Advanced Gait, Balance and Falls Risk Assessment
Instrumented gait analysis (IGA), which can provide accurate and precise quantitative measurement of gait patterns and characteristics, has long been the gold standard for gait assessment in research practice in the field it is far superior to general observation.
Gain precise rehab/exercise insights with gait analysis
1.
Instrumented Gait Analysis
The walking ability of a person is typically based on two main aspects: how far can an individual walk and what is his/her tolerance level [1]. For example, for post stroke gait assessment, 3-, 6-, or 10 meter walk tests are used, in addition to Functional Ambulation Category (FAC), Short Physical Performance Battery (SPPB), and/or Motor Assessment Scale (MAS).
The quality of gait or “how” the person walks, on the other hand, highly depends on the quantification of gait patterns and accurate identification of specific gait characteristics.
With an increase in age, physiologically characterised by a decrease in lean mass, bone mineral density and, to a lesser extent, fat mass disturbances in either one of these functions affect parameters of gait (i.e. speed, stride length, and swing time), thus resulting in abnormal gait [2]. Gait speed for example has been described as the ‘sixth vital sign’ because it is a core indicator of health and function in aging and disease [3] In clinical gait assessment, both a person's “ability” to walk and “how” the individual walks are highly relevant.
Instrumented gait analysis (IGA), which can provide accurate and precise quantitative measurement of gait patterns and characteristics, has long been the gold standard for gait assessment in research practice [4].
Mohan DM, Khandoker AH, Wasti SA, Ismail Ibrahim Ismail Alali S, Jelinek HF, Khalaf K. Assessment methods of post-stroke gait: a scoping review of technology-driven approaches to gait characterization and analysis. Front Neurol. (2021) 12:650024. 10.3389/fneur.2021.650024.
Pirker W, Katzenschlager R. Gait disorders in adults and the elderly. Wien Klin Wochenschr 2017;129:81–95.
Fritz S, Lusardi M. White paper: ‘walking speed: the sixth vital sign’. J Geriatr Phys Ther 2009;32:2–5.
Cappozzo A. Gait analysis methodology. Hum Mov Sci. (1984) 3:27–50. 10.1016/0167-9457(84)90004-6.
2.
The Analysis
What do we test broadly
Range of Motion and Strength
Kinetics and Agility
Coordination
(GAIT TEST)
A Free Distance Walk and Return , 10 Meter Walk and Return Test
(MOBILITY TEST)
2 Minute Walk Test , Timed Up and Go , 15 Seconds Treadmill Walk
(BALANCE TEST)
Single Leg Stance Test, Balance Squat, Y Balance Test ,1 Minute Balance Test ( BALANCE and MOBILITY)
(HOP TEST )
Balance Front Hop Test, Balance Side Hop, 30 Second Side Hop
(JUMP TEST not for seniors)
Single Leg Jump Distance, Counter Movement Jump, Drop Jump
(SPEED TEST)
Foot Tapping, 505 Agility Test, 30 Meter Sprint Test
(RUNNING TEST not for seniors)
1 Minute Run Test
3.
Examples of Use
Post Operative Assessment
Researchers have investigated the evaluation of ambulatory systems for gait analysis post hip replacement [5]. They found gait characteristics such as stride length and velocity, as well as thigh and shank rotations different from healthy individuals and recommended their use to monitor post-surgical rehabilitation efficacy.
Stroke Patients
Spatiotemporal characteristics of post-stroke gait include reduced step or stride length, increased step length on the hemiparetic side, wider base of support, greater toe-out angle, reduced walking speed and cadence. Stride time, stance period on both lower limb, and double support time are also increased, in addition to less time in stance and more time in swing phase for the paretic side, as well as asymmetries in spatial and temporal factors. So easily observable factors include; decreased plantarflexion of the ankle at toe-off, a significant decrease in peak hip and knee flexion during the swing phase, reduced knee extension prior to initial contact, as well as decreased ankle dorsiflexion during swing) [6].
Falls Risk
For falls risk in elderly the test-retest reliability of an accelerometer-based systems for measuring spatiotemporal parameters, including walking speed, step length, and cadence, as well as other parameters, including gait symmetry, gait regularity are excellent. There is a consensus on the definition of physical frailty [7]. Almost all of the studies in a recent 18 study meta-analysis of gait identified slowness as one of the most prevalent criterions in the definition of frailty status and observed that walking speed in the frail population was significantly lower than healthy controls [8]. A meaningful change in gait speed has been established at 0.1 ms-1 (at usual pace in a 4-meter walk), and it has been proven that increases in gait speed due to intervention increases survival, as high as a reduction of 17.7% in absolute risk of death [9].
5. Aminian K, Trevisan C, Najafi B, Dejnabadi H, Frigo C, Pavan E, et al. Evaluation of an ambulatory system for gait analysis in hip osteoarthritis and after total hip replacement. Gait Posture. (2004) 20:102–7. 10.1016/S0966-6362(03)00093-6.
6. Nadeau S, Betschart M, Bethoux F. Gait analysis for poststroke rehabilitation: the relevance of biomechanical analysis and the impact of gait speed. Phys Med Rehabil Clin N Am. (2013) 24:265–76. 10.1016/j.pmr.2012.11.007.
7. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56: M146–M156.
8. Bortone, I., Sardone, R., Lampignano, L., Castellana, F., Zupo, R., Lozupone, M., Moretti, B., Giannelli, G., & Panza, F. (2021). How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review. J Cachexia Sarcopenia Muscle, 12(2), 274-297.
9. Hardy SE, Perera S, Roumani YF, Chandler JM, Studenski SA. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007; 55:1727-1734.
Falls Risk Assessment + Training for its Reduction
IGA has also been successfully used to quantify and improve gait dysfunction associated with ageing and assess the risk of falling [1]. Spatiotemporal gait parameters such as velocity, swing time, stride length, stride time- and double support time variability, as well as heel strike and toe off angles, and foot clearance, have been suggested as plausible indicative quantitative measures , to assess the risk of falling in elderly subjects. [1].
However also in 2009 INTERNATIONAL ACADEMY ON NUTRITION AND AGING (IANA) TASK FORCE -gait speed, as a single-item tool, to be at least as sensible as the composite tools in predicting most of these outcomes over time. As such an “easy-to-remember” cutpoint for high falls risk, based on literature is 0.8 ms-1 [2]. But other parameters including balance tests can provide additional relative risk definition.
Multi-component exercise therapy which consisted of strength, range of motion (ROM) exercise, balance, flexibility and stretching exercises, circuit exercise training, and gait training was found to enhance gait function for individuals suffering with diabetic peripheral neuropathy compared to control groups using spatiotemporal gait parameters like velocity, cadence, step length, step time, double support time, stride length, stride time, ankle ROM. Gait assessment has potential to develop patient training paradigms for overcoming gait disorders [3].
References
Schülein S, Barth J, Rampp A, Rupprecht R, Eskofier BM, Winkler J, et al. Instrumented gait analysis: a measure of gait improvement by a wheeled walker in hospitalized geriatric patients. J Neuroeng Rehabil. (2017) 14:18.
Yen SC, Schmit BD, Wu M. Using swing resistance and assistance to improve gait symmetry in individuals post-stroke. Hum Mov Sci. (2015) 42:212–24.
Abellan van Kan, G., Rolland, Y., Andrieu, S., Bauer, J., Beauchet, O., Bonnefoy, M., Cesari, M., Donini, L. M., Gillette Guyonnet, S., Inzitari, M., Nourhashemi, F., Onder, G., Ritz, P., Salva, A., Visser, M., & Vellas, B. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging, 13(10), 881-889. https://doi.org/10.1007/s12603-009-0246-z.