Gait Alterations on Irregular Terrain in Older Adults with and Without Parkinson Disease: Fall Risk Implications

Details

• Personal Author:
  Foreman B ; Hunt M ; Merryweather A ; Minor M ; Smith L
• Description:
  Introduction: Persons with Parkinson disease (PD) are at risk for fall-related injuries as 60-80% of persons with PD fall annually. As a result of the motor and cognitive effects of the disease, the gait of persons with PD is distinguishably impaired as the disease severity progresses. Characteristic Parkinsonian gait includes a stooped torso and shuffling steps that are the result of overall reduced flexion and extension in the legs and nonzero velocity in the feet at the time of heel strike. Persons with PD have particularly high fall risks in comparison to healthy-older adults because their gait is impaired by both factors (age and the disease). The complexity of tasks involved and environments encountered while walking increase the gait impairments that PD inflicts, thus irregular terrain can add to the fall risk of this population. The purpose of this study was to characterize the gait of this fall-prone population on an irregular surface to accomplish the following goals: 1) Inform the general scientific community of the specific challenges that such environments present to those with PD so that such issues might be addressed 2) Provide biomechanical data to verify the ecological validity of a novel VR training environment being created for use in PD rehabilitation research. Method: Nine patients with PD and nine healthy age-matched controls were recruited. Two 40cm x 60cm force plates (Bertec, Columbus, OH, USA) were imbedded into custom built, raised walkways (0.76 m x 7.3 m). Uneven terrain was simulated by modifying polyurethane faux rock panels and fixing them to the walkway surface. In total, 3 surface/slope conditions were simulated in addition to a control flat/level condition. Conditions included a cobblestone surface, an off-camber surface, and an off-camber cobblestone surface. The walkway at a 0 degree condition without the cobblestone served as the control. Video data were collected at (100 Hz) with Capture2D (C-Motion, Germantown, MD, USA) and 24 - V100:R2 cameras (NaturalPoint, Corvallis, OR, USA). Data were processed and calculations were performed using AMASS (C-Motion) and Visual3D (C-Motion). Results: Surface rather than slope was shown to have a more significant effect on the gait parameters of focus (i.e. spatiotemporal measures, leg kinematics, and trunk stability measures). Specific gait changes exhibited by the participants with PD (on a 0 degree slope) included the following: 1) adoption of more conservative step patterns, 2) significant changes in the range of motion across all leg joints (while only the ankle was affected in the case of the control group), and 3) increased trunk COM acceleration variability in all directions (suggesting a challenge to stability in all planes of motion). In the case of surface effect on a 10 degree cross slope, the overall stability of the participants was more threatened than it had been due to the surface effect on the 0 degree slope. Discussion: This study is unique in that it has identified gait patterns of participants with PD on conditions not yet tested with such a population (i.e. irregular terrain, cross slope, and a combination of the two). Overall, participants did not perceive the represented conditions to be particularly difficult, as indicated by their responses in the post-trial questionnaire; however, gait analysis results indicate that compensation strategies were employed differently by each group. [Description provided by NIOSH]
• Subjects:
  Accidental Falls Accidents Age Factors Aging Biomechanical Phenomena Occupational Health Risk Assessment Safety
• Keywords:
  Age Factors Age Groups Author Keywords: Parkinson Disease Biomechanical Modeling Biomechanics Falls Floors Footwear Gait Irregular Terrain Parkinsonism Parkinsons Disease Risk Analysis Slips, Trips, And Falls STF Surface Properties Virtual Reality Walking Surfaces

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• Publisher:
  International Ergonomics Association
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Proceedings
• Place as Subject:
  OSHA Region 8 ; Utah
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-8
• NIOSHTIC Number:
  nn:20052095
• Citation:
  The Proceedings of the 19th Triennial Congress of the International Ergonomics Association (IEA Congress 2015), August 9-14, 2015, Melbourne, Australia. Lindgaard G, Moore D, eds. Madison, WI: International Ergonomics Association, 2015 Aug; :1-8
• Editor(s):
  Lindgaard G; Moore D
• Federal Fiscal Year:
  2015
• Performing Organization:
  University of Utah
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  The Proceedings of the 19th Triennial Congress of the International Ergonomics Association (IEA Congress 2015), August 9-14, 2015, Melbourne, Australia
• End Date:
  20280630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c3a5f88013f8dce01bb6b3f7606fdee6742ed1d231d520d321d250c38ba73ba2b3f8b01009ac545234bb79d1ac2584435e4a05bccf3170cd6a3246642004d99a
• Download URL:
  https://stacks.cdc.gov/view/cdc/211694/cdc_211694_DS1.pdf
• File Type:
  [PDF - 63.98 KB ]