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Jeffrey M Hausdorff - One of the best experts on this subject based on the ideXlab platform.
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effect of rivastigmine on mobility of patients with higher level Gait Disorder a pilot exploratory study
Drugs in R & D, 2014Co-Authors: Tanya Gurevich, Yacov Balash, Doron Merims, Chava Peretz, Talia Herman, Jeffrey M Hausdorff, Nir GiladiAbstract:Background Higher-level Gait Disorder (HLGD) in older adults is characterized by postural instability, stepping dysrhythmicity, recurrent falls and progressive immobility. Cognitive impairments are frequently associated with HLGD.
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high level Gait Disorder associations with specific white matter changes observed on advanced diffusion imaging
Journal of Neuroimaging, 2013Co-Authors: Michal Kafri, Jeffrey M Hausdorff, Efrat Sasson, Yaniv Assaf, Yaacov Balash, Orna Aiznstein, Nir GiladiAbstract:BACKGROUND AND PURPOSE High-level Gait Disorder (HLGD) is a debilitating Disorder causing mobility decline in the elderly. Although its clinical characteristics are well described, its anatomical and pathophysiological underpinnings are poorly understood. This study examined the anatomical distribution of white matter (WM) changes in patients with mild to moderate HLGD of the cautious/disequilibrium type, using advanced magnetic resonance imaging (MRI) methods. METHODS Thirteen patients with HLGD, 9 elderly and 13 middle-aged healthy controls were scanned using diffusion tensor imaging, Q-space imaging, and conventional MRI. The regions of significant differences between the HLGD group and the elderly control group were defined, and the mean fractional anisotropy and displacement values of these areas were extracted. RESULTS The HLGD patients had lower fractional anisotropy and higher displacement values in regions related to the motor system, including those along the corticospinal tract and the superior cerebellar peduncles, as well as in cognitive and affective-related areas, including the anterior limbs of the internal capsule and the genu of the corpus callosum. CONCLUSIONS The anatomical distribution associated with HLGD of the cautious/disequilibrium type involves WM pathways that convey motor-related, cognitive and affective-related functions. The underlying pathological process leading to these changes most probably includes demyelination.
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progressive nature of a higher level Gait Disorder a 3 year prospective study
Journal of Neurology, 2010Co-Authors: V Hubermahlin, Tanya Gurevich, Talia Herman, Jeffrey M Hausdorff, Nir Giladi, C PerezAbstract:The objective of the study was to characterize the natural history of patients with a higher level Gait Disorder (HLGD) of the cautious/disequilibrium type in a 3-year prospective study. Subjects were taken from an outpatient setting in a movement Disorders clinic. Twenty-two mobile, community-living patients with a HLGD of the cautious/disequilibrium type and 26 age- and gender-matched healthy controls were evaluated at baseline and approximately 3 years later. Detailed medical history, a complete, structured geriatric and neurological examination, mental and affective state, Gait and balance assessment were obtained. At follow-up, marked declines were observed in Gait, mobility and functional independence in the patients, but not in the controls. For example, 23% of the patients could not complete the Timed Up and Go test, compared to only 4% of the control group, and among those who could complete the test, time to completion was almost three times longer (P < 0.0001) in the patients (23 s), compared to the controls (8 s). At follow-up, 50% of the patients required a personal live-in caregiver compared to only 4% of the controls (P < 0.0001). Although mild extra-pyramidal, pyramidal, cognitive and affective alterations were observed at baseline in the patients, those symptoms were stable over time. Unexpectedly, there was no association between the presence of HLGD or its progression and vascular risk factors. HLGD is a debilitating, rapidly progressive disease. The profound deterioration in functional independence in a relatively short period of time suggests that early multidisciplinary interventions may be the appropriate clinical approach to the treatment of these patients who are at risk for a rapid decline in functional abilities.
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the effects of reducing fear of falling on locomotion in older adults with a higher level Gait Disorder
Journal of Neural Transmission, 2007Co-Authors: Yacov Balash, Chava Peretz, Talia Herman, Jeffrey M Hausdorff, Nir Giladi, M HadarfrumerAbstract:Fear of falling (FOF) is one of the key clinical features affecting older adults with a higher-level Gait Disorder (HLGD), however, its effect on Gait is not clear. Twenty-one HLGD patients walked under four conditions: 1) usual walking, 2) while holding a physical therapist’s hand, 3) while using a walker, and 4) while being guarded. All three interventions reduced FOF, but guarding did not significantly affect any Gait parameter (p > 0.10) and the walker only increased Gait speed. In contrast, handholding improved Gait speed and reduced Gait variability, however, an altered Gait pattern persisted even with handholding. Interventions such as handholding, guarding or use of a walker apparently may reduce FOF in HLGD patients, but the impact of this reduction on Gait is limited. Thus, it appears that the Gait disturbances in these patients are apparently not simply the consequence of FOF.
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shedding light on walking in the dark the effects of reduced lighting on the Gait of older adults with a higher level Gait Disorder and controls
Journal of Neuroengineering and Rehabilitation, 2005Co-Authors: Anat Kesler, Talia Herman, Jeffrey M Hausdorff, Nir Giladi, Gregory Leibovich, Leor GruendlingerAbstract:Objective To study the effects of reduced lighting on the Gait of older adults with a high level Gait Disorder (HLGD) and to compare their response to that of healthy elderly controls.
Nir Giladi - One of the best experts on this subject based on the ideXlab platform.
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effect of rivastigmine on mobility of patients with higher level Gait Disorder a pilot exploratory study
Drugs in R & D, 2014Co-Authors: Tanya Gurevich, Yacov Balash, Doron Merims, Chava Peretz, Talia Herman, Jeffrey M Hausdorff, Nir GiladiAbstract:Background Higher-level Gait Disorder (HLGD) in older adults is characterized by postural instability, stepping dysrhythmicity, recurrent falls and progressive immobility. Cognitive impairments are frequently associated with HLGD.
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high level Gait Disorder associations with specific white matter changes observed on advanced diffusion imaging
Journal of Neuroimaging, 2013Co-Authors: Michal Kafri, Jeffrey M Hausdorff, Efrat Sasson, Yaniv Assaf, Yaacov Balash, Orna Aiznstein, Nir GiladiAbstract:BACKGROUND AND PURPOSE High-level Gait Disorder (HLGD) is a debilitating Disorder causing mobility decline in the elderly. Although its clinical characteristics are well described, its anatomical and pathophysiological underpinnings are poorly understood. This study examined the anatomical distribution of white matter (WM) changes in patients with mild to moderate HLGD of the cautious/disequilibrium type, using advanced magnetic resonance imaging (MRI) methods. METHODS Thirteen patients with HLGD, 9 elderly and 13 middle-aged healthy controls were scanned using diffusion tensor imaging, Q-space imaging, and conventional MRI. The regions of significant differences between the HLGD group and the elderly control group were defined, and the mean fractional anisotropy and displacement values of these areas were extracted. RESULTS The HLGD patients had lower fractional anisotropy and higher displacement values in regions related to the motor system, including those along the corticospinal tract and the superior cerebellar peduncles, as well as in cognitive and affective-related areas, including the anterior limbs of the internal capsule and the genu of the corpus callosum. CONCLUSIONS The anatomical distribution associated with HLGD of the cautious/disequilibrium type involves WM pathways that convey motor-related, cognitive and affective-related functions. The underlying pathological process leading to these changes most probably includes demyelination.
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progressive nature of a higher level Gait Disorder a 3 year prospective study
Journal of Neurology, 2010Co-Authors: V Hubermahlin, Tanya Gurevich, Talia Herman, Jeffrey M Hausdorff, Nir Giladi, C PerezAbstract:The objective of the study was to characterize the natural history of patients with a higher level Gait Disorder (HLGD) of the cautious/disequilibrium type in a 3-year prospective study. Subjects were taken from an outpatient setting in a movement Disorders clinic. Twenty-two mobile, community-living patients with a HLGD of the cautious/disequilibrium type and 26 age- and gender-matched healthy controls were evaluated at baseline and approximately 3 years later. Detailed medical history, a complete, structured geriatric and neurological examination, mental and affective state, Gait and balance assessment were obtained. At follow-up, marked declines were observed in Gait, mobility and functional independence in the patients, but not in the controls. For example, 23% of the patients could not complete the Timed Up and Go test, compared to only 4% of the control group, and among those who could complete the test, time to completion was almost three times longer (P < 0.0001) in the patients (23 s), compared to the controls (8 s). At follow-up, 50% of the patients required a personal live-in caregiver compared to only 4% of the controls (P < 0.0001). Although mild extra-pyramidal, pyramidal, cognitive and affective alterations were observed at baseline in the patients, those symptoms were stable over time. Unexpectedly, there was no association between the presence of HLGD or its progression and vascular risk factors. HLGD is a debilitating, rapidly progressive disease. The profound deterioration in functional independence in a relatively short period of time suggests that early multidisciplinary interventions may be the appropriate clinical approach to the treatment of these patients who are at risk for a rapid decline in functional abilities.
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the effects of reducing fear of falling on locomotion in older adults with a higher level Gait Disorder
Journal of Neural Transmission, 2007Co-Authors: Yacov Balash, Chava Peretz, Talia Herman, Jeffrey M Hausdorff, Nir Giladi, M HadarfrumerAbstract:Fear of falling (FOF) is one of the key clinical features affecting older adults with a higher-level Gait Disorder (HLGD), however, its effect on Gait is not clear. Twenty-one HLGD patients walked under four conditions: 1) usual walking, 2) while holding a physical therapist’s hand, 3) while using a walker, and 4) while being guarded. All three interventions reduced FOF, but guarding did not significantly affect any Gait parameter (p > 0.10) and the walker only increased Gait speed. In contrast, handholding improved Gait speed and reduced Gait variability, however, an altered Gait pattern persisted even with handholding. Interventions such as handholding, guarding or use of a walker apparently may reduce FOF in HLGD patients, but the impact of this reduction on Gait is limited. Thus, it appears that the Gait disturbances in these patients are apparently not simply the consequence of FOF.
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shedding light on walking in the dark the effects of reduced lighting on the Gait of older adults with a higher level Gait Disorder and controls
Journal of Neuroengineering and Rehabilitation, 2005Co-Authors: Anat Kesler, Talia Herman, Jeffrey M Hausdorff, Nir Giladi, Gregory Leibovich, Leor GruendlingerAbstract:Objective To study the effects of reduced lighting on the Gait of older adults with a high level Gait Disorder (HLGD) and to compare their response to that of healthy elderly controls.
John G. Nutt - One of the best experts on this subject based on the ideXlab platform.
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progression of motor and nonmotor features of parkinson s disease and their response to treatment
British Journal of Clinical Pharmacology, 2012Co-Authors: John G. Nutt, Nicholas H G HolfordAbstract:WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • There is marked variability among patients with Parkinson's disease (PD) in the rate of progression of status (severity) assessed with a global functional score (Unified Parkinson's Disease Rating Scale; UPDRS). It has been hypothesized that there are distinct PD subtypes with different rates of progression. • Previous studies attempted to quantify the rates of progression for tremor-dominant and postural instability and Gait Disorder (PIGD)-dominant subtypes using only baseline clinical features. WHAT THIS STUDY ADDS • We used a nonlinear mixed effects modelling approach to describe the time course of the four cardinal features of PD before and during anti-parkinsonian treatment. • Tremor-dominant and PIGD-dominant subtypes appear to be different stages of the disease rather than persistent attributes in individual patients and do not explain variability in progression among patients. Tremor progresses more slowly than other cardinal features with and without drug treatment. Postural instability and Gait Disorder is much less sensitive to the symptomatic effects of levodopa than the other cardinal features. • We have extended the finding that anti-parkinsonian treatments have symptomatic and disease-modifying effects on overall function and demonstrate similar effects on each of the four cardinal features of PD. AIMS (i) To describe the progression of the cardinal features of Parkinson's disease (PD); (ii) to investigate whether baseline PD subtypes explain disease progression; and (iii) to quantify the symptomatic and disease-modifying effects of anti-parkinsonian treatments. METHODS Data were available for 795 PD subjects, initially untreated, followed for up to 8 years. Cardinal features [tremor, rigidity, bradykinesia, and postural instability and Gait Disorder (PIGD)] were derived from the total unified Parkinson's disease rating scale (total UPDRS), cognitive status from the mini-mental status exam score (MMSE) and depression status from the Hamilton depression scale (HAM-D). Analysis was performed using a nonlinear mixed effects approach with an asymptotic model for natural disease progression. Treatment effects (i.e. symptomatic and disease modifying) were evaluated by describing changes in the natural history model parameters. RESULTS Tremor progressed more slowly (half-time of 3.9 years) than all other motor features (half-time 2–3 years). The MMSE progression was negligible, while HAM-D progressed with a half-time of 5 years. Levodopa had marked symptomatic effects on all features, but low potency for effect on PIGD (ED50 of 1237 mg day−1 compared with 7–24 mg day−1 for other motor and nonmotor features). Other anti-parkinsonian treatments had much smaller symptomatic effects. All treatments had disease-modifying effects on the cardinal features of PD. Baseline PD subtypes only explained small differences in disease progression. CONCLUSIONS This analysis indicates that tremor progresses more slowly than other cardinal features and that PIGD is less treatment responsive in early PD patients. There was no evidence of baseline PD subtypes as a clinically useful predictor of disease progression rate. Anti-parkinsonian treatments have symptomatic and disease-modifying effects on all major features of PD.
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Joubert syndrome surviving to adulthood associated with a progressive movement Disorder.
Movement Disorders, 2007Co-Authors: Steven A. Gunzler, Robert A Egan, Richard G. Weleber, A. Jon Stoessl, Paul Wang, John G. NuttAbstract:A 48-year-old man presented with a progressive Gait Disorder. He had longstanding ataxia, oculomotor apraxia, motor delay, and cognitive impairment, diagnosed as cerebral palsy. Physical examination revealed ataxia, oculomotor apraxia, extrapyramidal signs, and a wide-based, shuffling Gait. Magnetic resonance imaging showed vermian aplasia, consistent with Joubert syndrome. Positron emission tomography scan revealed normal fluorodopa uptake, but elevated raclopride binding, compatible with dopamine deficiency. This case demonstrates that a patient with Joubert syndrome may survive into adulthood and present as a chronic neurologic Disorder with subacute extrapyramidal signs. © 2006 Movement Disorder Society
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Joubert syndrome surviving to adulthood associated with a progressive movement Disorder.
Movement disorders : official journal of the Movement Disorder Society, 2007Co-Authors: Steven A. Gunzler, Robert A Egan, Richard G. Weleber, A. Jon Stoessl, Paul Wang, John G. NuttAbstract:A 48-year-old man presented with a progressive Gait Disorder. He had longstanding ataxia, oculomotor apraxia, motor delay, and cognitive impairment, diagnosed as cerebral palsy. Physical examination revealed ataxia, oculomotor apraxia, extrapyramidal signs, and a wide-based, shuffling Gait. Magnetic resonance imaging showed vermian aplasia, consistent with Joubert syndrome. Positron emission tomography scan revealed normal fluorodopa uptake, but elevated raclopride binding, compatible with dopamine deficiency. This case demonstrates that a patient with Joubert syndrome may survive into adulthood and present as a chronic neurologic Disorder with subacute extrapyramidal signs.
Günther Deuschl - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of Gait Disorders in hospitalized neurological patients
Movement disorders : official journal of the Movement Disorder Society, 2004Co-Authors: H. Stolze, Stephan Klebe, Christoph Baecker, Christiane Zechlin, Lars Friege, Sabine Pohle, Günther DeuschlAbstract:The prevalence of Gait Disorders among neurological inpatients is unknown, although disturbed Gait is a common symptom. Gait Disorders often lead to loss of independence with restraints for the patients and caregivers and costs for the health system. We designed a prospective study and investigated all patients admitted to a neurological hospital during a 100-day period for the presence of a Gait Disorder. Clinical investigation and several disease-specific rating scales were carried out for 493 patients. In 60% of the patients, a disturbance of Gait was diagnosed. Most frequent diagnoses were stroke (21%), Parkinson's disease (17%), and polyneuropathy (7%). Within these diagnoses, the rate of patients with disturbed Gait was high in Parkinson's disease (93%), subcortical arteriosclerotic encephalopathy (85%), and motor neuron disease (83%). Advanced age, dementia, alcohol abuse, and treatment with antiepileptics, neuroleptics, benzodiazepines, and chemotherapeutics were identified as risk factors for a Gait Disorder. A decline of cognitive function was accompanied by a reduction of walking speed. According to these results, Gait Disorders are among the most frequent symptoms in neurology.
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The Gait Disorder of advanced essential tremor.
Brain, 2001Co-Authors: H. Stolze, Gesche Petersen, Jan Raethjen, R. Wenzelburger, Günther DeuschlAbstract:Gait disturbances of patients with essential tremor (ET) have been described anecdotally, but have never been investigated quantitatively. Recent studies provided evidence for a cerebellar-like hand tremor in some patients with ET. Therefore, we designed a study to assess cerebellar-like abnormalities of leg function. Twenty-five patients with ET, eight patients with cerebellar diseases (CD) and 21 age-matched healthy subjects were studied for their normal and tandem Gait using a three-dimensional Gait analysis system. During normal walking, CD and ET patients showed only slight abnormalities. However, ET patients exhibited abnormalities in tandem Gait with an increased number of mis-steps and a broad-based, ataxic and dysmetric Gait which was indistinguishable from the findings in CD. When ET patients were separated into groups of those with or without intention tremor of the hands, the Gait Disorder was found to be much more pronounced in the intention tremor group. Patients with this Gait Disorder were more severely disturbed in their activities of daily living, and suffer from an advanced stage of ET. The present results quantitatively describe a Gait disturbance in advanced ET which affects tandem Gait, but leaves normal Gait almost unaffected. This is strong evidence for a cerebellar-like disturbance in ET.
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comparative analysis of the Gait Disorder of normal pressure hydrocephalus and parkinson s disease
Journal of Neurology Neurosurgery and Psychiatry, 2001Co-Authors: H. Stolze, J P Kuhtzbuschbeck, H Drucke, K Johnk, M Illert, Günther DeuschlAbstract:OBJECTIVES Comparative Gait analyses in neurological diseases interfering with locomotion are of particular interest, as many hypokinetic Gait Disorders have the same main features. The aim of the present study was (1) to compare the Gait disturbance in normal pressure hydrocephalus and Parkinson9s disease; (2) to evaluate which variables of the disturbed Gait pattern respond to specific treatment in both diseases; and (3) to assess the responsiveness to visual and acoustic cues for Gait improvement. METHODS In study 1 Gait analysis was carried out on 11 patients with normal pressure hydrocephalus, 10 patients with Parkinson9s disease, and 12 age matched healthy control subjects, on a walkway and on a treadmill. In study 2, patients with normal pressure hydrocephalus were reinvestigated after removal of 30 ml CSF, and patients with Parkinson9s disease after administration of 150 mg levodopa. In part 3 visual cues were provided as stripes fixed on the walkway and acoustic cues as beats of a metronome. RESULTS The Gait Disorder in both diseases shared the feature of a reduced Gait velocity, due to a diminished and highly variable stride length. Specific features of the Gait disturbance in normal pressure hydrocephalus were a broad based Gait pattern with outward rotated feet and a diminished height of the steps. After treatment in both diseases, the speed increased, due to an enlarged stride length, now presenting a lower variability. All other Gait variables remained unaffected. External cues only mildly improved Gait in normal pressure hydrocephalus, whereas they were highly effective in raising the stride length and cadence in Parkinson9s disease. CONCLUSION The Gait pattern in normal pressure hydrocephalus is clearly distinguishable from the Gait of Parkinson9s disease. As well as the basal ganglia output connections, other pathways and structures most likely in the frontal lobes are responsible for the Gait pattern and especially the disturbed dynamic equilibrium in normal pressure hydrocephalus. Hypokinesia and its responsiveness to external cues in both diseases are assumed to be an expression of a disturbed motor planning.
Roman Schniepp - One of the best experts on this subject based on the ideXlab platform.
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The Gait Disorder in primary orthostatic tremor.
Journal of Neurology, 2020Co-Authors: Ken Möhwald, Max Wuehr, F. Schenkel, Katharina Feil, Michael Strupp, Roman SchnieppAbstract:OBJECTIVE To uncover possible impairments of walking and dynamic postural stability in patients with primary orthostatic tremor (OT). METHODS Spatiotemporal Gait characteristics were quantified in 18 patients with primary OT (mean age 70.5 ± 5.9 years, 10 females) and 18 age-matched healthy controls. One-third of patients reported disease-related fall events. Walking performance was assessed on a pressure-sensitive carpet under seven conditions: walking at preferred, slow, and maximal speed, with head reclination or eyes closed, and while performing a cognitive or motor dual-task paradigm. RESULTS Patients exhibited a significant Gait impairment characterized by a broadened base of support (p = 0.018) with increased spatiotemporal Gait variability (p = 0.010). Walking speed was moderately reduced (p = 0.026) with shortened stride length (p = 0.001) and increased periods of double support (p = 0.001). Gait dysfunction became more pronounced during slow walking (p \textless 0.001); this was not present during fast walking. Walking with eyes closed aggravated Gait disability as did walking during cognitive dual task (p < 0.001). CONCLUSION OT is associated with a specific Gait Disorder with a staggering wide-based walking pattern indicative of a sensory and/or a cerebellar ataxic Gait. The aggravation of Gait instability during visual withdrawal and the normalization of walking with faster speeds further suggest a proprioceptive or vestibulo-cerebellar deficit as the primary source of Gait disturbance in OT. In addition, the Gait decline during cognitive dual task may imply cognitive processing deficits. In the end, OT is presumably a complex network Disorder resulting in a specific spino-cerebello-frontocortical Gait Disorder that goes beyond mere tremor networks.
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P124. Evaluation of Gait parameters in functional Gait Disorders
Clinical Neurophysiology, 2018Co-Authors: Katharina Breitkopf, Max Wuehr, F. Schenkel, J. Decker, T. Brandt, Roman SchnieppAbstract:Objective To identify thresholds for pathognomonic Gait parameters in functional Gait Disorders. Background Characteristics of functional Gait Disorders are e.g. transient fluctuations in stance and Gait, excessive slowness or hesitation that is not compatible with neurological disease, uneconomic postures with wastage of muscular energy, the ‘walking on ice’ Gait pattern with typical small cautious steps with fixed ankle joints and sudden buckling of the knees that generally do not lead to falls ( Lempert et al., 1991 ). Early diagnosis is important: Over half of the patients with psychogenic Disorder of stance and Gait remain unchanged after five and a half years. If the Disorder is present no longer than four months complete remission can often be achieved ( Brandt et al., 1994 ). Methods We used a pressure-sensitive GaitRite© carpet to assess Gait analysis during eight Gait conditions (three different walking speeds, two sensory and three cognitive tasks). Each of the 23 Gait parameters was edited with custom software. A binary logistic regression, ROC (receiver operating characteristic) analysis and an inversed regression were performed to identify thresholds for pathological deviations from normal range. Results In the preferred speed condition, patients with functional Gait Disorder differed from healthy subjects in all Gait parameters, particularly in velocity, spatial, and variability measures. In the cognitive dual task condition (i.e. dual task words), however, the Gait parameters almost normalized, especially the variability parameters assimilate healthy subjects. Conclusion Characteristics of Gait parameters of patients with functional Gait Disorder were similar to postural performance in patients with phobic postural vertigo (PPV; Wuehr et al., 2017 ): The dual-task effect in patients with functional Gait Disorder revealed that cognitive distraction led to a normalization in walking. This is typical for functional Disorders and can also be observed in patients with PPV.
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Gait Disorders in geriatric patients. Classification and therapy
Der Nervenarzt, 2015Co-Authors: Klaus Jahn, C. Heinze, Charlotte Selge, K. Heßelbarth, Roman SchnieppAbstract:BACKGROUND: Slow walking with reduced body dynamics is a characteristic feature of locomotion in the elderly. Impaired mobility and falls associated with Gait Disorders significantly contribute to a reduced quality of life in the elderly. OBJECTIVES: A Gait Disorder is not an inevitable consequence of aging. This article shows that it is worth recognizing specific deficits and differentiating specific aspects in multifactorial Disorders because many causes can be well treated. Also provided are the bases for clinical classification and therapeutic principles. METHODS: Review of recent literature and clinical review based on own experience and own scientific results. RESULTS: Common causes of disturbed Gait in the elderly are neurological deficits, including sensory deficits (e.g. peripheral neuropathy and vestibulopathy), neurodegeneration (e.g. cerebellar ataxia and parkinsonian syndromes, cognitive impairment (e.g. degenerative dementia), degeneration of joints (e.g. coxarthrosis) and general loss of muscle mass (sarcopenia). Furthermore, a fear of falling also contributes to the Gait Disorder. Multimodal therapies are often necessary and the principles are presented. CONCLUSION: Identification of deficits is a prerequisite for specific therapy. As physical activity protects against cognitive impairment, reduces the risk of falling and improves overall quality of life, a structured assessment of causes for Gait impairment is crucial. Language: de
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the Gait Disorder in downbeat nystagmus syndrome
PLOS ONE, 2014Co-Authors: Roman Schniepp, Max Wuehr, Sabrina Huth, Cauchy Pradhan, Cornelia Schlick, Thomas Brandt, Klaus JahnAbstract:Background: Downbeat nystagmus (DBN) is a common form of acquired fixation nystagmus with key symptoms of oscillopsia and Gait disturbance. Gait disturbance could be a result of impaired visual feedback due to the involuntary ocular oscillations. Alternatively, a malfunction of cerebellar locomotor control might be involved, since DBN is considered a vestibulocerebellar Disorder. Methods: Investigation of walking in 50 DBN patients (age 72611 years, 23 females) and 50 healthy controls (HS) (age 70611 years, 23 females) using a pressure sensitive carpet (GaitRite). The patient cohort comprised subjects with only ocular motor signs (DBN) and subjects with an additional limb ataxia (DBNCA). Gait investigation comprised different walking speeds and walking with eyes closed. Results: In DBN, Gait velocity was reduced (p,0.001) with a reduced stride length (p,0.001), increased base of support (p, 0.050), and increased double support (p,0.001). Walking with eyes closed led to significant Gait changes in both HS and DBN. These changes were more pronounced in DBN patients (p,0.001). Speed-dependency of Gait variability revealed significant differences between the subgroups of DBN and DBNCA (p,0.050). Conclusions: (I) Impaired visual control caused by involuntary ocular oscillations cannot sufficiently explain the Gait Disorder. (II) The Gait of patients with DBN is impaired in a speed dependent manner. (III) Analysis of Gait variability allows distinguishing DBN from DBNCA: Patients with pure DBN show a speed dependency of Gait variability similar to that of patients with afferent vestibular deficits. In DBNCA, Gait variability resembles the pattern found in cerebellar ataxia.
