The impact of different types of assistive devices on gait measures and safety in Huntington's disease

Abstract

Background: Gait and balance impairments lead to frequent falls and injuries in individuals with Huntington's disease (HD). Assistive devices (ADs) such as canes and walkers are often prescribed to prevent falls, but their efficacy is unknown. We systematically examined the effects of different types of ADs on quantitative gait measures during walking in a straight path and around obstacles.

Methods: Spatial and temporal gait parameters were measured in 21 subjects with HD as they walked across a GAITRite walkway under 7 conditions (i.e., using no AD and 6 commonly prescribed ADs: a cane, a weighted cane, a standard walker, and a 2, 3 or 4 wheeled walker). Subjects also were timed and observed for number of stumbles and falls while walking around two obstacles in a figure-of-eight pattern.

Results: Gait measure variability (i.e., coefficient of variation), an indicator of fall risk, was consistently better when using the 4WW compared to other ADs. Subjects also walked the fastest and had the fewest number of stumbles and falls when using the 4WW in the figure-of-eight course. Subjects walked significantly slower using ADs compared to no AD both across the GAITRite and in the figure-of-eight. Measures reflecting gait stability and safety improved with the 4WW but were made worse by some other ADs.

Figure 1. Footfall Patterns.

Footfall pattern recordings in one individual with HD under five conditions (A) no assistive device and using a (B) cane, (C) standard walker, (D) two-wheeled walker or (E) four-wheeled walker. The four-wheeled walker (E) produced a gait pattern with the least variability.

Figure 2. Gait Parameters.

Comparison of gait parameters: (A) velocity, (B) stride length, (C) percent time in swing, and (D) percent time in double support with standard deviation across 6 walking conditions: no AD, no assistive device; StW, standard walker; 2WW, two-wheeled walker; 3WW, three-wheeled walker; 4WW, four-wheeled walker. * * significantly different than no AD at p<.05; **significantly different than all other conditions at p<.05; † significantly different than cane at p<.05; # significantly different than StW at p<.05; ∞ significantly different than 3WW at p<.05; § significantly different than 2WW, 4WW at p<.05.

Figure 3. Coefficients of Variation.

Comparison of mean coefficients of variation across six walking conditions: (A) step time and (B) stride length coefficients of variation (CV) with standard deviation. Variability was consistently low when using the four-wheeled walker (4WW); no AD, no assistive device; StW, standard walker; 2WW, two-wheeled walker; 3WW, three-wheeled walker; *significantly different than no AD at p<.05. * significantly different than no AD at p<.05; † significantly different than cane at p<.05; # significantly different than StW at p<.05; ∞ significantly different than 3WW at p<.05; § significantly different than 2WW, 4WW at p<.05; Ψ significantly different than cane and 4WW at p<.05.

Figure 4. Figure of Eight Course.

Comparison of mean time and stumbles on a figure of eight course: (A) mean time with standard deviation for one lap around figure-of-eight course and (B) number of stumbles and number of individuals who stumbled walking in the figure-of-eight course across conditions; no AD, no assistive device; StW, standard walker; 2WW, two-wheeled walker; 3WW, three-wheeled walker; 4WW, four-wheeled walker. * significantly different than no AD at p<.001.