity disorder (ADHD) compared to controls. This study examined whether gait variability in children with ADHD eventually approaches normality with increasing age (delay hypothesis) or whether these gait alterations represent a persistent deviation from typical development (deviation hypothesis).MethodThis cross-sectional study compared 30 children with ADHD (25 boys; M_age = 10 years 11 months, range 8–13 years; n = 21 off medication, n = 9 without medication) to 28 controls (25 boys; M_age = 10 years 10 months, range 8–13 years). Gait parameters (i.e. velocity and variability in stride length and stride time) were assessed using an electronic walkway system (GAITRite) while children walked at their own pace.ResultsChildren with ADHD walked with significantly higher variability in stride time compared to controls. Age was negatively associated with gait variability in children with ADHD such that children with higher age walked with lower variability, whereas in controls there was no such association.ConclusionsChildren with ADHD displayed a less regular gait pattern than controls, indicated by their higher variability in stride time. The age-dependent decrease of gait variability in children with ADHD showed that gait performance became more regular with age and converged toward that of typically developing children. These results may reflect a maturational delay rather than a persistent deviation of gait regularity among children with ADHD compared to typically developing children.     

Consistency and cost of dual-task gait balance measure in healthy adolescents and young adults

Matched control data are commonly used to examine recovery from concussion. Limited data exist, however, examining dual-task gait data consistency collected over time in healthy individuals. The study purposes were to: 1) assess the consistency of single-task and dual-task gait balance control measures, 2) determine the minimal detectable change (MDC) of gait balance control measures, and 3) examine the extent to which age and task complexity affect dual-task walking costs in healthy adolescents and young adults. Twenty-four adolescent (mean age = 15.5 ± 1.1 years) and 21 young adult (mean age = 21.2 ± 4.5 years) healthy participants completed 5 testing sessions across a two-month period, which involved analyses of gait balance control and temporal-distance variables during single-task and dual-task walking conditions in a motion analysis laboratory. Cronbach’s α and MDCs were used to determine the consistency of the gait balance control variables and the smallest amount of change required to distinguish true performance from change due to the performance/measurement variability, respectively. Dual-task costs were evaluated to determine the effect of task complexity and age across time using 3-way ANOVAs. Good to excellent test-retest consistency was found for all single-task and dual-task walking (Cronbach’s α range: 0.764–0.970), with a center-of-mass medial-lateral displacement MDC range of 0.835–0.948 cm. Greater frontal plane dual-task costs were observed during more complex secondary tasks (p < 0.001). The results revealed good-excellent consistency across testing sessions for all variables and indicated dual-task costs are affected by task complexity. Thus, healthy controls can be effective comparators when assessing injured subjects.