Clinical and automated gait analysis in patients with vestibular, cerebellar, and functional gait disorders: perspectives and limitations

Schniepp, Roman; Möhwald, Ken; Wuehr, Max

doi:10.1007/s00415-019-09378-x

Cited by 40 publications

(32 citation statements)

References 28 publications

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“…Withdrawal of visual feedback has stronger deteriorating effects on gait instability in patients with sensory deficits compared to patients with cerebellar ataxia. In contrast, patients with functional ataxia show a paradoxical improvement during fast walking modes [22] and during cognitive dual-task conditions, presumably due to a distraction of the excessive attentional focus on balance adjustments in these patients [31].…”

Section: Scenario I: Gait Ataxia and Unsteadinessmentioning

confidence: 94%

“…The clinical gait profiles, which are discussed in the subsequent paragraphs were recorded on a pressure-sensitive gait carpet (GAITRite ® , CIR System, Franklin, NJ, USA). A multi-condition assessment protocol with walking at selfchosen walking speed (PWS), at slow speed (SS), at maximally fast speed (MS), with reclination of the head (HR), with eyes closed (EC), with performance of a serial seven dual task (DTC), with performance of a verbal fluency dual task (DTS), and while carrying an empty tray (DTM) was performed as described elsewhere [15,22].…”

Section: Multi-condition Gait Assessment and Data Visualizationmentioning

confidence: 99%

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Key gait findings for diagnosing three syndromic categories of dynamic instability in patients with balance disorders

Schniepp

Möhwald

Wuehr³

2020

J Neurol

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With the emergence of affordable, clinical-orientated gait analysis techniques, clinicians may benefit from a general understanding of quantitative gait analysis procedures and their clinical applications. This article provides an overview of the potential of a quantitative gait analysis for decision support in three clinically relevant scenarios of early stage gait disorders: scenario I: gait ataxia and unsteadiness; scenario II: hypokinesia and slow gait; scenario III: apparently normal gait with a specific fall tendency in complex mobility situations. In a first part, we justify the advantages of standardized data collection and analysis procedures including data normalization and dimensionality reduction techniques that facilitate clinical interpretability of instrument-based gait profiles. We then outline typical patterns of pathological gait and their modulation during different walking conditions (variation of speed, sensory perturbation, and dual tasking) and highlight key aspects that are particularly helpful to support and guide clinical decision-making.

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Section: Scenario I: Gait Ataxia and Unsteadinessmentioning

confidence: 94%

Section: Multi-condition Gait Assessment and Data Visualizationmentioning

confidence: 99%

Key gait findings for diagnosing three syndromic categories of dynamic instability in patients with balance disorders

Schniepp

Möhwald

Wuehr³

2020

J Neurol

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“…It has to be investigated whether the same results can be maintained over a longer measuring period. Furthermore, next steps should be made regarding the validity of continuously obtained data and feedback loops, because there is a need for automated data analysis and categorization procedures that offer reliable and ad hoc interpretation [58].…”

Section: Limitationsmentioning

confidence: 99%

Feasibility of a Sensor-Based Technological Platform in Assessing Gait and Sleep of In-Hospital Stroke and Incomplete Spinal Cord Injury (iSCI) Patients

Hendriks

Hulst

Keijsers

2020

Sensors

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Recovery of the walking function is one of the most common rehabilitation goals of neurological patients. Sufficient and adequate sleep is a prerequisite for recovery or training. To objectively monitor patients’ progress, a combination of different sensors measuring continuously over time is needed. A sensor-based technological platform offers possibilities to monitor gait and sleep. Implementation in clinical practice is of utmost relevance and has scarcely been studied. Therefore, this study examined the feasibility of a sensor-based technological platform within the clinical setting. Participants (12 incomplete spinal cord injury (iSCI), 13 stroke) were asked to wear inertial measurement units (IMUs) around the ankles during daytime and the bed sensor was placed under their mattress for one week. Feasibility was established based on missing data, error cause, and user experience. Percentage of missing measurement days and nights was 14% and 4%, respectively. Main cause of lost measurement days was related to missing IMU sensor data. Participants were not impeded, did not experience any discomfort, and found the sensors easy to use. The sensor-based technological platform is feasible to use within the clinical rehabilitation setting for continuously monitoring gait and sleep of iSCI and stroke patients.

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“…Having patients walk under conditions that challenge their biomechanical, sensory, or cognitive resources can help better characterize the causes of their gait impairment. 49 Typically, gait variability levels are higher in cerebellar ataxia compared with vestibular gait ataxia. In cerebellar syndromes, gait variability is increased both during slow and fast walking, and in vestibular ataxia only during slow walking.…”

Section: Laboratory Examinations Of Posture and Gaitmentioning

confidence: 99%

Cerebellar Dizziness and Vertigo: Etiologies, Diagnostic Assessment, and Treatment

et al. 2019

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Cerebellar dizziness and vertigo account for approximately 10% of diagnoses in a tertiary dizziness center. This term summarizes a large group of disorders with chronic (degenerative, hereditary, acquired cerebellar ataxias), recurrent (episodic ataxias), or acute (stroke, inflammation) presentations. Key to the diagnosis is a comprehensive examination of central ocular motor and vestibular function. Patients with cerebellar dizziness and vertigo usually show a pattern of deficits in smooth pursuit, gaze-holding, saccade accuracy, or fixation-suppression of the vestibulo-ocular reflex. Central fixation nystagmus (e.g., downbeat nystagmus), gaze-evoked nystagmus, central positional nystagmus, or head-shaking nystagmus with cross-coupling (i.e., horizontal head shaking causing inappropriate vertical nystagmus) occurs frequently. Overlap syndromes with peripheral vestibular disorders, such as cerebellar ataxia, neuropathy, and vestibular areflexia, exist rarely. Posturography and gait analysis can contribute to diagnostic differentiation, estimation of the risk of falls, as well as quantification of progression and treatment effects. Patients with cerebellar dizziness and vertigo should receive multimodal treatment, including balance training, occupational therapy, and medication.

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Clinical and automated gait analysis in patients with vestibular, cerebellar, and functional gait disorders: perspectives and limitations

Cited by 40 publications

References 28 publications

Key gait findings for diagnosing three syndromic categories of dynamic instability in patients with balance disorders

Key gait findings for diagnosing three syndromic categories of dynamic instability in patients with balance disorders

Feasibility of a Sensor-Based Technological Platform in Assessing Gait and Sleep of In-Hospital Stroke and Incomplete Spinal Cord Injury (iSCI) Patients

Cerebellar Dizziness and Vertigo: Etiologies, Diagnostic Assessment, and Treatment

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