Tandem gait step-width increases more rapidly in more severely affected people with Parkinson's disease.

INTRODUCTION: Tandem gait performance reportedly predicts fall risk in people with Parkinson's disease (PwPD) and help distinguish PwPD from atypical parkinsonism. In a cross-sectional study, we previously showed that tandem gait step-width widens with increasing Hoehn and Yahr (H&Y) staging scores. In this longitudinal study, we aimed to determine if progression in tandem gait deficits is dependent on disease severity in PwPD. METHODS: Participants underwent an instrumented tandem gait measurement every 6 months for at least 2 years. The mean and variability of 4 tandem gait parameters were calculated at each visit: step-width, step-length, step-time, and step-velocity. The change in these parameters over time for 3 H&Y groups (stage 1, 2 and 2.5+) compared to aging controls was determined using a random coefficients regression model. The annual percent change in tandem gait parameters was correlated with initial disease features using Kendall's τB. RESULTS: 66 participants were analyzed (46 PD, 20 controls). Mean step-width increased over time in an H&Y stage-dependent manner, with H&Y 2 and H&Y 2.5+ experiencing increases of 6% and 10% per year (p = 0.001 and 0.024 respectively). Annual percent-change in step-width was correlated with initial motor Unified Parkinson's Disease Rating Scale (UPDRS) scores (Kendall's τB = 0.229), total UPDRS scores (τB = 0.249), H&Y scores (τB = 0.266) and inversely correlated with Montreal Cognitive Assessment (MoCA) scores (τB = -0.209; ps ≤ 0.019). CONCLUSION: Tandem gait step-width widens over time more rapidly in more severely affected PD patients. These results suggest that tandem gait should be routinely clinically evaluated and considered in the management of imbalance in PwPD.

Analyzing Dual-Task Paradigms to Improve Postconcussion Assessment and Management.

CONTEXT: Dual-task (simultaneous cognitive-motor activities) assessments have been adapted into reliable and valid clinical concussion measures. However, abundant motor and cognitive variations leave researchers and clinicians uncertain about which combinations elicit the intended dual-task effect. Our objective was to examine differences between commonly employed dual-task motor and cognitive combinations among healthy, college-aged individuals. DESIGN: Cross-sectional laboratory study. METHODS: Twenty participants (age: 21.3 [2.4] y; height: 176.0 [9.1] cm; mass: 76.0 [16.4] kg; 20% with concussion history) completed 4 motor tasks (gait, tandem gait, single-leg balance, and tandem balance) under 5 cognitive conditions (single task, subtraction, month reversal, spelling backward, and visual Stroop) in a research laboratory. The motor performance outcomes were spatiotemporal variables for gait and tandem gait and center of pressure path length (in centimeters) for single-leg and tandem balance. Cognitive outcomes were response rate (responses/second) and cognitive accuracy. We used separate repeated-measures analyses of variance for each motor and cognitive outcome with post hoc Tukey t tests. RESULTS: Gait velocity, gait stride length, and tandem gait velocity demonstrated significant cognitive-motor interactions (P's < .001) such that all dual-task conditions resulted in varyingly slower or shorter movement than single task. Conversely, single-leg balance (P = .627) and tandem balance (P = .434) center of pressure path length did not significantly differ among the dual-task cognitive conditions or relative to single task. Statistically significant cognitive-motor interactions were observed only for spelling backward accuracy (P = .004) and response rates for spelling backward, month reversal, and visual Stroop (P's < .001) such that worse accuracy, but faster response rates, occurred during motor tasks. CONCLUSIONS: Gait and tandem gait motor tasks accompanied with spelling backward or subtraction cognitive tasks demonstrated consistently strong dual-task effects and, therefore, may be the best suited for clinical and research use following concussion.

Prevalence and risk factors for abnormal tandem gait in patients with essential tremor syndrome: A cross-sectional study in Southwest China.

Objectives: Patients with essential tremor (ET) syndrome have more prevalent and more serious gait and balance impairments than healthy controls. In this cross-sectional study, we explored whether balance impairments are associated with falls as well as more pronounced non-motor symptoms in patients with ET syndrome. Methods: We assessed the tandem gait (TG) test, as well as falls or near-falls that occurred over the previous year. Non-motor symptoms-including cognitive deficits, psychological and sleep disorders-were evaluated. In univariate analyses, statistical significance was corrected for multiple comparisons using the Benjamini-Hochberg method. Multiple logistic regression was utilized to evaluate the risk factors of poor TG performance in patients with ET syndrome. Results: A total of 358 patients with ET syndrome were divided into the abnormal TG (a-TG) and normal TG (n-TG) groups based on their performances in the TG test. We revealed that 47.2% of patients with ET syndrome had a-TG. The patients with a-TG were older, were more likely female, and were more likely present with cranial tremors and falls or near-falls (all adjusted P < 0.01). The patients with a-TG had significantly lower Mini-Mental Status Examination scores, as well as significantly higher Hamilton Depression/Anxiety Rating Scale and Pittsburgh Sleep Quality Index scores. Multiple logistic regression analysis demonstrated that female sex (OR 1.913, 95% CI: 1.180-3.103), age (OR 1.050, 95% CI: 1.032-1.068), cranial tremor scores (OR 1.299, 95% CI: 1.095-1.542), a history of falls or near-falls (OR 2.952, 95% CI: 1.558-5.594), and the presence of depressive symptoms (OR 1.679, 95% CI: 1.034-2.726) were associated with the occurrence of a-TG in patients with ET syndrome. Conclusion: TG abnormalities may be a predictor of fall risk in patients with ET syndrome and are associated with non-motor symptoms, especially depression.

Upper limb contribution during tandem gait in multiple sclerosis: An early marker of balance impairments.

Tandem gait is widely used during clinical exams to evaluate dynamic balance in chronic diseases, such as multiple sclerosis (MS). The early detection of balance impairments in MS is challenging to improve the understanding of patients' complaints. The objective was to propose two indexes to quantify the contributions and inefficiency of limb and trunk movements during tandem gait in early-stage MS patients. Fifteen patients with remitting-relapsed MS, with a median Expanded Disability Status Scale of 2.5 [0-4] were compared to 15 matched healthy participants. Three-dimensional motion analysis was performed during tandem gait to calculate spatiotemporal parameters, contribution and inefficiency indexes, based on the linear momentum of body segments. Compared to healthy participants, MS patients at the early stage of disease executed tandem gait with higher speed (p = 0.03) and increased step length (p = 0.03). The contribution indexes of upper limbs were significantly decreased during swing phase in MS patients. The inefficiency index for the upper limbs were around twice higher for MS patients compared to healthy participants. Since the additional movements concerned only light body segments and not contribute to the whole-body forward progression during tandem gait, they could reflected more both upper limb movements alterations and restoring movements to avoid loss of balance during tandem gait around swing phase in MS. These quantified indexes could be used as physical markers to quantify both the balance deterioration and the efficiency of rehabilitation program during the follow up of MS from the early stage of their disease.

RGB-Depth Camera-Based Assessment of Motor Capacity: Normative Data for Six Standardized Motor Tasks.

BACKGROUND: Instrumental motion analysis constitutes a promising development in the assessment of motor function in clinical populations affected by movement disorders. To foster implementation and facilitate interpretation of respective outcomes, we aimed to establish normative data of healthy subjects for a markerless RGB-Depth camera-based motion analysis system and to illustrate their use. METHODS: We recorded 133 healthy adults (56% female) aged 20 to 60 years with an RGB-Depth camera-based motion analysis system. Forty-three spatiotemporal parameters were extracted from six short, standardized motor tasks-including three gait tasks, stepping in place, standing-up and sitting down, and a postural control task. Associations with confounding factors, height, weight, age, and sex were modelled using a predictive linear regression approach. A z-score normalization approach was provided to improve usability of the data. RESULTS: We reported descriptive statistics for each spatiotemporal parameter (mean, standard deviation, coefficient of variation, quartiles). Robust confounding associations emerged for step length and step width in comfortable speed gait only. Accessible normative data usage was lastly exemplified with recordings from one randomly selected individual with multiple sclerosis. CONCLUSION: We provided normative data for an RGB depth camera-based motion analysis system covering broad aspects of motor capacity.

Hip muscle strength, dynamic balance and functional capacity of community-dwelling older adults aged 60 and older: A cross-sectional study.

The objective of the present study was to evaluate the association of hip muscle strength, dynamic balance and functional capacity in the older adults aged 60 to 79 years and older adults aged 80 years and older. A total of 191 community-dwelling older adults participated in this study. Isometric muscle strength was quantified as the peak torque (PT), measured using an isokinetic dynamometer. Functional capacity was determined by the forward step test (ST) and the dynamic balance by the tandem gait (TG) test. The hip flexor, extensor, abductor and adductor PT in the older adults aged 60 to 79 years had a positive influence on the execution of the step test (p < 0.05). The peak adductor torque did not show a significant association with tandem gait (p = 0.649). In older adults aged 80 years and older, the peak adductor torque was the only one that showed an association with the performance of the ST (p = 0.001) and TG (p = 0.024) tests. The hip adductors may have a higher contribution in adults aged 80 years and older during the execution of clinical tests. These findings are relevant to clinical practice as they can help in the development of appropriate physical exercise programs targeting older adults of different age groups.

Balance Assessment of Children with Sensorineural Hearing Loss.

This study aimed to assess the balance function in children with sensorineural hearing loss (SNHL) using different tests to assess vestibulospinal pathway and tests to assess vestibular system and to compare the result obtained with those of children with normal hearing sensitivity. Detailed balance assessment was done for 15 children with severe to profound SNHL and 15 children with normal hearing sensitivity in the age range of 6-10 years. The audiological evaluation included pure-tone audiometry, speech audiometry, immittance evaluation, otoacoustic emission, vestibular evoked myogenic potential (cervical VEMP and ocular VEMP), and tests to assess vestibulospinal pathway and cerebellar function, such as Romberg test, Fukuda stepping test, Tandem gait test, and Finger-to-nose test. cVEMP and oVEMP were absent in 8 ears (27%) of a total of 30 ears with SNHL. Statistical analysis shows no significant difference between latency and amplitude of cVEMP peaks and latency of oVEMP peaks across groups. Significant reduction of oVEMP peaks amplitude was seen in children with SNHL compared to children with normal hearing. Fukuda stepping test showed an abnormal response in 2 children with SNHL (13%) and one child could not perform tandem gait test (7%). Children with SNHL showed an evident abnormality on the balance assessment test results. The abnormal function of the vestibular system and the vestibulospinal pathway can compromise the child's motor development and thus needs investigation early in life.

Liver Transplant Is Associated with Sustained Improvement in Tandem Gait and Risk of Falls.

BACKGROUND: Cirrhosis is associated with poor health-related quality of life (HRQOL), cognitive dysfunction (CD), and lack of coordination leading to falls. Tandem gait (TG; heel-toe) can be used to assess coordination. The impact and relationship between CD, TG and falls pre-/post-liver transplant (LT) is unclear. We aimed to determine the impact of LT on CD, abnormal TG, and HRQOL in cirrhosis. METHODS: We analyzed patients who underwent complete neurological examination, cognitive testing by psychometric hepatic encephalopathy score (PHES), and HRQOL assessment using sickness impact profile (SIP). All patients were followed for 1 post-LT visit at 6 or 12 months post-LT for clinical course and falls. Change in CD, TD, and falls pre-/post-LT were compared. RESULTS: Off 131 recruited, 61 patients completed all visits. Majority were men (84%), with HCV etiology (34%). Pre-LT: Abnormal TG trended towards increased falls (OR 3.3, P = 0.08). Forty-nine % had abnormal TG, 61% had CD, 32.7% had CD + abnormal TG, 62% had prior OHE, and 14.7% had falls. Abnormal and normal TG patients had similar ages, BMI, sex, education level, and MELD scores. Abnormal TG group had higher prior overt HE (P = 0.03) and worse physical SIP score (P = 0.008). Post-LT: There was sustained improvement in CD, HRQOL, falls, and TG post-LT more at 12 than 6 months in all patients. Patients who had abnormal TG pre-LT continued to have a worse PHES (P = 0.0064) and physical SIP score (P = 0.008) compared to normal pre-LT TG patients. CONCLUSION: After LT, there is a sustained improvement in coordination measured via tandem gait, accompanied by a lower rate of falls.

Longitudinal prediction of falls and near falls frequencies in Parkinson's disease: a prospective cohort study.

INTRODUCTION AND OBJECTIVE: Several prediction models for falls/near falls in Parkinson's disease (PD) have been proposed. However, longitudinal predictors of frequency of falls/near falls are poorly investigated. Therefore, we aimed to identify short- and long-term predictors of the number of falls/near falls in PD. METHODS: A prospective cohort of 58 persons with PD was assessed at baseline (mean age and PD duration, 65 and 3.2 years, respectively) and 3.5 years later. Potential predictors were history of falls and near falls, comfortable gait speed, freezing of gate, dyskinesia, retropulsion, tandem gait (TG), pain, and cognition (Mini-Mental State Exam, MMSE). After each assessment, the participants registered a number of falls/near falls during the following 6 months. Multivariate Poisson regression was used to identify short- and long-term predictors of a number of falls/near falls. RESULTS: Baseline median (q1-q3) motor (UPDRS) and MMSE scores were 10 (6.75-14) and 28.5 (27-29), respectively. History of falls was the only significant short-time predictor [incidence rate ratio (IRR), 15.17] for the number of falls/near falls during 6 months following baseline. Abnormal TG (IRR, 3.77) and lower MMSE scores (IRR, 1.17) were short-term predictors 3.5 years later. Abnormal TG (IRR, 7.79) and lower MMSE scores (IRR, 1.49) at baseline were long-term predictors of the number of falls/near falls 3.5 years later. CONCLUSION: Abnormal TG and MMSE scores predict the number of falls/near falls in short and long term, and may be indicative of disease progression. Our observations provide important additions to the evidence base for clinical fall prediction in PD.

Clinical feasibility and utility of a dual-task tandem gait protocol for pediatric concussion management.

CONTEXT: Clinical management of sport-related concussion requires the assessment of various factors, including motor performance. The tandem gait test, a measure of post-injury motor performance, has demonstrated clinical utility, but is limited by time availability and test uniformity. OBJECTIVE: To assess intrasession reliability between tandem gait test trials and determine the number trials necessary for optimal utility and feasibility in clinical decision-making following concussion. DESIGN: Cross-Sectional Study Setting: Pediatric Sport Medicine Clinic Participants: Adolescent athletes who recently sustained a concussion (n=44; age=15.4±1.8 years; 39% female) and were seen for care within 14 days (7.3±3.2 days) of their injury, as well as uninjured control participants (n=73; age=15.8±1.3 years; 41% female). All participants completed three single-task and three dual-task tandem gait trials. OUTCOME MEASURES: We collected test completion time and cognitive performance for each trial and calculated Pearson correlation coefficients between trials and Intraclass Correlation Coefficients to determine intrasession reliability. We also compared performance between groups, and calculated area under the curve (AUC) values to identify the ability of each trial to distinguish between groups. RESULTS: Both the concussion and control group demonstrated high intrasession reliability between tandem gait trials under single (R ≥ 0.82; ICC≥ 0.93) and dual-task conditions (R ≥ 0.79; ICC≥ 0.92). The greatest group classification values were obtained from the second single-task trial (AUC = 0.89) and first dual-task trial (AUC = 0.83). Test completion time provided excellent between-group discrimination in single-task and dual-task conditions. However, cognitive performance during dual-task trials demonstrated only marginally significant clinical utility (AUC ≤ 0.67). CONCLUSION: Tandem gait assessments may only require two trials under single-task and one trial under dual-task conditions to effectively discriminate between concussion and control groups. This approach may improve the feasibility (time requirement) of the test, while maintaining excellent discriminatory ability.

Diagnostic Accuracy of Clinical Tests for the Indirect Assessment of Hip Abductor Muscle Strength in Community-Dwelling Older Women.

OBJECTIVE: The objective of this study was to determine the accuracy of 3 clinical tests (lateral step [LS], tandem gait [TG], and single-leg stance [SS]) in identifying older women with reduced hip abductor muscle strength and to determine the post-test probability of each test and of their combination in changing the certainty of diagnosis. METHODS: In this cross-sectional study, a total of 123 older women received clinical testing to obtain the variables LS height, time for TG execution, percentage of errors in TG, and time of permanence on SS and were tested for isometric hip abductor peak torque using an isokinetic dynamometer. Only the dominant lower limb was evaluated. Multiple linear regression analysis with adjustment was performed to determine the association among variables, followed by the receiver operating characteristic curve to identify clinical variables that can discriminate older women with reduced abductor muscle strength. Post-test probability was then calculated based on the receiver operating characteristic curve data. RESULTS: Although the 4 clinical variables showed correlation with abductor peak torque, only LS and TG time were able to discriminate reduced abductor muscle strength with low accuracy (area under the curve was between 0.5 and 0.7). However, the combination of LS and TG time increased post-test probability from 47% (prevalence of weakness in the population) to 76% when both tests were positive and reduced it from 47% to 18% when both tests were negative. CONCLUSION: The combination of the LS test and TG time is useful for the indirect assessment of hip abductor strength in community-dwelling older women. IMPACT: Hip abductor muscle strength is extremely important for function in older women. This study presents clinicians with simple, fast, and inexpensive methods for assessing hip abductor muscle strength.

Relations between gait characteristics and subjective visual vertical results in young adults.

OBJECTIVE: Subjective visual vertical (SVV) deviation can indicate impairments of motion perception and spatial orientation in individuals with vestibular disorders. This study investigated the influence of SVV on tandem gait ability by assessing differences between temporal, spatial, and kinematic characteristics in young adults. METHODS: We recruited sixteen young adults with increased SVV and 17 age-matched control subjects. All subjects recruited for this study were with no history of neurological or musculoskeletal diseases. Knee and hip-joint kinematic data, spatio-temporal parameters, and gait variability were measured during tandem gait. RESULTS: Stride time variability and stride velocity variability were significantly greater in the experimental group than the control group (p < 0.05). In addition, a significant correlation was observed between stride time variability and SVV results (r = 0.345, p < 0.05). However, hip and knee joint angles were non-significantly different in the experimental and control groups (p > 0.05) and spatio-temporal parameters were similar between the two groups (p > 0.05). CONCLUSION: Stride time variability and stride velocity variability during tandem gait were significantly different in the experimental and control groups. We presume that increased SVV deviation is related to greater gait variability during tandem gait.

Objective impairment of tandem gait in Parkinson's disease patients increases with disease severity.

INTRODUCTION: Tandem gait abnormalities have been reported to increase with advancing age, play a role in fall-prediction in Parkinson's disease, and distinguish it from atypical parkinsonism. Tandem gait has been scored based on the number of side steps off a straight line in these studies. Objective measurement of spatiotemporal tandem gait parameters in Parkinson's disease has not been previously reported. METHODS: Subjects (74 Parkinson's disease and 28 controls) were enrolled after IRB approval. Those with more than 1 fall/day or a Montreal Cognitive Assessment score <10 were excluded. Subjects tandem walked ("heel to toe") on a 20 foot pressure-sensor mat. Data was collected and analyzed using PKMAS software (Protokinetics). RESULTS: Compared to controls, on tandem gait, Parkinson's subjects had increased step width, stride width and path width, with a slower stride velocity and an increased time spent in all phases of the gait cycle. Parkinson's subjects also applied greater pressure with each step and had greater step-to-step variability in tandem gait measures. While Hoehn & Yahr stage 1 subjects were not significantly different from controls, stage 2 and 2.5 + groups were different. Parkinson's subjects with freezing of gait also walked with a wider base compared to those without gait freezing. Tandem gait spatiotemporal parameters were not correlated with fall frequency. CONCLUSIONS: Tandem gait is impaired in Parkinson's disease in a stage-dependent manner, with wider base and increased step-to-step variability, which could suggest involvement of cerebellar and mediolateral balance pathways.

Kinetic analysis of tandem gait on a sine-wave-shaped walkway.

[Purpose] The purpose of this study was to ascertain the kinetic characteristics on a horizontal plane, including knee joint rotation, when performing tandem gait on a sine-wave walkway. [Participants and Methods] The participants were 10 healthy adults. The movement task included tandem gait on a sine-wave walkway. The instruments used were an electromyograph and a three-dimensional motion analysis system. Regarding data analysis, we determined the knee joint rotation angle and muscle activity of the biceps femoris and semitendinosus muscle. [Results] The knee joint rotation angle range was 48.1 ± 6.7°. Two strategies were confirmed with regard to the direction of knee joint rotation: a case in which the agonist muscle acts actively and a case in which the antagonist muscle acts passively. [Conclusion] It has been suggested that the knee joint rotational angle and muscular activity of the rotator muscle group are important for tandem gait on a sine-wave-shaped walking path.

Single and dual tandem gait assessment post concussion: What performance time is clinically relevant across adult ages and what can influence results?

AIM: The three-metre tandem gait test (TG) is used to assess postural control during locomotion following sports concussion. However, values used to determine a pass/fail result are currently based on young athletic populations. Times for test completion may be influenced by several intrinsic or extrinsic factors. The aim of this study was to collate healthy individual single, dual task as well as dual task cost - motor TG times for a non-elite athlete population, across several age groups, and to investigate several potential influencing factors. METHODS: Healthy individuals aged 18-55+, who had never experienced a concussion completed single and dual task TG following the SCAT5 protocol. A separate group (n = 20, age, foot length and body mass index matched) performed the tests with alternate instructions. RESULTS: Mean best TG time for all participants were: single task 21.03 (±5.26s), dual task 29.59 (±9.84s) and DTC-motor 8.57 (±7.5s:41.7%). Age and foot length but not specificity of verbal instructions were related to TG times. Significantly slower single and dual task times were identified for the 55 + age group when compared to the three youngest groups (p < 0.01). No difference was seen for DTC-motor time or % between age groups (p > 0.05). CONCLUSION: Healthy individual data collected exceeded previously reported average times. Faster times were evident in younger participants and those with longer foot length. Results from this study can be used as a reliable guideline to inform clinical decisions around the pass/fail result of TGT across age ranges in non-elite athlete populations post-concussion.

Tandem gait abnormality in Parkinson disease: Prevalence and implication as a predictor of fall risk.

INTRODUCTION: We report the prevalence of abnormal tandem gait (TG) in patients with idiopathic Parkinson disease (PD) and its association with symptoms of subjective unsteadiness, falls, freezing of gait, and cognitive impairment. METHODS: We assessed subjective balance impairment, fall history, antero-posterior postural instability, and TG in PD patients (Hoehn and Yahr (HY) stage 0-4). We recorded the age, sex, current medications, HY stage, Schwab and England (S&E) scale score, and MOCA score for each patient. Logistic regression was used to evaluate age-adjusted associations between TG and other demographic and clinical factors. RESULTS: A total of 102 patients with PD were assessed. Of those, 63.5% of HY 2 patients and 100% of HY 2.5 and 3 patients had a TG abnormality. The presence of TG abnormality was associated with subjective imbalance, falls, freezing of gait, S&E < 80, and MOCA score <24 after adjustment for age. CONCLUSIONS: TG abnormality is common in PD, precedes the development of antero-posterior postural instability, is associated with cognitive impairment, and may predict fall risk. A longitudinal study will help determine if TG is a predictor of impending progression from HY 2 to HY 3.

Contribution of hip abductor-adductor muscles on static and dynamic balance of community-dwelling older adults.

BACKGROUND: The previous studies have investigated causes of and risk factors for falls and impairment of functional capability in older adults. However, the biomechanical factors involved in functional performance and postural control, and the contribution of hip muscles, are still unknown. AIMS: The aim of the present study was to verify the association between the muscle function of hip abductors and adductors and static and dynamic balance, in a narrow base of support, in community-dwelling older adults. METHODS: Eighty-one older adults, including both women and men, were evaluated. Tandem gait and single-leg stance were used to assess static and dynamic balance, and an isokinetic dynamometer was used to analyze muscle function (peak torque and rate of torque development according to body weight). Data were analyzed by a multivariate linear regression test without adjustment and with adjustment using two models: adjustment I (sex) and adjustment II (age). RESULTS: There was a statistically significant association between peak torque of abductor in single-leg stance and tandem gait speed. The PT of hip adductors contributed to static balance performance, in a narrow base of support from the unadjusted data and from the adjusted data by sex. CONCLUSION: The findings of the present study are relevant, because if deficits in balance and functionality in older adults can be linked to a decline in maximum muscle strength of hip abductors, this parameter can be treated to maintain independence in older adults for as long as possible.

Clinical differences in patients with Parkinson's disease according to tandem gait performance.

Some of patients with Parkinson's disease (PD) have abnormal tandem gait (TG) performance without any symptoms and signs of cerebellar dysfunction. Clinical difference between patients with good and poor TG performance has not yet been studied. We report the relationship between tandem gait performance and clinical characteristics including 37 patients with PD who had no evidence of cerebellar dysfunction. Using tandem gait test, the patients were divided into two groups (good-TG and poor-TG). We evaluated the two groups with Montreal Cognitive Assessment (MoCA), Mini Mental Status Examination (MMSE), Frontal Assessment Batter (FAB), Beck Depression Index (BDI-II), REM Sleep Behavior Disorder Single-Question Screen (RBD1Q), MDS-UPDRS items related to axial disability and freezing. Fifteen participants were classified as good-TG group and 22 were as poor-TG group. Participants in good-TG group had higher MoCA score and lower BDI-II score. The proportion of participants who answered "yes" to RBD1Q was lower in good-TG group (27%, 4 of 15) than that in poor-TG group (55%, 12 of 22). All participants in good-TG group marked "0" for the MDS-UPDRS item 2.13 which addresses freezing event over the past week, whereas 18% (4 of 22) of participants in poor-TG group marked "1". In conclusion, tandem gait performance may be related to various clinical characteristics including cognitive function, mood, RBD, and freezing in patients with PD.

Functional balance assessment in recreational college-aged individuals with a concussion history.

OBJECTIVES: Despite evidence for increased musculoskeletal injury after concussion recovery, there is a lack of dynamic balance assessments that could inform management and research into this increased injury risk post-concussion. Our purpose was to identify tandem gait dynamic balance deficits in recreational athletes with a concussion history within the past 18-months compared to matched controls. DESIGN: Cross-sectional, laboratory study. METHODS: Fifteen participants with a concussion history (age: 19.7±0.9years; 9 females; median time since concussion 126 days, range 28-432 days), and 15 matched controls (19.7±1.6years; 9 females) with no recent concussion history participated. We measured center-of-pressure (COP) outcomes (velocity, path length, speed, dual-task cost) under 4 tandem gait conditions: (1) tandem gait, (2) tandem gait, eyes closed, (3) tandem gait, eyes open, cognitive distraction, and (4) tandem gait, eyes closed, cognitive distraction. RESULTS: The concussion history group demonstrated slower tandem gait velocity compared to the control group (4.0cm/s difference), thus velocity was used as a covariate when analyzing COP path length and speed. The concussion history group (23.5%) demonstrated greater COP speed dual-task cost than the control group (16.3%) during the eyes closed dual-task condition. No other comparisons were statistically significant. CONCLUSIONS: There may be subtle dynamic balance differences during tandem gait that are detectable after return-to-activity following concussion, but the clinical significance of these findings is unclear. Longitudinal investigations should identify acute movement deficits in varying visual and cognitive scenarios after concussion in comparison with recovery on traditional concussion assessment tools while also recording musculoskeletal injury outcomes.

Objective measures of gait and balance in healthy non-falling adults as a function of age.

BACKGROUND: Neurodegenerative diseases increase in incidence with age. Prior studies using differing populations and gait paradigms have reported various parameters changing with age, some of which correlate with falls and mortality. Here we use three different paradigms to evaluate gait and balance in healthy non-fallers. RESEARCH QUESTION: What objective gait and balance parameters are correlated with aging. METHODS: Healthy subjects aged 21-79 years without histories of falls, lower extremity orthopedic procedures or chronic pain were included. Subjects walked on a 20 × 4 foot pressure sensor mat (Zeno Walkway, Protokinetics, Havertown, PA) under three different gait paradigms, (i) steady-state gait, (ii) dual-task while texting on a cellular phone and (iii) tandem gait. Data was collected and analyzed using PKMAS software (Protokinetics). Linear regression analysis, stepwise multivariate analysis, and grouped analysis of gait parameters was performed using SPSS 24 (IBM). RESULTS: Seventy-five subjects were enrolled. Grouped analysis and linear regression analysis showed differing significance in parameters tested. Step-wise multivariate analysis of all 31 parameters assessed from three different gait paradigms, showed weak but significant correlations in age with (i) stride-to-stride variability in (i) integrated-pressure of footsteps and (ii) stride-length during steady-state gait, (iii) mean stride-length on dual-task, and (iv) mean step-width on tandem gait (R2 = 0.382, t = 2.26, p = 0.026). SIGNIFICANCE: In a population of healthy subjects without prior history of falls or medical illness that should affect gait, there were weak but significant age-related changes in objective measures of steady state gait and balance. Future prospective longitudinal data will help predict the relevance of this in relation to falls in the elderly.