kressig

Gait Changes in Older Adults

Reto W. Kressig

“MOBEQ” Unit

Geriatrics Department

Geneva University Hospitals, Switzerland

Outline

• Definition of Gait Parameters

• Age-Related Gait Changes

• Pathological Gait Changes

Stance Swing

Initial Double Support Terminal Double Support

Gait Cycle (right side)

Gait Cycle (Temporal Measures)

Stride Width

Stride Length

Spatial Gait Measures

Step Length

Gait Laboratory

Light Barrier1

Light Barrier2

Camera 1

Camera 2

Camera 3

StartingLine

Force Plates

1 2

6 meters2 meters 2 meters

Visual Target(Traffic Cone)

Biomechanical Gait Analysis

Electronic Walkway: GAITRite®Temporal and Spatial Measurements

One Completed Walk

Normal Walking

Age-Related Gait Changes

Normal Walking: Velocity

Normal velocity during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = meters/minuteHorizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992

Normal Walking: Stride Length

Normal stride length during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = meters; Horizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992

Normal Walking: Cadence

Normal cadence during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = steps/minute; Horizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992

Comparison of Young Adults and Elderly Subjects

Spatial and Temporal Gait Parameters

Winter DA. The biomechanics and motor control of human gait: Normal, elderly and pathological. 2nd ed. Waterloo: University of Waterloo Press; 1990

Variable Young Adult Elderly Signif. (N = 11) (N = 18)

Age (yrs.) 24.9 ± 1.9 68.9 ± 4.0Height (m) 1.75 ± 0.08 1.71 ± 0.10Cadence (steps/min.) 110.5 ± 8.3 111.8 ± 8.7Velocity (m/sec.) 1.29 ± 0.13 1.44 ± 0.19 p < 0.01Stride Length (m) 1.56 ± 0.10 1.38 ± 0.12 p < 0.01Stance Time (%) 62.3 ± 1.48 65.7 ± 1.52 p < 0.01

Comparison of Young Adults and Elderly Subjects

Significant Differences in Other Gait Parameters

Winter DA. The biomechanics and motor control of human gait: Normal, elderly and pathological. 2nd ed. Waterloo: University of Waterloo Press; 1990

Variable Young Adult Elderly Signif. (N = 11) (N = 18)

Push-off work (J/kg) 0.293 ± 0.057 0.190 ± 0.043 p < 0.01Head Hor. Acc (m/s²) 0.475 ± 0.365 0.621 ± 0.215 p < 0.05Hor HC Vel (m/sec) 0.872 ± 0.148 1.15 ± 0.29 p < 0.01

Gait Changes Related to :

• Psychological Factors

• Increased Falling Risk

• Interventions

Slow Walkers are more likely to be fearful...

Variable

OR (95% CI)* p OR (95% CI) p

Depression by CES-D 1.9 (1.1, 3.4) 0.028 1.6 (1.3, 2.3) 0.012

Use of Walking Aid 2.1 (1.2, 3.7) 0.008 1.4 (1.2, 1.9) 0.001

Slow Gait Speed 2.1 (1.2, 3.7) 0.009 1.5 (1.3, 2.2) 0.006

Ethnicity: African American 1.2 (0.7, 2.2) 0.492 2.0 (1.3, 2.5) 0.025

*OR = Odds Ratio, CI = Confidence Interval

FES ABC

Table 4. Multiple Logistic Regression Modeling Results

Kressig RW, Wolf SL, Sattin RW et al. Associations of demographic, functional and behavioral characteristics with activity related fear of falling among older adults transitioning to frailty. J Am Geriatr Soc 2001; 49:1456-1462.

Fear of Falling and Gait Performance

Descriptive Statistics (mean ± SD) for the Gait Measures

Non-fallers Fallers Fearless Fearful Fearless Fearful n = 19 n = 13 n = 17 n = 26 Gait Measure Stride length (m) 1.01 ± 0.23 0.87 ± 0.17 0.89 ± 0.19 0.83 ± 0.16 Stride width (m) 0.14 ± 0.04 0.14 ± 0.03 0.15 ± 0.03 0.16 ± 0.04 Double support (% of stride) 14.1 ± 4.40 19.0 ± 5.00 18.2 ± 6.00 19.8 ± 5.50 Stride velocity (ms) 0.79 ± 0.20 0.68 ±0.19 0.76 ± 0.19 0.66 ± 0.19 Maki BE. Gait changes in older adults : Predictors of falls or indicators of fear ? J Am Geriatr Soc 1997 ; 45:313-320.

Associations of Gait Measures with Falling and Fear of Falling

Gait Measure OR for Falling OR for Fear of Falling(95% confidence interval) (95% confidence interval)

Stride-to-Stride Average Stride length 1.25 (0.64-2.47) 1.98 (1.04-3.75)*Double-support 1.38 (0.76-2.50) 1.98 (1.10-3.54)*Stride velocity 0.90 (0.50-1.63) 1.74 (1.01-3.02)*

Stride-to-Stride SDStride length 1.95 (1.08-3.52)* 1.27 (0.77-2.11)Double-support 2.05 (1.11-3.77)* 1.38 (0.83-2.27)Stride velocity 2.30 (1.17-4.51)* 0.94 (0.58-1.51)

* (p < 0.05)

Maki BE. Gait changes in older adults: Predictors of falls of indicators of fear ? J Am Geriatr Soc 1997;45:313-20.

Correlation of Perceived Physical Health Status (Sickness Impact Profile Score, SIP) and Depression (CES-D Scale) With Gait Speed (N = 152, Age = 75±4.4) Pearson R p-value SIP Physical -.42 < .01 Depression (CES-D) -.22 < .01 Notes : CES-D scored from 0 (best) to 60 (worst). SIP scored from 0 (best) to 100 (worst) Buchner DM, Cress ME, Esselman PC et al. Factors Associated with changes in gait speed in older adults. J Gerontol 1996,51 :M297-302.

Gait Changes Related to :

Increased Falling Risk

Gait Variability: Stride-to-Stride Variability

Example: Stride Length

Coefficient of Variation, CoVar = (SD/M) 100

Stride-to-Stride Variabilityand Falls in Older Adults

Odds Ratio for Falling

Gait Measure Change (95% Confidence Interval)

Stride-to-Stride-Standard DeviationStride Length +0.017m 1.95(1.08-3.52) Double-Support +0.72% 2.05(1.11-3.77)Stride Velocity +0.016m/s 2.30(1.17-4.51)

Maki BE. Gait changes in older adults: Predictors of falling or indicators of fear? J Am Geriatr Soc 1997;45:313-320

Stride/Swing Time Variabilityand Falls in Older Adults

(N = 52; mean age = 80.3 years)

Gait Measure Fallers Non-Fallers p(n = 20) (n = 32)

Stride time variability (msec) 106 ± 30 49 ± 4 < .04Swing time variability (msec) 39 ± 4 27 ± 2 < .03

Hausdorff J, Rios D, Edelberg H. Gait variability and fall risk in community-living older adults: A 1-year prospective Study. Arch Phys Med Rehabil 2001; 82: 1050-6.

Spatial and Temporal Gait Changes

Related to Interventions ?

Individual Balance Training

Tinetti ME, Baker DI, Garrett PA et al. Yale FICSIT: Risk factor abatement strategy for fall prevention. J Am Geriatr Soc 1993;41:315-20

T’ai Chi Inspired Exercise Program

Kressig RW, Wolf SL. Exploring guidelines for the application of T’ai Chi to patients with stroke. Neurology Report 2001;25:50-54

Resistance Training

In comparison to the young, the elderly

walk slower, have a shorter step length

an increase in stance time and double support, and a far less vigorous push off.

Adaptations representing a safer gait pattern

Take Home Messages (1)

Reduced speed, reduced stride length,

and increased double support time

- are associated with fear of falling

- but show no association with falling

Take Home Messages (2)

Stride-to-stride variability in the control of gait

• is an independent predictor of falling

• may be an important measure for

Take Home Messages (3)

- identifying high risk individuals- evaluating preventive interventions