PubMed · 15070560
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Shaun T O'Keeffe. 2004-01-31. Down with bedrails?. https://doi.org/10.1016/s0140-6736(04)15473-1
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While it is known that certain pathologies may impact on left-right symmetry of gait, little is known about the mechanisms that contribute to gait symmetry or how high in the hierarchy of the control of gait symmetry is regulated in humans. To assess the contribution of cognitive function to gait symmetry, we measured gait asymmetry (GA) in three subject groups, patients with Parkinson's disease (PD, n = 21), idiopathic elderly fallers (n = 15), and healthy elderly controls (n = 11). All subjects walked, under two walking conditions: usual walking and dual tasking (cognitive loading) condition. For each subject, the swing time (SW) was calculated and averaged across strides for the left and right feet (SWL and SWR). GA was defined as: 100 x /ln(SWR/SWL)/. For both the PD patients and the elderly fallers GA values were significantly higher during the usual walking condition, as compared with the control group (P < 0.01). In addition, for both the PD patients and the elderly fallers, GA significantly increased when they walked and performed a dual task, compared with the usual walking condition (P < 0.003). In contrast, dual tasking did not affect the GA of the healthy controls (P = 0.518). GA was associated with gait speed and gait variability, but no correlations were found between GA and the asymmetry of the classic PD motor symptoms. Thus, the results suggest that the ability to generate a steady, rhythmic walk with a bilaterally coordinated gait does not rely heavily on mental attention and cognitive resources in healthy older adults. In contrast, however, when gait becomes impaired and less automatic, GA apparently relies on cognitive input and attention.
This study investigated whether long-term, habitual practice of Tai Chi (or Taiji) results in behavioral modifications during gait. Specifically, we examined whether Tai Chi (TC) experience alters gait behavior during normal and obstructed walking. Fifteen experienced TC practitioners and fifteen control subjects (average age 45 years, 23-66 year range) completed level walking trials with or without a stationary obstacle placed in their path. TC practitioners in this study had an average of 6.5 years (1.5-15 year range) of Chen-style Tai Chi experience. Kinematic analyses performed on their step-to-step gait characteristics over multiple steps revealed that TC practitioners used a more cautious strategy by using slower gait speeds and shorter and slower steps than controls (p <or= 0.003). TC practitioners also spent significantly longer time in single leg support while crossing the obstacle (p < 0.001). The deleterious effect of this typically risky behavior may be mitigated in TC practitioners because of their comfort with single leg stance due to continual practice in this posture. It has been suggested that TC may reduce the risk of falls in older adults. Future studies will need to determine whether these observed gait behaviors are found in older adults and are related to reductions in fall risk.