Advertisement

The effect of limb selection methods on gait analysis in Parkinson's disease

      Highlights

      • Methods to calculate gait outcomes, including those related to fall risk, vary.
      • Methods can include using left and right limb or most- and least-affected limb.
      • Using different limbs in analysis significantly altered statistical results.
      • Interactions were found between the method used to quantify gait and faller status.
      • Limb averaging may alter interpretation of findings and mask compensation patterns.

      Abstract

      Introduction

      Asymmetry of motor symptoms is a common characteristic of Parkinson's disease (PD), yet gait outcomes are often reported as limb averages or authors fail to report which limb is being analyzed. This study aimed to investigate how varying limb selection methods may impact statistical comparisons of common gait measures amongst fallers and non-fallers with PD. Methods: Overground walking data was collected on 53 fallers and 117 non-fallers during routine clinical visits. The relationship between limb selection method (left, right, most-affected, least-affected, and limbs averaged) and faller status (faller vs non-faller) on spatiotemporal gait parameters was analyzed using a mixed linear model. Results: Significant interactions between limb selection method and faller status were found for step time variability and swing time variability. Regardless of selection method, it was possible to discern significant differences between fallers and non-fallers. Yet, if researchers only analyze the least-affected limb during gait analysis, the differences between fallers and non-fallers are less apparent. Conclusion: In individuals experiencing uneven laterality of symptoms that affect gait, limb averaging may alter interpretation of statistical findings and mask compensation patterns. This study promotes a refined gait analysis process, particularly in individuals that present with possible asymmetric walking. Including limb selection methods in future studies encourages holistic and transparent analyses within the literature.

      Keywords

      Abbreviations:

      PWP (people with Parkinson's disease), PD (Parkinson's disease), CV (coefficient of variation), H&Y (Hoehn and Yahr), UPDRS-III (Unified Parkinson’s Disease Rating Scale Part III)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Parkinsonism & Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sadeghi H.
        • Allard P.
        • Prince F.
        • Labelle H.
        Symmetry and limb dominance in able-bodied gait: a review.
        Gait Posture. 2000; 12: 34-45https://doi.org/10.1016/S0966-6362(00)00070-9
        • Kowalski E.
        • Catelli D.S.
        • Lamontagne M.
        Side does not matter in healthy young and older individuals – examining the importance of how we match limbs during gait studies.
        Gait Posture. 2019; 67: 133-136https://doi.org/10.1016/j.gaitpost.2018.10.008
        • Arcolin I.
        • Corna S.
        • Giardini M.
        • Giordano A.
        • Nardone A.
        • Godi M.
        Proposal of a new conceptual gait model for patients with Parkinson's disease based on factor analysis.
        Biomed. Eng. Online. 2019; 18: 70https://doi.org/10.1186/s12938-019-0689-3
        • Grajić M.
        • Stanković I.
        • Radovanović S.
        • Kostić V.
        Gait in drug naïve patients with de novo Parkinson's disease – altered but symmetric.
        Neurol. Res. 2015; 37: 712-716https://doi.org/10.1179/1743132815Y.0000000043
        • Marinus J.
        • van Hilten J.J.
        The significance of motor (A)symmetry in Parkinson's disease.
        Mov. Disord. 2015; 30: 379-385https://doi.org/10.1002/mds.26107
        • Sadeghi H.
        • Allard P.
        • Duhaime M.
        Functional gait asymmetry in able-bodied subjects.
        Hum. Mov. Sci. 1997; 16: 243-258https://doi.org/10.1016/S0167-9457(96)00054-1
        • Zanardi A.P.J.
        • Martinez F.G.
        • da Silva E.S.
        • Casal M.Z.
        • Martins V.F.
        • Passos-Monteiro E.
        • Haas A.N.
        • Peyré-Tartaruga L.A.
        Effects of nordic walking on gait symmetry in mild Parkinson's disease.
        Symmetry. 2019; 11: 1481https://doi.org/10.3390/sym11121481
        • Schaafsma J.D.
        • Giladi N.
        • Balash Y.
        • Bartels A.L.
        • Gurevich T.
        • Hausdorff J.M.
        Gait dynamics in Parkinson's disease: relationship to Parkinsonian features, falls and response to levodopa.
        J. Neurol. Sci. 2003; 212: 47-53https://doi.org/10.1016/S0022-510X(03)00104-7
        • Yogev G.
        • Plotnik M.
        • Peretz C.
        • Giladi N.
        • Hausdorff J.M.
        Gait asymmetry in patients with Parkinson's disease and elderly fallers: when does the bilateral coordination of gait require attention?.
        Exp. Brain Res. 2007; 177: 336-346https://doi.org/10.1007/s00221-006-0676-3
        • Rafferty M.R.
        • Prodoehl J.
        • Robichaud J.A.
        • David F.J.
        • Poon C.
        • Goelz L.C.
        • Vaillancourt D.E.
        • Kohrt W.M.
        • Comella C.L.
        • Corcos D.M.
        Effects of 2 Years of exercise on gait impairment in people with Parkinson disease: the PRET-PD randomized trial.
        J. Neurol. Phys. Ther. 2017; 41: 21-30https://doi.org/10.1097/NPT.0000000000000163
        • Pozzi N.G.
        • Canessa A.
        • Palmisano C.
        • Brumberg J.
        • Steigerwald F.
        • Reich M.M.
        • Minafra B.
        • Pacchetti C.
        • Pezzoli G.
        • Volkmann J.
        Freezing of gait in Parkinson's disease reflects a sudden derangement of locomotor network dynamics.
        Brain. 2019; 142: 2037-2050
        • Johnsen E.L.
        • Mogensen P.H.
        • Sunde N.Aa
        • Østergaard K.
        Improved asymmetry of gait in Parkinson's disease with DBS: gait and postural instability in Parkinson's disease treated with bilateral deep brain stimulation in the subthalamic nucleus: improved Asymmetry of Gait in PD with STN-DBS.
        Mov. Disord. 2009; 24: 588-595https://doi.org/10.1002/mds.22419