Gait Variability as a Potential Motor Marker of Cerebellar Disease-Relationship between Variability of Stride, Arm Swing and Trunk Movements, and Walking Speed

Abstract

Excessive stride variability is a characteristic feature of cerebellar ataxias, even in pre-ataxic or prodromal disease stages. This study explores the relation of variability of arm swing and trunk deflection in relationship to stride length and gait speed in previously described cohorts of cerebellar disease and healthy elderly: we examined 10 patients with spinocerebellar ataxia type 14 (SCA), 12 patients with essential tremor (ET), and 67 healthy elderly (HE). Using inertial sensors, recordings of gait performance were conducted at different subjective walking speeds to delineate gait parameters and respective coefficients of variability (CoV). Comparisons across cohorts and walking speed categories revealed slower stride velocities in SCA and ET patients compared to HE, which was paralleled by reduced arm swing range of motion (RoM), peak velocity, and increased CoV of stride length, while no group differences were found for trunk deflections and their variability. Larger arm swing RoM, peak velocity, and stride length were predicted by higher gait velocity in all cohorts. Lower gait velocity predicted higher CoV values of trunk sagittal and horizontal deflections, as well as arm swing and stride length in ET and SCA patients, but not in HE. These findings highlight the role of arm movements in ataxic gait and the impact of gait velocity on variability, which are essential for defining disease manifestation and disease-related changes in longitudinal observations.

Keywords: cerebellar ataxia; gait and posture; gait assessment; motor performance marker.

Figure 1

Distribution of stride velocity (%stature/s) for each walking speed category and cohort. * indicates significant differences between walking speed categories within cohorts or across cohorts. * p < 0.05, ** p < 0.01, *** p < 0.0001.

Figure 2

(A–C) Spatiotemporal gait parameters (right half of plots) and their respective coefficients of variability (CoV) mirrored to the left half of plots. Values of parameters and CoV values for slow and fast walking speed category are normalized to results at comfortable walking speed (black dotted line) to display relative differences. * indicates significant differences of gait parameters between speed categories.

Figure 3

(A,B) Dependence of gait parameters on velocity in SCA: gait parameters and respective CoV values (y axis) plotted against absolute gait velocity (x axis). Dots represent individual values, with colors indicating the walking speed category in which they were obtained. Linear fit of linear regression modeling is superimposed for each parameter/CoV with results for R², p-value, slope, and intercept above each plot.

Figure 3

(A,B) Dependence of gait parameters on velocity in SCA: gait parameters and respective CoV values (y axis) plotted against absolute gait velocity (x axis). Dots represent individual values, with colors indicating the walking speed category in which they were obtained. Linear fit of linear regression modeling is superimposed for each parameter/CoV with results for R², p-value, slope, and intercept above each plot.