Independent domains of daily mobility in patients with neurological gait disorders

Abstract

The aim of this study was to establish a comprehensive and yet parsimonious model of daily mobility activity in patients with neurological gait disorders. Patients (N = 240) with early-stage neurological (peripheral vestibular, cerebellar, hypokinetic, vascular or functional) gait disorders and healthy controls (N = 35) were clinically assessed with standardized scores related to functional mobility, balance confidence, quality of life, cognitive function, and fall history. Subsequently, daily mobility was recorded for 14 days by means of a body-worn inertial sensor (ActivPAL ®). Fourteen mobility measures derived from ActivPAL recordings were submitted to principle component analysis (PCA). Group differences within each factor obtained from PCA were analyzed and hierarchical regression analysis was performed to identify predictive characteristics from clinical assessment for each factor. PCA yielded five significant orthogonal factors (i.e., mobility domains) accounting for 92.3% of the total variance from inertial-sensor-recordings: ambulatory volume (38.7%), ambulatory pattern (22.3%), postural transitions (13.3%), sedentary volume (10.8%), and sedentary pattern (7.2%). Patients' mobility performance only exhibited reduced scores in the ambulatory volume domain but near-to-normal scores in all remaining domains. Demographic characteristics, clinical scores, and fall history were differentially associated with each domain explaining 19.2-10.2% of their total variance. This study supports a low-dimensional five-domain model for daily mobility behavior in patients with neurological gait disorders that may facilitate monitoring the course of disease or therapeutic intervention effects in ecologically valid and clinically relevant contexts. Further studies are required to explore the determinants that may explain performance differences of patients within each of these domains and to examine the consequences of altered mobility behavior with respect to patients' risk of falling and quality of life.

Gait speed in clinical and daily living assessments in Parkinson’s disease patients: performance versus capacity

“…Moreover, the context of the environment is different at home or outdoor where there are multiple obstacles and more complexity compared to the clinical setting 27,28 . Therefore, unsupervised assessments at home can provide additional information through long-term monitoring 29 . Furthermore, it would also be possible to capture rare incidents such as falls or stage before an injury which may not be measurable during a clinical visit.…”

A Multifactorial Model of Multiple Sclerosis Gait and Its Changes Across Different Disability Levels

“…The need to reduce the number of gait metrics to a more manageable size, while retaining as much of the original information as possible has previously led to the development of several conceptual gait models. In particular, these models have been proposed for community-dwelling older adults [28]- [30], older adults with mild cognitive impairment syndromes [31], people with dementia [32], people with Parkinson's disease (PD) [33]- [36], people with early-stage neurological (peripheral vestibular, cerebellar, hypokinetic, vascular or functional) gait disorders [37], and people with hip fracture [38]. Overall, these studies showed that gait characteristics of different cohorts do not consistently load onto identical domains.…”

Impact on daily mobility and risk of falling in bilateral vestibulopathy

“…As of recently, advances in real-world mobility assessment based on body-worn inertial sensors offer the possibility to directly study the impact of BVH-related impairments on daily-life activities and mobility in individual patients [ 16 ]. Whereas lab-based measures commonly focus on the detailed spatiotemporal features of balance and gait deficits, measures from body-worn sensors provide complementary insights into a patient’s overall mobility status and balance capabilities from a macroscopic perspective [ 17 , 18 ]. This information could entail important information to elucidate the ecological relevance of vestibular hypofunction for patients’ activities of daily living and mobility, to establish new clinical endpoints for future clinical trials in BVH, and to supplement currently available screening tools for fall risk assessment in BVH.…”