Gait Changes in Older Adults

Reto W. Kressig
³MOBEQ´ Unit Geriatrics Department Geneva University Hospitals, Switzerland

Outline
‡ Definition of Gait Parameters ‡ Age-Related Gait Changes ‡ Pathological Gait Changes

Gait Cycle
(Temporal Measures)

Gait Cycle
(right side)

Stance

Swing

Initial Double Support

Terminal Double Support

Spatial Gait Measures Stride Width Step Length Stride Length .

Gait Laboratory Camera 1 Light Barrier 1 2 meters 6 meters Force Plates 1 2 Light Barrier 2 2 meters Camera 3 Starting Line Visual Target (Traffic Cone) Camera 2 .

Biomechanical Gait Analysis .

Electronic Walkway: GAITRite® Temporal and Spatial Measurements .

One Completed Walk .

Normal Walking Age-Related Gait Changes .

Normal Walking: Velocity Normal velocity during free pace walking.. (a) Males (n=135). Vertical scale = meters/minute Horizontal scale = age (20 to 85 yrs). Thorofare (NJ): Slack. Inc. 1992 . Perry J: Gait Analysis: Normal and Pathological Function. (b) Females (n=158).

Perry J: Gait Analysis: Normal and Pathological Function. Vertical scale = meters. Thorofare (NJ): Slack.. Inc. Horizontal scale = age (20 to 85 yrs). (b) Females (n=158). 1992 .Normal Walking: Stride Length Normal stride length during free pace walking. (a) Males (n=135).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack.Normal Walking: Cadence Normal cadence during free pace walking. Inc.. 1992 . (b) Females (n=158). Vertical scale = steps/minute. (a) Males (n=135). Horizontal scale = age (20 to 85 yrs).

Waterloo: University of Waterloo Press.7 1.3 Velocity (m/sec. elderly and pathological.5 ± 8. Age (yrs.48 68.7 ± 1.9 ± 4.19 1.0 1.) 1.10 Stance Time (%) 62.12 65. The biomechanics and motor control of human gait: Normal.56 ± 0.44 ± 0.75 ± 0. 2nd ed.13 Stride Length (m) 1.71 ± 0.3 ± 1.8 ± 8.Comparison of Young Adults and Elderly Subjects Spatial and Temporal Gait Parameters Variable Young Adult (N = 11) Elderly (N = 18) Signif.9 ± 1.29 ± 0. 1990 .) 24.01 p < 0.38 ± 0.52 p < 0.9 Height (m) 1.) 110.08 Cadence (steps/min.10 111.01 Winter DA.01 p < 0.

215 1.475 ± 0.15 ± 0.293 ± 0.043 0.190 ± 0. 2nd ed.01 p < 0.621 ± 0.872 ± 0. Push-off work (J/kg) Head Hor.365 0.29 p < 0. Waterloo: University of Waterloo Press.057 0. 1990 .01 Winter DA.Comparison of Young Adults and Elderly Subjects Significant Differences in Other Gait Parameters Variable Young Adult (N = 11) Elderly (N = 18) Signif. Acc (m/s²) Hor HC Vel (m/sec) 0.148 0.05 p < 0. The biomechanics and motor control of human gait: Normal. elderly and pathological.

Gait Changes Related to : ‡ Psychological Factors ‡ Increased Falling Risk ‡ Interventions .

3.6 1.9 2.7) (1.0 ABC (95% CI) (1. Wolf SL.025 1.1 2.006 0. CI = Confidence Interval FES (95% CI)* (1.2.7) (0. 2. . functional and behavioral characteristics with activity related fear of falling among older adults transitioning to frailty. 3. 3.028 0. Multiple Logistic Regression Modeling Results Variable OR Depression by CES-D Use of Walking Aid Slow Gait Speed Ethnicity: African American *OR = Odds Ratio. Sattin RW et al.2) p 0.9) (1. 2.5 2.4) (1.Slow Walkers are more likely to be fearful.012 0. 2.. Table 4.2. 1.3.3) (1.009 0.1..3. 49:1456-1462. Associations of demographic.5) p 0.7.001 0.2) (1.2 Kressig RW.4 1. 2. 3.1 1.2.008 0.492 OR 1. J Am Geriatr Soc 2001.

17 0.16 ± 0.83 ± 0.00 0.04 19.0 ± 5.03 18. .01 ± 0.Fear of Falling and Gait Performance Descriptive Statistics (mean ± SD) for the Gait Measures Non-fallers Fearless Fearful n = 19 n = 13 Gait Measure Stride length (m) Stride width (m) Double support (% of stride) Stride velocity (ms) 1. Gait changes in older adults : Predictors of falls or indicators of fear ? J Am Geriatr Soc 1997 .19 0.19 0.04 14.15 ± 0.23 0.14 ± 0.40 0.87 ± 0.50 0.89 ± 0.03 19. 45:313-320.14 ± 0.20 0.76 ± 0.68 ±0.00 0.2 ± 6.16 0.79 ± 0.19 Fallers Fearless Fearful n = 17 n = 26 0.19 Maki BE.1 ± 4.66 ± 0.8 ± 5.

05 (1.52)* 1.27 (0. Gait changes in older adults: Predictors of falls of indicators of fear ? J Am Geriatr Soc 1997.74 (1.77)* 1.75)* 1.38 (0.08-3.45:313-20.11-3.10-3.54)* 1.51)* 0.98 (1.77-2.25 (0.51) Maki BE.50-1.30 (1.98 (1.01-3.76-2.27) 2.94 (0.17-4.64-2.04-3.58-1.63) 1.05) 1.90 (0. .47) 1.50) 0.11) 2.02)* 1.Associations of Gait Measures with Falling and Fear of Falling Gait Measure OR for Falling (95% confidence interval) OR for Fear of Falling (95% confidence interval) Stride-to-Stride Average Stride length Double-support Stride velocity Stride-to-Stride SD Stride length Double-support Stride velocity * (p < 0.95 (1.83-2.38 (0.

ress .42 -.01 epression ( Notes : - scored rom 0 (best) to 60 ( orst). Age = 75±4.01 .) -.51 : 297-302. SI ) and Depression (CES-D Scale) ith ait Speed ( = 152. ssociated ith changes in gait speed in . sselman et al. actors older adults.Correlatio of erceive hysical Health Stat s (Sickness Impact rofile Score. I scored rom 0 (best) to 100 ( orst) uchner .22 p-value . J erontol 1996.4) earson I hysical .

Gait Changes Related to : Increased Falling Risk .

Gait Variability: Stride-to-Stride Variability Example: Stride Length Coefficient of Variation. CoVar = (SD/M) 100 .

08-3.72% +0.30(1.016m/s 1.11-3.17-4.017m +0.05(1.77) 2.95(1.Stride-to-Stride Variability and Falls in Older Adults Odds Ratio for Falling Gait Measure Change (95% Confidence Interval) Stride-to-Stride-Standard Deviation Stride Length Double-Support Stride Velocity +0. Gait changes in older adults: Predictors of falling or indicators of fear? J Am Geriatr Soc 1997.45:313-320 .52) 2.51) Maki BE.

3 years) Gait Measure Fallers (n = 20) Non-Fallers (n = 32) p Stride time variability (msec) Swing time variability (msec) 106 ± 30 39 ± 4 49 ± 4 27 ± 2 < .Stride/Swing Time Variability and Falls in Older Adults (N = 52. Rios D. mean age = 80. Edelberg H.03 Hausdorff J. 82: 1050-6. .04 < . Arch Phys Med Rehabil 2001. Gait variability and fall risk in community-living older adults: A 1-year prospective Study.

Spatial and Temporal Gait Changes Related to Interventions ? .

Individual Balance Training Tinetti ME. J Am Geriatr Soc 1993. Garrett PA et al. Yale FICSIT: Risk factor abatement strategy for fall prevention.41:315-20 . Baker DI.

25:50-54 .T¶ai Chi Inspired Exercise Program Kressig RW. Exploring guidelines for the application of T¶ai Chi to patients with stroke. Wolf SL. Neurology Report 2001.

Resistance Training .

and a far less vigorous push off. Adaptations representing a safer gait pattern . the elderly walk slower.Take ome Messages (1) In comparison to the young. have a shorter step length an increase in stance time and double support.

reduced stride length.are associated with fear of falling . and increased double support time .but show no association with falling .Take ome Messages (2) Reduced speed.

evaluating preventive interventions .identifying high risk individuals .Take ome Messages (3) Stride-to-stride variability in the control of gait ‡ is an independent predictor of falling ‡ may be an important measure for .

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