Original Communication

Journal of Neurology

, Volume 261, Issue 1, pp 213-223

Increased gait variability is associated with the history of falls in patients with cerebellar ataxia

  • Roman SchnieppAffiliated withDepartment of Neurology, University of MunichGerman Center for Vertigo and Balance Disorders (DSGZ), University of Munich Email author 
  • , Max WuehrAffiliated withGerman Center for Vertigo and Balance Disorders (DSGZ), University of Munich
  • , Cornelia SchlickAffiliated withDepartment of Neurology, University of MunichGerman Center for Vertigo and Balance Disorders (DSGZ), University of Munich
  • , Sabrina HuthAffiliated withGerman Center for Vertigo and Balance Disorders (DSGZ), University of Munich
  • , Cauchy PradhanAffiliated withGerman Center for Vertigo and Balance Disorders (DSGZ), University of Munich
  • , Marianne DieterichAffiliated withDepartment of Neurology, University of MunichGerman Center for Vertigo and Balance Disorders (DSGZ), University of Munich
  • , Thomas BrandtAffiliated withGerman Center for Vertigo and Balance Disorders (DSGZ), University of MunichInstitute for Clinical Neurosciences, University of Munich
  • , Klaus JahnAffiliated withDepartment of Neurology, University of MunichGerman Center for Vertigo and Balance Disorders (DSGZ), University of Munich

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Abstract

Falls are common in patients with cerebellar ataxia (CA). Identification of gait variables associated with a higher risk of falls allows us to detect fallers and initiate protective procedures early. Gait variability, which is increased in CA patients, is a good predictor of falls in elderly subjects and patients with neurodegenerative diseases. The relationship between gait variability and fall risk in patients with different cerebellar disorders was systematically investigated. A total of 48 patients with different cerebellar ataxia entities [adult-onset cerebellar atrophy (SAOA) (n = 23), unknown entity (n = 7), vascular (n = 5), post-cerebellitis (n = 6), congenital (n = 2), Louis–Bar syndrome (n = 2), ethyltoxic (n = 2) posttraumatic (n = 1)] were examined using a GAITRite® sensor mat. Spatial and temporal variability parameters were used for ANOVA testing and logistic regression models with categorized fall events as dependent variables. Gait variability in the fore–aft direction showed significant differences between the fall groups (p < 0.05–0.01). Model effects were highest for walking with slow speed (correct prediction 0.50–0.72). The speed-dependent integral of gait variability markers showed a higher discriminatory power (correct prediction 0.74–0.94). Gait variability is linked to the fall risk of patients with CA, slow walking and temporal gait variability being most relevant. The use of speed-dependent integrals of gait variability improves the accuracy of fall prediction. To predict fall risks in cerebellar ataxia, gait variability measurements made during slow walking should be included in a gait analysis procedure. The effects of speed-adjusted physiotherapeutic interventions have to be further investigated.

Keywords

Gait variability Falls Fall-related injuries Cerebellar ataxia Gait analysis