Session Title: Clinical Practice/Patient Care
Session Type: Abstract Submissions (ARHP)
Interest in ambulatory gait analysis is increasing thanks to validated gait analysis apparatus dedicated to clinical practice. Such methodology has to be reproducible, sensitive, specific and pertinent. Traditionally gait analysis was carried out during a walking test with no additional tasks (called single task (ST)). Recently due to the fact that gait control involves the cognitive domain, gait analysis has additionally been carried out using the dual task paradigm, when a task demanding attention is performed during walking – this type of gait analysis is known as Dual Task (DT). We hypothesize that gait analysis under ST or DT conditions has to be chosen according to the objectives of the clinician, as well as that of the choice of gait variables.
Locometrix is a validated accelerometric device which allows the measurement of the following gait variables: walking speed (WS, m/s), stride frequency (SF, Hz), stride length (SL, m), step symmetry (SS, dimensionless), stride regularity, an index of similarity of successive strides (SR, dimensionless), cranio-caudal power (CCP,W/Kg ), high frequency energy modulus at heel contact (HFEM,%: a measurement of shock wave (SW)).
ST gait analysis was performed in three pathological conditions : 1- knee osteoarthritis compared to a control group (41 patients, age: 65±10y, BMI 28±4 kg/m², mean Lequesne index: 9±4/24); 2- newly diagnosed Parkinson patients with no treatment, compared to a control group (22 patients, age 69±9y, BMI: 26±3 kg/m², mean motor score: 23.5±3.0); 3-Fibromyalgia patients (52 matched pairs of female patients and controls, age: 44±7y, BMI: 24±4 kg/m²).
DT gait analysis was performed in 80 elderly patients (age 68±14y, BMI 25±5 kg/m²). suffering from gait instability, memory impairment, recurrent falls.
Study 1: In knee osteoarthritis two gait variables are highly significant and relevant: area under the ROC curve (SR: 0.79±0.05), SW: 0.78±0.06)
Study 2: In Parkinson’s disease two gait variables are highly significant and correlated to motor score: SR (r=0.59, p<0.01); CCP (r=-0.65, p<0.003)
Study 3: Fibromyalgia patients
– ROC curves confirmed the utility of SF (0.74±0.04), SR (0.68±0.05) and CCP (0.69±0.05) in the identification of fibromyalgia patients,
– SR is correlated to the Fibromyalgia Impact Questionnaire (r=-0.33, p=0.01)
– SR is correlated to cognitive dysfunction measured by the Coping Strategy Questionnaire (r=0.31, p=0.003)
– CCP is correlated to pain (weekly VAS: r=-0.33, p=0.01)
Study 4: Gait exhibited no abnormality under ST in 13 patients. Gait abnormalities occurred under DT in each patient, moreover the decrease of one or more of the following gait variables (WS, SR, SF) alerted the clinician to an underlying neurological pathology.
The Single Task Gait Analysis condition is well adapted to knee osteoarthritis (SR and SW: a measurement of shock wave), to Parkinson’s disease (SR, CCP: a measurement of kinesia); to fibromyalgia patients (SR, SF, CCP: a method for the identification of homogenous subgroups). Gait Analysis Test under Dual Task conditions is of major interest in exploring the cognitive reserve and explaining gait instability in the elderly.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ambulatory-gait-analysis-in-clinical-practice-single-or-dual-task-conditions/