Kinematic movement and balance parameter analysis in neurological gait disorders

Abstract

Background: Neurological gait disorders are mainly classified based on clinical observation, and therefore difficult to objectify or quantify. Movement analysis systems provide objective parameters, which may increase diagnostic accuracy and may aid in monitoring the disease course. Despite the increasing wealth of kinematic movement and balance parameter data, the discriminative value for the differentiation of neurological gait disorders is still unclear. We hypothesized that kinematic motion and balance parameter metrics would be differently altered across neurological gait disorders when compared to healthy controls.

Methods: Thirty one patients (9 normal pressure hydrocephalus < NPH > , 16 cervical myelopathy < CM > , 6 lumbar stenosis < LST >) and 14 healthy participants were investigated preoperatively in an outpatient setting using an inertial measurement system (MyoMotion) during 3 different walking tasks (normal walking, dual-task walking with simultaneous backward counting, fast walking). In addition, the natural postural sway of participants was measured by pedobarography, with the eyes opened and closed. The range of motion (ROM) in different joint angles, stride time, as well as sway were compared between different groups (between-subject factor), and different task conditions (within-subject factor) by a mixed model ANOVA.

Results: Kinematic metrics and balance parameters were differently altered across different gait disorders compared to healthy controls. Overall, NPH patients significantly differed from controls in all movement parameters except for stride time, while they differed in balance parameters only with regard to AP movement. LST patients had significantly reduced ROMs of the shoulders, hips, and ankles, with significantly altered balance parameters regarding AP movement and passed center-of-pressure (COP) distance. CM patients differed from controls only in the ROM of the hip and ankle, but were affected in nearly all balance parameters, except for force distribution.

Conclusion: The application of inertial measurement systems and pedobarography is feasible in an outpatient setting in patients with different neurological gait disorders. Rather than defining singular discriminative values, kinematic gait and balance metrics may provide characteristic profiles of movement parameter alterations in the sense of specific ´gait signatures´ for different pathologies, which could improve diagnostic accuracy by defining objective and quantifiable measures for the discrimination of different neurological gait disorders.

Trial registration: The study was retrospectively registered on the 27th of March 2023 in the 'Deutsches Register für Klinische Studien' under the number DRKS00031555.

Keywords: Gait analysis; IMU; Pedobarography.

Fig. 1

Sensor placement for the MyoMotion IMUs

Fig. 2

Mean ankle dorsiflexion over one gait cycle for all participant groups

Fig. 3

Spider plot of the mean deviations of different patient groups relative to healthy controls. Legend: On each axis, the deviation for one parameter is shown, with kinematic angles in degree and stride time in milliseconds. The center represents no deviation from controls. The mean deviation is presented for each patient group for each walking task separately

Fig. 4

Spider plot of the mean deviations of different patient groups relative to healthy controls. Legend: On each axis, the deviation for one parameter is shown, with movement and distance in millimeters and force distribution in percent. The center represents no deviation from controls. The mean deviation is presented for each patient group for each balance task separately

Fig. 5

Spider plots of mean deviation of patients across walking (top) and balance tasks (bottom). Legend: These plots are comparable with the results from the mixed ANOVA in Tables 3 and 4