Contribution of Motor and Cognitive Factors to Gait Variability and Fall Risk:From Clinical Assessment to Neural Connectivity
Year: 2013
Type: article
Abstract: Both motor and cognitive factors contribute to increases in gait variability and fall risk in individuals with neurologic disorders.Tasks requiring simultaneous mobility and cognition (i.e.dual-tasks) have been linked with accidental falls.Although these deficits have been well documented in elderly adults, relapsing remitting multiple sclerosis (RRMS), Parkinson's disease, traumatic brain injury and stroke, the individual contributions of mobility and cognition have not been explored and there are few studies exploring rehabilitation for these impairments using dual-task training.In order to move toward interventional techniques that effectively improve dual-tasking in individuals with neurologic conditions, a better understanding of tasks that amplify gait variability, the contribution of cognition to mobility and who may benefit from such programs is needed.Together, a systematic review of the literature and a case study provided evidence to support the importance of the interaction between mobility and cognition, the presence of dualtask deficits, and the feasibility of dual-task training in neurologic disorders.Gaps in the literature identified in the systematic review were used to direct the research questions of this document.The results of cross-sectional and baseline data from a randomized controlled trial suggest that tasks that amplify gait variability may be related to falls and underlying cognition.Backward walking amplified gait variability in both elderly adults and individuals with RRMS, and a backward walking velocity of <0.6 m/s accurately predicted elderly fallers.Dual-task walking iii amplified gait variability in individuals with RRMS, and higher gait variability correlated with lower performance on neuropsychological tests (p<0.01).Diffusion imaging is a useful tool to examine neural connectivity in individuals with RRMS.The supplemental motor area (SMA) has been implicated in cognitive dual-tasks, but its relationship with motor-cognitive dual-tasks has not been explored.Our baseline imaging work suggests that connectivity of the interhemispheric SMA tract is associated with velocity of dualtask walking in RRMS; regression analysis demonstrates a significant relationship between dualtask walking velocity and SMA axial diffusivity (r 2 =0.436, p=0.014).Although work is ongoing to characterize dual-task deficits in individuals with neurologic conditions, our review of the literature suggests that this is an impairment that spans diagnoses and that rehabilitation focused on training both motor and cognitive domains can be successful in improving dual-task deficits.Our case study demonstrated that dual-task deficits can be improved even in individuals with severe impairment.These studies were limited by small sample sizes, the paucity of dual-task training intervention studies to date, differences in measurement tools across studies, making it difficult to compare and generalize results.Our findings were also limited by the preliminary nature of our RRMS dataset.However, our results provide guidance for future studies to understand the contribution of motor and cognitive factors to gait variability and falls in individuals with neurologic conditions.Rehabilitation of dual-task impairments could improve quality of life, safety and independence in these individuals.Further research is needed to establish appropriate training programs for different diagnoses, effective measuring tools for demonstrating improvement, and predictive factors to explore which individuals can benefit from such programs.vii
Author: Nora E. Fritz
Institution: The Ohio State University
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2515066894