Instrumented Version of the Modified Dynamic Gait Index in Patients With Neurologic Disorders

Abstract

Background: Gait instability is common in adults with neurologic disorders and the modified Dynamic Gait Index (mDGI) was recently introduced to assess dynamic balance. However, instrumental assessment is needed to provide quantitative measures. Objective: To develop and validate an instrumented version of the mDGI. Design: Cross-sectional study. Setting: Clinical setting. Participants: Thirty adults with neurologic disorders (10 with multiple sclerosis, 10 with Parkinson disease, and 10 with stroke) and 20 healthy volunteers. Methods: Participants were assessed with the Timed Up and Go test (TUG) and with the mDGI. During the assessment of mDGI, data were collected by a single Inertial Measurement Unit (IMU) positioned on the sternum. Principal component analysis (PCA) was performed on the instrumented data extracting eight PC scores (ImPC) describing dynamic balance. The instrumented overall score (ImDGI) was then calculated as the sum of the mPCs. PCA revealed two components associated with stride features and regularity (ImDGI_Gait_Pattern) and trunk movements (ImDGI_Trunk_Sway). Spearman coefficients were calculated between mDGI and ImDGI, whereas Mann-Whitney (U) and Kruskal-Wallis (H) tests assessed differences between groups and neurologic conditions. Main Outcome Measurements: ImDGI. Results: ImDGI did not show ceiling effects, and good correlations were found between ImDGI and mDGI (r = .84), and TUG (r = .84) for people with neurologic disorders (P < .001). Significant differences among pathologies (H test (2) =12.5, P = .002) and between healthy participants and adults with neurologic disorders (U test = 47.0, P = .001) were found. ImDGI_Trunk_Sway discriminated between people using or not using walking aids and among the three pathologies (H (2) = 10.0, P = .007). Conclusions:The ImDGI test seems to provide valid measures to objectively assess dynamic balance in neurologic conditions and possibly quantify balance deficits also in adults with neurologic disorders.

Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice

“…However, it must be highlighted that some PwMS showing normal ImRomberg and tandem gait tests could present with dynamic balance deficits that can be detected only through more difficult tasks (i.e., walking over/around an obstacle, walking with head rotations, stairway walking, etc. [ 11 , 20 , 35 , 81 , 82 ]) which are usually executed with physiotherapists in rehabilitation gyms. For this reason, it would be important to advise these individuals, especially if sedentary, to carry out regular physical activity, including dynamic balance.…”

Is a Wearable Sensor-Based Characterisation of Gait Robust Enough to Overcome Differences Between Measurement Protocols? A Multi-Centric Pragmatic Study in Patients with Multiple Sclerosis

“…In particular, wearable inertial measurement units (IMUs), including accelerometers, gyroscopes, and magnetometers, represent cost-effective tools to perform objective assessments of walking in pwMS outside movement analysis labs [19,20], and even during free-living and community contexts [21,22]. IMUs have been widely used to analyse different locomotor tasks in pwMS, such as straight-line over ground [17,[23][24][25][26][27] and treadmill walking [28], standing up, walking, turning, and sitting down (e.g., the TUG) [15,29], walking with head turns and over/around obstacles [30,31], walking while texting [32], and stairway walking [33]. During these tests, several parameters have been extracted from IMUs, including spatio-temporal parameters [15,24,27,28,31,32,34], indexes of gait variability and stability [17,23,24,26,31,33], trunk sway metrics [15,23,30,34], and angular variables [15,25,27,34].…”

Walking With Horizontal Head Turns Is Impaired in Persons With Early-Stage Multiple Sclerosis Showing Normal Locomotion

“…Importantly, WHHT, as measured by the Fullerton Advanced Balance scale-short version (10), resulted to be the most impaired item (together with turning 360 • ) also in early-stage PwMS (11). Recently, Cattaneo et al (12) found that WHHT is more impaired in PwMS compared to stroke survivors and people with Parkinson's disease, complementing previous results showing more severe static and dynamic balance deficits in PwMS (7,13,14).…”

“…Healthy subjects (HS) and NW-PwMS were equipped with three wireless IMUs (MTw, Xsens, The Netherlands) secured on both shanks (above lateral malleoli) and the sternum. The position of the latter IMU was chosen to better describe sway and possible instability of the upper trunk that, based on our clinical experience, seem to occur more frequently during locomotor tasks particularly demanding in terms of dynamic balance [e.g., TUG test (34), walking while turning the head (13), walking around/over obstacles (13), stairway walking (14)], than during straight-line walking. IMU-derived accelerations and angular velocities were recorded at 75 Hz.…”