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Analysis of gait abnormalities in Huntington disease
N C Reynolds1, J B Myklebust, T E Prieto
1Neurology Department, Medical College of Wisconsin, Veterans Affairs Medical Center, Milwaukee 53219, USA.
Insights
Huntington disease (HD) patients exhibit variable gait patterns that worsen with disease severity. Despite this variability, their gait consistently achieves the target at heel strike, aiding independence.
Area of Science:
- Neurology
- Biomechanics
- Movement Disorders
Background:
- Huntington disease (HD) is a progressive neurodegenerative disorder.
- Gait disturbances and falls are significant challenges for individuals with HD, impacting independence.
- Understanding gait strategies is crucial for fall prevention in HD patients.
Purpose of the Study:
- To analyze successful gait strategies in Huntington disease (HD) patients across different disease stages.
- To identify factors contributing to successful ambulation and fall avoidance in HD.
- To inform interventions aimed at maintaining independence in individuals with HD.
Main Methods:
- Gait kinematic parameters and joint performance were measured in six ambulatory HD patients and 30 age-matched controls.
- Patients were selected based on disease severity, ranging from minimal chorea to generalized dystonia.
- Data were collected in a standard gait laboratory using motion capture technology.
Main Results:
- Significant variability in gait parameters and joint interactions was observed among HD patients, increasing with disease severity.
- Distal joint movements showed more pronounced, random variability during gait cycles.
- Despite variability, gait profiles at heel strike remained consistent, indicating successful target achievement.
Conclusions:
- Chorea in Huntington disease (HD) does not significantly alter the center of gravity during walking.
- Consistent gait profiles at heel strike suggest that individuals with HD can achieve their intended step target.
- These findings highlight the potential for maintaining ambulation and independence despite progressive gait variability in HD.
Objective:
To evaluate patterns of successful gait strategy in Huntington disease (HD) at various stages of illness to improve fall avoidance and maintenance of independence.
Design:
Repeated measurements of gait kinematic parameters and joint performance during gait cycles of six HD patients compared to 30 age-matched controls.
Setting:
A standard gait laboratory.
Subjects:
Six HD patients, rank-ordered for disease severity from minimal chorea to generalized dystonia, selected because they were ambulatory despite 3 to 17 years' disease duration. One patient was from a nursing home (walked with assistance) and five were living independently, either alone or with a working spouse who was the caregiver.
Main Outcome Measures:
Standardized gait evaluations (retroreflective markers on standard bony landmarks) from five video angles, fed into digitizer to computer-generate joint angles and standard gait kinematic parameters.
Results:
Wide variability in gait kinematic parameters and joint interaction plots (phase plane and angle-angle plots) was observed between individuals and successive trials of the same limb, tending to increase with disease severity. Joint interaction plots show that random, highly variable distractions from planned trajectories are more apparent distally.
Conclusions:
Chorea in HD does not appreciably affect the center of gravity during ambulation, and the consistency of gait profiles at heel strike shows that the ultimate target is achieved in each step despite random and frequent variability during the gait cycle.