title: 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.
abstract: 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.
  
  
  METHODS
  22 patients with a HLGD and 20 age-matched healthy controls were studied under usual lighting conditions (1000 lumens) and in near darkness (5 lumens). Gait speed and gait dynamics were measured under both conditions. Cognitive function, co-morbidities, depressive symptoms, and vision were also evaluated.
  
  
  RESULTS
  Under usual lighting conditions, patients walked more slowly, with reduced swing times, and increased stride-to-stride variability, compared to controls. When walking under near darkness conditions, both groups slowed their gait. All other measures of gait were not affected by lighting in the controls. In contrast, patients further reduced their swing times and increased their stride-to-stride variability, both stride time variability and swing time variability. The unique response of the patients was not explained by vision, mental status, co-morbidities, or the values of walking under usual lighting conditions.
  
  
  CONCLUSIONS
  Walking with reduced lighting does not affect the gait of healthy elderly subjects, except for a reduction in speed. On the other hand, the gait of older adults with a HLGD becomes more variable and unsteady when they walk in near darkness, despite adapting a slow and cautious gait. Further work is needed to identify the causes of the maladaptive response among patients with a HLGD and the potential connection between this behavior and the increased fall risk observed in these patients.
authors.affiliation: Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. kesler@netvision.net.il
authors.forename: Anat
authors.initials: A
authors.lastname: Kesler
authors.forename: Gregory
authors.initials: G
authors.lastname: Leibovich
authors.forename: Talia
authors.initials: T
authors.lastname: Herman
authors.forename: Leor
authors.initials: L
authors.lastname: Gruendlinger
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Hausdorff