Sensor-based gait analysis in atypical parkinsonian disorders

Cecilia Raccagni, Heiko Gaßner, Sabine Eschlboeck, Sylvia Boesch, Florian Krismer, Klaus Seppi, Werner Poewe, Bjoern M Eskofier, Juergen Winkler, Gregor Wenning, Jochen Klucken, Cecilia Raccagni, Heiko Gaßner, Sabine Eschlboeck, Sylvia Boesch, Florian Krismer, Klaus Seppi, Werner Poewe, Bjoern M Eskofier, Juergen Winkler, Gregor Wenning, Jochen Klucken

Abstract

Background and objectives: Gait impairment and reduced mobility are typical features of idiopathic Parkinson's disease (iPD) and atypical parkinsonian disorders (APD). Quantitative gait assessment may have value in the diagnostic workup of parkinsonian patients and as endpoint in clinical trials. The study aimed to identify quantitative gait parameter differences in iPD and APD patients using sensor-based gait analysis and to correlate gait parameters with clinical rating scales.

Subjects and methods: Patients with iPD and APD including Parkinson variant multiple system atrophy and progressive supranuclear palsy matched for age, gender, and Hoehn and Yahr (≤3) were recruited at two Movement Disorder Units and assessed using standardized clinical rating scales (MDS-UPDRS-3, UMSARS, PSP-RS). Gait analysis consisted of inertial sensor units laterally attached to shoes, generating as objective targets spatiotemporal gait parameters from 4 × 10 m walk tests.

Results: Objective sensor-based gait analysis showed that gait speed and stride length were markedly reduced in APD compared to iPD patients. Moreover, clinical ratings significantly correlated with gait speed and stride length in APD patients.

Conclusion: Our findings suggest that patients with APD had more severely impaired gait parameters than iPD patients despite similar disease severity. Instrumented gait analysis provides complementary rater independent, quantitative parameters that can be exploited for clinical trials and care.

Keywords: atypical parkinsonian disorders; multiple system atrophy; parkinson's disease; progressive supranuclear palsy; sensor-based gait analysis.

© 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Spatiotemporal gait parameters (Mean ± SD) in patients with atypical Parkinson disorders (APD), patients with Parkinson's disease (iPD)—(matched by age, gender, age of onset, and Hoehn & Yahr disease stage), and healthy controls (matched by age and gender). Max toe clearance (cm), Maximum toe height during swing phase; Heel strike angle (°), Angle of heel contacting the floor at initiation of stance phase; Toe off angle (°), Angle of toe during push‐off at end of stance phase. * p < 0.05, ** p < 0.01, *** p < 0.001 Bonferroni post‐hoc test
Figure 2
Figure 2
Spatiotemporal gait parameters (Mean ± SD) in patients with MSA, PSP, patients with idiopathic Parkinson's disease (iPD)—(matched by age, gender, age of onset and Hoehn & Yahr disease stage), and healthy controls (matched by age and gender). * p < 0.05, ** p < 0.01, *** p < 0.001 Bonferroni post‐hoc test
Figure 3
Figure 3
Correlations between spatiotemporal gait parameters (gait speed, stride length) and UMSARS total score, UMSARS‐1 (Historical review of motor and non‐motor symptoms) (a) as well as UMSARS‐2 (Motor examination) (b) in MSA patients. (c). Correlations between gait parameters (gait speed, stride length), and PSP‐RS in PSP patients (d). rSp = Spearman's rank correlation coefficient
Figure 4
Figure 4
Comparison of gait parameters between (a) MSA patients with and without postural instability (BODY SWAY) and (b) between gait impairment levels rated by item gait of the UMSARS‐2. No/mildly (0/1) impaired gait and moderately/severely (>1) impaired gait in MSA patients were compared to objective gait parameters

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Source: PubMed

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