age related changes in gait
TRANSCRIPT
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Gait Changes in Older Adults
Reto W. Kressig
“MOBEQ” Unit
Geriatrics Department
Geneva University Hospitals, Switzerland
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Outline
• Definition of Gait Parameters
• Age-Related Gait Changes
• Pathological Gait Changes
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Stance Swing
Initial Double Support Terminal Double Support
Gait Cycle (right side)
Gait Cycle (Temporal Measures)
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Stride Width
Stride Length
Spatial Gait Measures
Step Length
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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)
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Biomechanical Gait Analysis
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Electronic Walkway: GAITRite®Temporal and Spatial Measurements
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One Completed Walk
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Normal Walking
Age-Related Gait Changes
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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
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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
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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
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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
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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
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Gait Changes Related to :
• Psychological Factors
• Increased Falling Risk
• Interventions
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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.
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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.
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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.
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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.
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Gait Changes Related to :
Increased Falling Risk
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Gait Variability: Stride-to-Stride Variability
Example: Stride Length
Coefficient of Variation, CoVar = (SD/M) 100
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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
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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.
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Spatial and Temporal Gait Changes
Related to Interventions ?
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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
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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
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Resistance Training
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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)
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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)
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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