title: Increased gait variability is associated with the history of falls in patients with cerebellar ataxia.
abstract: Falls are common in patients with cerebellar ataxia (CA). Identification of gait variables associated with a higher risk of falls allows us to detect fallers and initiate protective procedures early. Gait variability, which is increased in CA patients, is a good predictor of falls in elderly subjects and patients with neurodegenerative diseases. The relationship between gait variability and fall risk in patients with different cerebellar disorders was systematically investigated. A total of 48 patients with different cerebellar ataxia entities [adult-onset cerebellar atrophy (SAOA) (n = 23), unknown entity (n = 7), vascular (n = 5), post-cerebellitis (n = 6), congenital (n = 2), Louis-Bar syndrome (n = 2), ethyltoxic (n = 2) posttraumatic (n = 1)] were examined using a GAITRite® sensor mat. Spatial and temporal variability parameters were used for ANOVA testing and logistic regression models with categorized fall events as dependent variables. Gait variability in the fore-aft direction showed significant differences between the fall groups (p < 0.05-0.01). Model effects were highest for walking with slow speed (correct prediction 0.50-0.72). The speed-dependent integral of gait variability markers showed a higher discriminatory power (correct prediction 0.74-0.94). Gait variability is linked to the fall risk of patients with CA, slow walking and temporal gait variability being most relevant. The use of speed-dependent integrals of gait variability improves the accuracy of fall prediction. To predict fall risks in cerebellar ataxia, gait variability measurements made during slow walking should be included in a gait analysis procedure. The effects of speed-adjusted physiotherapeutic interventions have to be further investigated.
authors.affiliation: Department of Neurology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany, roman.schniepp@med.uni-muenchen.de.
authors.forename: Roman
authors.initials: R
authors.lastname: Schniepp
authors.forename: Max
authors.initials: M
authors.lastname: Wuehr
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schlick
authors.forename: Sabrina
authors.initials: S
authors.lastname: Huth
authors.forename: Cauchy
authors.initials: C
authors.lastname: Pradhan
authors.forename: Marianne
authors.initials: M
authors.lastname: Dieterich
authors.forename: Thomas
authors.initials: T
authors.lastname: Brandt
authors.forename: Klaus
authors.initials: K
authors.lastname: Jahn
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000704:Analysis of Variance; D019540:Area Under Curve; D002524:Cerebellar Ataxia / Q000150:complications*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged