title: The interrelationship between disease severity, dynamic stability, and falls in cerebellar ataxia.
abstract: Cerebellar ataxia (CA) results in discoordination of body movements (ataxia), a gait disorder, and falls. All three aspects appear to be obviously interrelated; however, experimental evidence is sparse. This study systematically correlated the clinical rating of the severity of ataxia with dynamic stability measures and the fall frequency in patients with CA. Clinical severity of CA in patients with sporadic (n = 34) and hereditary (n = 24) forms was assessed with the Scale for the Assessment and Rating of Ataxia (SARA). Gait performance was examined during slow, preferred, and maximally fast walking speeds. Spatiotemporal variability parameters in the fore-aft and medio-lateral directions were analyzed. The fall frequency was assessed using a standardized interview about fall events within the last 6 months. Fore-aft gait variability showed significant speed-dependent characteristics with highest magnitudes during slow and fast walking. The SARA score correlated positively with fore-aft gait variability, most prominently during fast walking. The fall frequency was significantly associated to fore-aft gait variability during slow walking. Severity of ataxia, dynamic stability, and the occurrence of falls were interrelated in a speed-dependent manner: (a) Severity of ataxia symptoms was closely related to instability during fast walking. (b) Fall frequency was associated with instability during slow walking. These findings suggest the presence of a speed-dependent, twofold cerebellar locomotor control. Assessment of gait performance during non-preferred, slow and fast walking speeds provides novel insights into the pathophysiology of cerebellar locomotor control and may become a useful approach in the clinical evaluation of patients with CA.
authors.affiliation: Department of Neurology, University of Munich, Munich, Germany. roman.schniepp@med.uni-muenchen.de.|German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany. roman.schniepp@med.uni-muenchen.de.
authors.forename: Roman
authors.initials: R
authors.lastname: Schniepp
authors.affiliation: Department of Neurology, University of Munich, Munich, Germany.|German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schlick
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Cauchy
authors.initials: C
authors.lastname: Pradhan
authors.affiliation: Department of Neurology, University of Munich, Munich, Germany.|German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Marianne
authors.initials: M
authors.lastname: Dieterich
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.|Institute for Clinical Neurosciences, University of Munich, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brandt
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.|Schoen Klinik Bad Aibling, Bad Aibling, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Jahn
authors.affiliation: German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Munich, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Wuehr
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D002524:Cerebellar Ataxia / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008124:Locomotion / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012678:Sensation Disorders / Q000209:etiology*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
keywords: Cerebellar ataxia; Fall-related injuries; Falls; Gait variability; SARA; Walking speed