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Objective:To compare the gait characteristics of cognitive and motor dual task walking (DTW) in patients with cerebral small vessel disease (CSVD), and determine the best gait parameters to diagnose CSVD and judge the severity of the disease.Methods:A total of 106 patients with CSVD and 21 healthy individuals were included from September 1, 2020 to July 1, 2021 in the Seventh Medical Center of Chinese People′s Liberation Army General Hospital. According to the Fazekas scores, the subjects were divided into mild ( n=34, 1 point), moderate ( n=34, 2 points), severe ( n=38,3 points) groups and control group ( n=21). Participants were recorded parameters under single task walking (STW) and DTW conditions, and calculated dual task effect (DTC) through the difference between single task and dual task. The differences in gait variances and their DTC were shown by generalized estimation equations when performed in STW and DTW and 4 groups of the severity of disease. Post-hoc comparisons were corrected using Bonferroni′s method. Spearman analyses were applied to explore the correlations between gait parameters and their DTC during STW or DTW and severity of disease. Based on the Logistic model, combining predictors or probabilities were gained and applied to establish receiver operating characteristic curve in order to calculate sensitivity, specificity, and the area under the curve. Results:In the control group, there was no statistically significant difference in gait parameters between STW and DTW. In the CSVD group, the gait parameters of STW were significantly better than cognitive or motor DTW (all P<0.05). In the control group, there was no statistically significant difference in basic gait parameters under different tasks (all P>0.05). In cognitive DTW, temporal gait parameters (stride frequency and stride time) deteriorated significantly only in moderate and severe groups [stride frequency:moderate group 100.220±1.795/min,severe group 94.525±2.139/min;stride time:moderate group (1.227±0.024) s, severe group (1.299±0.031) s], but spatial parameters [stride length: control group (1.050±0.021) m, mild group (0.974±0.022) m, moderate group (0.903±0.025) m, severe group (0.793±0.026) m; stride speed: control group (0.944±0.028) m/s, mild group (0.866±0.030) m/s, moderate group (0.751±0.027) m/s, severe group (0.606±0.022) m/s] were significantly different among all groups (except the control group and mild group;all P<0.05). The DTC of all gait parameters during cognitive DTW was higher than that during motor DTW (all P<0.05) for CSVD patients. While no any difference was found between cognitive DTW and motor DTW in the control group (all P>0.05). Similarly, the temporal parameters′ DTC of cognitive DTW was abnormal only in the late stage of disease, while the spatial parameters′ DTC showed statistically significant difference among all the groups (including the control group and the mild group;all P<0.05). Correlation coefficients of the spatial parameters and their DTC in condition of cognitive DTW were significantly higher than temporal parameters and their DTC (0.50< r<0.64 vs 0.15< r<0.39). The area under curve of the combined predictor was significantly higher than that of any single index. Conclusions:Cognitive DTW can better reflect the abnormal gait of CSVD patients. The spatial parameters and DTC of cognitive DTW could effectively diagnose CSVD and distinguish the disease of severity. And DTC might be better indicators. For diagnosis of CSVD, there was no significant discrepancy between the spatial parameters and DTC, but the combined predictor could significantly improve the sensitivity and reduce the false negative rate.
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Dual task walking (DTW) refers to the task of performing another attentional demand while walking naturally. It is quite common in our daily life, such as having a conversation while walking, or taking a call while crossing the street. People can simultaneously perform dual tasks normally. However, the performance of dual tasks will decline when the gait is impaired or cognitive dysfunction occurs.Neurodegenerative disease (NDD) is mainly characterized by motor and cognitive dysfunction, which seriously affects patients' ability of daily living activities. In recent years, studies on DTW in patients with NDD have found that decreased performance of DTW may be a feature of NDD patients, which may have important clinical value for early identification of NDD and predict disease progression. In the future, effective DTW training may improve the patients' ability of daily living activities, and it is important for the rehabilitation of NDD patients. This article mainly reviews the definition, common methods and mechanisms of DTW, as well as the clinical research findings and applications of DTW in patients with NDD, and provides theoretical basis for further clinical research.
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Objective To find a simple, sensitive and effective method to predict the occurrence of cogni-tive impairment in patients after a transient ischemic attack ( TIA) . Methods Thirty-six persons who had survived a first TIA and could walk independently were selected into a TIA group, with another 36 healthy counterparts chosen to form a control group. Those in both groups were given a gait analysis during dual-task walking at the outset and then assessed using the MoCA scale 12 months later. Statistical analyses were conducted to assess the reliability of gait pa-rameters in predicting cognitive dysfunction, and the area under the receiver operating characteristics curve was calcu-lated. Results On the day after enrollment the variation in step length among the TIA patients with an abnormal step length was compared with variation among the normal controls and among the TIA patients with non-abnormal step-size. The differences were significant. The average walking speed of the TIA patients with an abnormal average walking speed was significantly different from that of the control group and that of the TIA patients with non-abnormal average speed. On the day after enrolling, the accuracy rate of the control group in the dual-task walking test was sig-nificantly better than that of any of the TIA patients, and the accuracy rate of the TIA patients with an abnormal gait in the dual-task walking test was significantly lower than that of the patients with a non-abnormal gait. Twelve months later the number of patients whose MoCA scores were less than 26 in the abnormal gait group was compared with that in the normal gait group, and the difference was statistically significant. The area under the receiver operating charac-teristics curve suggests that both the incidence of step length variation and the average stepping speed could signifi-cantly predict the occurrence of cognitive dysfunction 12 months later. Conclusion Quantitative analysis of gait while dual-task walking can effectively predict the occurrence of cognitive impairment in patients with TIA, and can detect abnormalities earlier than the MoCA scale test.
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Dual task walking ( DTW) refers to the task of performing another attentional demand while walking naturally. It is quite common in our daily life,such as having a conversation while walking,or taking a call while crossing the street. People can simultaneously perform dual tasks normally. However,the performance of dual tasks will decline when the gait is impaired or cognitive dysfunction occurs. Neurodegen-erative disease (NDD) is mainly characterized by motor and cognitive dysfunction,which seriously affects patients' ability of daily living activities. In recent years,studies on DTW in patients with NDD have found that decreased performance of DTW may be a feature of NDD patients,which may have important clinical val-ue for early identification of NDD and predict disease progression. In the future,effective DTW training may improve the patients' ability of daily living activities,and it is important for the rehabilitation of NDD pa-tients. This article mainly reviews the definition,common methods and mechanisms of DTW,as well as the clinical research findings and applications of DTW in patients with NDD,and provides theoretical basis for further clinical research.
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Background: The walking gait of older adults with balance impairment is affected by dual tasking. Several studies have shown that external cues can stimulate improvement in older adults’ performance. There is, however, no current evidence to support the usefulness of external cues, such as audio-visual cueing, in dual task walking in older adults. Thus, the aim of this study was to investigate the influence of an audio-visual cue (simulated traffic light) on dual task walking in healthy older adults and in older adults with balance impairments. Methods: A two-way repeated measures study was conducted on 14 healthy older adults and 14 older adults with balance impairment, who were recruited from the community in Chiang Rai, Thailand. Their walking performance was assessed using a four-metre walking test at their preferred gait speed and while walking under two further gait conditions, in randomised order: dual task walking and dual task walking with a simulated traffic light. Each participant was tested individually, with the testing taking between 15 and 20 minutes to perform, including two-minute rest periods between walking conditions. Two Kinect cameras recorded the spatio-temporal parameters using MFU gait analysis software. Each participant was tested for each condition twice. The mean parameters for each condition were analysed using a two-way repeated measures analysis of variance (ANOVA) with participant group and gait condition as factors. Result: There was no significant between-group effect for walking speed, stride length and cadence. There were also no significant effects between gait condition and stride length or cadence. However, the effect between gait condition and walking speed was found to be significant [F(1.557, 40.485) = 4.568, P = 0.024, η = 0.149]. Conclusion: An audio-visual cue (simulated traffic light) was found to influence walking speed in both healthy older adults and in older adults with balance impairment. The results suggest that audio-visual cues could be incorporated into healthy lifestyle promotion in older adults with balance impairment.