Date Presented 04/200/21
Current methods to assess functional performance often rely on subjective reporting and are commonly not generalizable. A cross-sectional comparison of standard straight-line gait under a cognitive load and a functional task that included cognitive and visual components was performed using instrumented gait mats. Preliminary results suggest traditional linear dual-task walking may not accurately depict functional gait, highlighting the need for ecologically valid assessments of function.
Primary Author and Speaker: Maxwell Toepfer
Additional Authors and Speakers: Natalie Robek, Megan Dougherty, and Anna Murray
Contributing Authors: Lindy Weaver, Amy Darragh
Current methods to assess functional ability and activities of daily living often rely on self-report and subjective measures (Roedl, Wilson & Fine, 2016). While important, these assessments can be limited in adult participants by reporting biases, memory limitations and impaired cognition. Spatiotemporal measures of straight-line gait are commonly used to measure gait function in clinical and research settings however, these methods lack ecological validity and do not reliably portray real world gait parameters (Hillel et al., 2019). To address these limitations, non-linear spatiotemporal measures of functional gait were collected during the performance of a prespecified instrumental activity of daily living (IADL). Instrumenting a standardized, functional assessment that mimics common ADLs and IADLs could provide researchers and clinicians quantitative measures of function.
DESIGN: Rural dwelling adults over the age of 60 years who were able to complete a 10 minute walking task and met inclusion criteria for an ongoing intervention study were included in this quasi-experimental, cross-sectional analysis.
METHODS: Each participant performed both straight-line preferred speed forward and dual task walking on a GAITRite© walkway. This was followed by walking on a non-linear Zeno© walkway while completing an IADL task (grocery shopping) in a complex visual scene. The IADL task was modified from the Performance Assessment of Self-care Skills (PASS). Individual footfalls were identified and verified for the entire IADL task. Spatiotemporal parameters of gait such as normalized velocity, stride length, stride width, and gait variance were analyzed. Means and correlations were compared between techniques.
RESULTS: Data analysis is ongoing. All participants were able to successfully complete both the IADL task and linear walking trials. Preliminary data from 10 participants suggest individuals walked slower (p-value = 0.0002) and took longer steps (p-value < 0.0001), but did not take significantly wider strides (p-value = 0.103) during the IADL task. Similarly, variance was significantly higher for velocity (p-value = 0.0001) and stride length (p-value < 0.0001), but not stride width (p-value = 0.249).
CONCLUSION: The results of this study indicate that older adults perform IADL tasks with gait patterns more indicative of individuals at higher risk for falls (Verghese, Holtzer, Lipton & Wang, 2009). These findings are predictable in that falls are more likely and fear of falling is higher during tasks of increasing complexity. Quantitative data from a standardized functional task could provide information that complements established qualitative measures commonly utilized by clinicians and researchers to evaluate function. The cognitive demands of IADL tasks may require greater attention than typical dual task walking paradigms and may therefore be better able to reflect deficit as well as improvement following an intervention. Gait related measures collected in environments that are ecologically similar to those experienced by individuals during their everyday life may provide increased sensitivity in detection of affected gait and function.
IMPACT STATEMENT: Preliminary findings from this study show decreased stride length and velocity during the performance of a complex cognitive task highlight the importance of ecologically valid assessments that lead to more generalizable findings and guide clinical decisions.
References
Roedl, K. J., Wilson, L. S., & Fine, J. (2016). A systematic review and comparison of functional assessments of community-dwelling elderly patients. Journal of the American Association of Nurse Practitioners, 28(3), 160-169. https://doi.org/10.1002/2327-6924.12273
Hillel, I., Gazit, E., Nieuwboer, A., Avanzino, L., Rochester, L., Cereatti, A., ... & Del Din, S. (2019). Is every-day walking in older adults more analogous to dual-task walking or to usual walking? Elucidating the gaps between gait performance in the lab and during 24/7 monitoring. European review of aging and physical activity, 16(1), 6. https://doi.org/10.1186/s11556-019-0214-5
Verghese, J., Holtzer, R., Lipton, R. B., & Wang, C. (2009). Quantitative Gait Markers and Incident Fall Risk in Older Adults. The Journals of Gerontology: Series A, 64A(8), 896–901. https://doi.org/10.1093/gerona/glp033
