Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people.
Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people.
复制标题
DOI：
10.1186/1743-0003-8-2
复制
发表时间：
2011-01-17
影响因子：
5.1
通讯作者：
Pijnappels M
中科院分区：
文献类型：
--
作者：
Lamoth CJ;van Deudekom FJ;van Campen JP;Appels BA;de Vries OJ;Pijnappels M
体弱老年人跌倒是一个常见问题，而且发病率不断上升。步态和姿势不稳定是跌倒的主要危险因素，尤其是老年患者。由于步行需要注意力，认知障碍可能会增加跌倒风险。需要对步态和平衡能力进行客观量化来识别跌倒倾向较高的人。最近的研究表明，老年人和双重任务条件下的步幅变异性增加，并且可能比步行速度更能敏感地检测跌倒风险。在本研究中，我们用量化躯干运动模式的措施来补充与步幅相关的措施，作为步行过程中动态平衡能力的指标。该研究的目的是量化认知受损和双重任务对老年患者步态变异性和稳定性的影响。从老年日间诊所招募了 13 名患有痴呆症的老年人（平均年龄：82.6 ± 4.3 岁）和 13 名没有痴呆症的老年人（平均年龄：79.4 ± 5.55），以自行选择的速度行走，执行或不执行语言双重任务。进行了简易精神状态检查和七分钟筛查。用加速度计测量躯干加速度。除了步行速度、步幅时间的平均值和变异性之外，还使用随机动态测量来量化步态稳定性，即规律性（样本熵、长程相关性）和躯干加速度的局部稳定性指数。双重任务显着（p < 0.05）降低了步行速度，而步幅时间变异性增加，并且侧向躯干加速度的稳定性和规律性降低。认知受损的老年人比认知完好的老年人在步态变异方面表现出显着更多的变化（p < 0.05）。在双重任务条件下，组间动态参数的差异更加明显。观察到的躯干适应是一个一致的不稳定因素。这些结果支持这样的概念：认知功能的变化有助于步态模式的可变性和稳定性的变化。在双重任务条件下行走并使用动态参数量化步态可以改善步行障碍的检测，并可能有助于识别那些能够适应步行能力的老年人和那些不能适应步行能力的老年人，因此跌倒的风险更大。
Falls in frail elderly are a common problem with a rising incidence. Gait and postural instability are major risk factors for falling, particularly in geriatric patients. As walking requires attention, cognitive impairments are likely to contribute to an increased fall risk. An objective quantification of gait and balance ability is required to identify persons with a high tendency to fall. Recent studies have shown that stride variability is increased in elderly and under dual task condition and might be more sensitive to detect fall risk than walking speed. In the present study we complemented stride related measures with measures that quantify trunk movement patterns as indicators of dynamic balance ability during walking. The aim of the study was to quantify the effect of impaired cognition and dual tasking on gait variability and stability in geriatric patients. Thirteen elderly with dementia (mean age: 82.6 ± 4.3 years) and thirteen without dementia (79.4 ± 5.55) recruited from a geriatric day clinic, walked at self-selected speed with and without performing a verbal dual task. The Mini Mental State Examination and the Seven Minute Screen were administered. Trunk accelerations were measured with an accelerometer. In addition to walking speed, mean, and variability of stride times, gait stability was quantified using stochastic dynamical measures, namely regularity (sample entropy, long range correlations) and local stability exponents of trunk accelerations. Dual tasking significantly (p < 0.05) decreased walking speed, while stride time variability increased, and stability and regularity of lateral trunk accelerations decreased. Cognitively impaired elderly showed significantly (p < 0.05) more changes in gait variability than cognitive intact elderly. Differences in dynamic parameters between groups were more discerned under dual task conditions. The observed trunk adaptations were a consistent instability factor. These results support the concept that changes in cognitive functions contribute to changes in the variability and stability of the gait pattern. Walking under dual task conditions and quantifying gait using dynamical parameters can improve detecting walking disorders and might help to identify those elderly who are able to adapt walking ability and those who are not and thus are at greater risk for falling.
登录
查看更多内容
影响因子：
2.4
作者：
Dingwell, JB;Marin, LC
通讯作者：
Marin, LC
影响因子：
2.4
作者：
Lamoth, Claudine J. C.;van Lummel, Rob C.;Beek, Peter J.
通讯作者：
Beek, Peter J.
影响因子：
5.1
作者：
Beauchet, Olivier;Dubost, Veronique;Kressig, Reto W
通讯作者：
Kressig, Reto W
影响因子：
8.2
作者：
Li, KZH;Lindenberger, U;Baltes, PB
通讯作者：
Baltes, PB
影响因子：
2.4
作者：
Allali, Gilles;Assal, Frederic;Beauchet, Olivier
通讯作者：
Beauchet, Olivier