Research Article

Experimental Brain Research

, Volume 177, Issue 3, pp 336-346

Gait asymmetry in patients with Parkinson’s disease and elderly fallers: when does the bilateral coordination of gait require attention?

  • Galit YogevAffiliated withMovement Disorders Unit, Neurology Department, Tel-Aviv Sourasky Medical Center
  • , Meir PlotnikAffiliated withMovement Disorders Unit, Neurology Department, Tel-Aviv Sourasky Medical Center
  • , Chava PeretzAffiliated withMovement Disorders Unit, Neurology Department, Tel-Aviv Sourasky Medical CenterDepartment of Physical Therapy, Sackler School of Medicine, Tel-Aviv University
  • , Nir GiladiAffiliated withMovement Disorders Unit, Neurology Department, Tel-Aviv Sourasky Medical CenterDepartment of Physical Therapy, Sackler School of Medicine, Tel-Aviv UniversityDepartment of Neurology, Sackler School of Medicine, Tel-Aviv University
  • , Jeffrey M. HausdorffAffiliated withMovement Disorders Unit, Neurology Department, Tel-Aviv Sourasky Medical CenterDepartment of Physical Therapy, Sackler School of Medicine, Tel-Aviv UniversityDivision on Aging, Harvard Medical SchoolLaboratory for Gait Analysis and Neurodynamics, Movement Disorders Unit, Tel-Aviv Sourasky Medical Center Email author 

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Abstract

While it is known that certain pathologies may impact on left–right symmetry of gait, little is known about the mechanisms that contribute to gait symmetry or how high in the hierarchy of the control of gait symmetry is regulated in humans. To assess the contribution of cognitive function to gait symmetry, we measured gait asymmetry (GA) in three subject groups, patients with Parkinson’s disease (PD, n = 21), idiopathic elderly fallers (n = 15), and healthy elderly controls (n = 11). All subjects walked under two walking conditions: usual walking and dual tasking (cognitive loading) condition. For each subject, the swing time (SW) was calculated and averaged across strides for the left and right feet (SWL and SWR). GA was defined as: \( 100 \times {\left| {\ln ({\text{SWR}}/{\text{SWL}})} \right|.} \) For both the PD patients and the elderly fallers GA values were significantly higher during the usual walking condition, as compared with the control group (< 0.01). In addition, for both the PD patients and the elderly fallers, GA significantly increased when they walked and performed a dual task, compared with the usual walking condition (< 0.003). In contrast, dual tasking did not affect the GA of the healthy controls (= 0.518). GA was associated with gait speed and gait variability, but no correlations were found between GA and the asymmetry of the classic PD motor symptoms. Thus, the results suggest that the ability to generate a steady, rhythmic walk with a bilaterally coordinated gait does not rely heavily on mental attention and cognitive resources in healthy older adults. In contrast, however, when gait becomes impaired and less automatic, GA apparently relies on cognitive input and attention.

Keywords

Asymmetry Bilateral coordination Gait Cognitive function Dual tasking