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首页> 外文期刊>Gait & posture >Gait instability and fractal dynamics of older adults with a 'cautious' gait: why do certain older adults walk fearfully?
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Gait instability and fractal dynamics of older adults with a 'cautious' gait: why do certain older adults walk fearfully?

机译：具有“谨慎”步态的老年人的步态不稳定性和分形动态：为什么某些老年人会恐惧地行走？

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Many older adults walk with a cautious and impaired gait of unknown origin, however, the relationship between fear of falling and the observed gait changes is not well understood. To better understand the "cautious" gait of the elderly, we tested the hypothesis that temporal gait variability, putatively a marker of intrinsic walking unsteadiness, is increased among older adults with a cautious gait and a higher-level gait disorder (HLGD), an altered gait that cannot be attributed to a well-defined cause. Twenty-five older adults (mean age: 78 years) with a HLGD were compared to healthy controls of similar age and sex (n=28). The clinical characteristics (e.g., neurological status, fear of falling), the magnitude of the stride-to-stride variations in gait cycle timing (a measure of temporal gait variability), and a fractal index of gait (a measure of the stride dynamics independent of the magnitude of the variability) were studied in both groups. Gait variability was significantly increased (P<0.0001) in HLGD subjects (52+/-26 ms) compared to controls (27+/-9 ms). Changes in frontal lobe and extra-pyramidal function were also found in the patient group. Among HLGD subjects, gait variability was not associated (P>0.05) with age, gender, MMSE score, muscle strength, # of co-morbidities, balance, cerebellar signs, or pyramidal signs, but was significantly associated with scores on the Geriatric Depression Scale (r=0.46, P<0.02) and fear of falling (r=0.69, P<0.0001). Among HLGD subjects, only a fractal index was significantly different in fallers and non-fallers. These findings underscore the idea that the gait changes in older adults who walk with fear may be an appropriate response to unsteadiness, are likely a marker of underlying pathology, and are not simply a physiological or psychological consequence of normal aging.
机译：许多老年人走路时步态谨慎且受损，来历不明，但是，人们对跌倒的恐惧与观察到的步态变化之间的关系尚不清楚。为了更好地理解老年人的“谨慎”步态，我们测试了以下假设：假定步态谨慎且步态障碍较高（HLGD）的老年人的时间步态变异性（可能是内在行走不稳定的标志）会增加不能归因于明确原因的步态改变。将25名患有HLGD的老年人（平均年龄：78岁）与年龄和性别相仿的健康对照组进行比较（n = 28）。临床特征（例如，神经系统状况，害怕跌倒），步态周期时间跨步变化的幅度（时间步态变异性的量度）和步态的分形指数（步幅动态的量度）两组均不考虑变异性的大小）。与对照组（27 +/- 9 ms）相比，HLGD受试者（52 +/- 26 ms）的步态变异性显着增加（P <0.0001）。患者组也发现额叶和锥体外系功能改变。在HLGD受试者中，步态变异性与年龄，性别，MMSE评分，肌肉力量，合并症数，平衡，小脑体征或锥体束征不相关（P> 0.05），但与老年抑郁症的得分显着相关量表（r = 0.46，P <0.02）和害怕跌倒（r = 0.69，P <0.0001）。在HLGD受试者中，跌倒者和非跌倒者中只有一个分形指数显着不同。这些发现强调了这样一种观点，即恐惧行走的老年人的步态变化可能是对不稳定的适当反应，可能是潜在病理的标志，而不仅仅是正常衰老的生理或心理后果。

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