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      Quantitative Normative Gait Data in a Large Cohort of Ambulatory Persons with Parkinson’s Disease

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          Abstract

          Background

          Gait performance is widely evaluated to assess health status in older adult populations. While several investigators have presented normative values for spatiotemporal gait parameters drawn from older adult populations, the literature has been void of large-scale cohort studies, which are needed in order to provide quantitative, normative gait data in persons with Parkinson’s disease. The aim of this investigation was to provide reference values for clinically important gait characteristics in a large sample of ambulatory persons with Parkinson’s disease to aid both clinicians and researchers in their evaluations and treatments of gait impairment.

          Methodology/Principal Findings

          Gait performance was collected in 310 individuals with idiopathic Parkinson’s disease as they walked across a pressure sensitive walkway. Fourteen quantitative gait parameters were measured and evaluated with respect to Hoehn and Yahr disease staging and gender. Disease duration and age were controlled for in all analyses. Individuals with the greatest Parkinson’s disability walked significantly slower with shorter steps and stride lengths than the mild and moderately affected groups. Further, the most affected patients spent more time with both feet on the ground, and walked with a wider base of support than the moderately disabled patients. No differences were detected between the mild and moderate disability groups on any of the gait parameters evaluated.

          Conclusions/Significance

          Reference values for 14 gait parameters in a large cohort of ambulatory patients with Parkinson’s disease are provided and these may be highly useful for assessing and interpreting an individual’s gait dysfunction. It is important for clinicians and researchers to appreciate the lack of change in quantitative parameters as PD patients move from mild to moderate gait impairment.

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          Most cited references12

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          Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force.

          The use of a simple, safe, and easy to perform assessment tool, like gait speed, to evaluate vulnerability to adverse outcomes in community-dwelling older people is appealing, but its predictive capacity is still questioned. The present manuscript summarises the conclusions of an expert panel in the domain of physical performance measures and frailty in older people, who reviewed and discussed the existing literature in a 2-day meeting held in Toulouse, France on March 12-13, 2009. The aim of the IANA Task Force was to state if, in the light of actual scientific evidence, gait speed assessed at usual pace had the capacity to identify community-dwelling older people at risk of adverse outcomes, and if gait speed could be used as a single-item tool instead of more comprehensive but more time-consuming assessment instruments. A systematic review of literature was performed prior to the meeting (Medline search and additional pearling of reference lists and key-articles supplied by Task Force members). Manuscripts were retained for the present revision only when a high level of evidence was present following 4 pre-selected criteria: a) gait speed, at usual pace, had to be specifically assessed as a single-item tool, b) gait speed should be measured over a short distance, c) at baseline, participants had to be autonomous, community-dwelling older people, and d) the evaluation of onset of adverse outcomes (i.e. disability, cognitive impairment, institutionalisation, falls, and/or mortality) had to be assessed longitudinally over time. Based on the prior criteria, a final selection of 27 articles was used for the present manuscript. Gait speed at usual pace was found to be a consistent risk factor for disability, cognitive impairment, institutionalisation, falls, and/or mortality. In predicting these adverse outcomes over time, gait speed was at least as sensible as composite tools. Although more specific surveys needs to be performed, there is sufficient evidence to state that gait speed identifies autonomous community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment at usual pace over 4 meters was the most often used method in literature and might represent a quick, safe, inexpensive and highly reliable instrument to be implemented.
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            Age-related changes in speed of walking.

            Self-paced walking was used as a measure of the neuromuscular slowing observed with aging. The effects of age on the choice of speed of walking, stride length, and step frequency were described for 289 males and 149 females aged 19 to 102 yr. These subjects were asked to walk at three self-selected paces (slow, normal, and fast) over an 80-m indoor course. Sixty-two years coincided with an accelerated decline in speed of walking. Before 62 yr, there was a 1 to 2% per decade decline in normal walking speed. After 63 yr, females showed a 12.4% per decade decrease and males showed a 16.1% per decade decrease. The eldest group (63 yr and older) had a significantly slower speed of walking and smaller step length than the younger groups (19 to 39 and 40 to 62 yr) for all paces. Heart rate at the three paces was not changed across age. In a multiple regression analysis, the only significant independent variable for walking speed at all three paces was (age), which accounted for 19 to 38% of the variance. When the population was divided into two age ranges (19 to 62 and 63 to 102 yr), walking speed was associated with height before 62 yr and with height and age after 62 yr.
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              Slower gait, slower information processing and smaller prefrontal area in older adults.

              Slower gait in older adults is related to smaller volume of the prefrontal area (PFAv). The pathways underlying this association have not yet been explored. Understanding slowing gait could help improve function in older age. We examine whether the association between smaller PFAv and slower gait is explained by lower performance on numerous neuropsychological tests. We hypothesise that slower information processing explains this association, while tests of language or memory will not. Data on brain imaging, neuropsychological tests (information processing speed, visuospatial attention, memory, language, mood) and time to walk 15 feet were obtained in 214 adults (73.3 years, 62% women) free from stroke and dementia. Covariates included central (white matter hyperintensities, vision) and peripheral contributors of gait (vibration sense, muscle strength, arthritis, body mass index), demographics (age, race, gender, education), as well as markers of prevalent vascular diseases (cardiovascular disease, diabetes and ankle arm index). In linear regression models, smaller PFAv was associated with slower time to walk independent of covariates. This association was no longer significant after adding information processing speed to the model. None of the other neuropsychological tests significantly attenuated this association. We conclude that smaller PFAv may contribute to slower gait through slower information processing. Future longitudinal studies are warranted to examine the casual relationship between focal brain atrophy with slowing in information processing and gait.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                3 August 2012
                : 7
                : 8
                : e42337
                Affiliations
                [1 ]Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, United States of America
                [2 ]Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States of America
                [3 ]Brain Rehabilitation Research Center, Malcom Randall VAMC and Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States of America
                [4 ]Department of Neurology, University of Florida, Gainesville, Florida, United States of America
                The Chinese University of Hong Kong, Hong Kong
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: CH JN AS IM MO NM. Performed the experiments: PM ES CJ. Analyzed the data: CH PM JN ES CJ. Contributed reagents/materials/analysis tools: CH AS IM MO NM. Wrote the paper: CH JN ES AS IM MO NM.

                Article
                PONE-D-12-09264
                10.1371/journal.pone.0042337
                3411737
                22879945
                ed5b3b4f-cad1-4d13-93b0-192ea192a842
                Copyright @ 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 30 March 2012
                : 3 July 2012
                Page count
                Pages: 5
                Funding
                This work was funded in part by National Institutes of Health (NIH R21AG033284-1R2), University of Florida National Parkinson’s Disease Center of Excellence, and the generosity of the Allen Family. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Neuroscience
                Behavioral Neuroscience
                Motor Systems
                Medicine
                Anatomy and Physiology
                Neurological System
                Motor Systems
                Geriatrics
                Rehabilitation
                Neurology
                Movement Disorders
                Parkinson Disease
                Physiotherapy and Rehabilitation

                Uncategorized
                Uncategorized

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