Temporal gait variability is a critical parameter in patients with balance problems. Increased magnitude of temporal gait variability corresponds to a higher risk of falls. The purpose of this study was to investigate the influence of walking speed on temporal stride-to-stride variability in patients with cerebellar and vestibular deficits. A GAITRite system was used to analyze the gait of 40 patients with cerebellar ataxia, 22 patients with bilateral vestibular failure, and 51 healthy subjects over the entire range of the individual's speed capacity. The coefficient of variability of stride time was calculated for each walk. Temporal gait variability was increased in cerebellar patients and vestibular patients. The magnitude of this variability depended on walking speed in a disease-specific manner. In patients with cerebellar ataxia, variability was increased during slow (8.4 ± 5.3%, P < .01) and fast (7.9 ± 6.4%, P < .01) walking speed but was normal during preferred walking speed. This resulted in a speed-related U-shaped function of stride-time variability. Patients with vestibular failure had increased variability during slow walking (9.9 ± 4.3%, P < .01). During walking with medium and fast walking speed, stride time variability was normal. Minimal temporal gait variability appears to be attractive for the locomotor system in cerebellar patients because these patients preferred to walk at a velocity associated with minimal stride-time variability. In contrast to previous studies, vestibular patients accelerate rather than decelerate gait to achieve dynamic stability. This may be explained by reduced sensory integration during fast locomotion.

BACKGROUND The use of a subdural drain (SDD) after burr-hole drainage of chronic subdural hematoma (cSDH) reduces recurrence at 6 mo. Subperiosteal drains (SPDs) are considered safer, since they are not positioned in direct contact to cortical structures, bridging veins, or hematoma membranes. OBJECTIVE To investigate whether the recurrence rate after insertion of a SPD is noninferior to the insertion of a more commonly used SDD. METHODS Multicenter, prospective, randomized, controlled, noninferiority trial analyzing patients undergoing burr-hole drainage for cSDH aged 18 yr and older. After hematoma evacuation, patients were randomly assigned to receive either a SDD (SDD-group) or a SPD (SPD-group). The primary endpoint was recurrence indicating a reoperation within 12 mo, with a noninferiority margin of 3.5%. Secondary outcomes included clinical and radiological outcome, morbidity and mortality rates, and length of stay. RESULTS Of 220 randomized patients, all were included in the final analysis (120 SPD and 100 SDD). Recurrence rate was lower in the SPD group (8.33%, 95% confidence interval [CI] 4.28-14.72) than in the SDD group (12.00%, 95% CI 6.66-19.73), with the treatment difference (3.67%, 95% CI -12.6-5.3) not meeting predefined noninferiority criteria. The SPD group showed significantly lower rates of surgical infections (P = .0406) and iatrogenic morbidity through drain placement (P = .0184). Length of stay and mortality rates were comparable in both groups. CONCLUSION Although the noninferiority criteria were not met, SPD insertion led to lower recurrence rates, fewer surgical infections, and lower drain misplacement rates. These findings suggest that SPD may be warranted in routine clinical practice

ASA, acetylsalicylic acidCAD, coronary artery diseaseCI, confidence intervalcSDH, chronic subdural hematomaGCS, Glasgow Coma ScalemRS, modified Rankin ScaleOR, odds ratioRD, risk difference.

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