Gait dynamics, fractals and falls: finding meaning in the stride-to-stride fluctuations of human walking.

Until recently, quantitative studies of walking have typically focused on properties of a typical or average stride, ignoring the stride-to-stride fluctuations and considering these fluctuations to be noise. Work over the past two decades has demonstrated, however, that the alleged noise actually conveys important information. The magnitude of the stride-to-stride fluctuations and their changes over time during a walk - gait dynamics - may be useful in understanding the physiology of gait, in quantifying age-related and pathologic alterations in the locomotor control system, and in augmenting objective measurement of mobility and functional status. Indeed, alterations in gait dynamics may help to determine disease severity, medication utility, and fall risk, and to objectively document improvements in response to therapeutic interventions, above and beyond what can be gleaned from measures based on the average, typical stride. This review discusses support for the idea that gait dynamics has meaning and may be useful in providing insight into the neural control of locomotion and for enhancing functional assessment of aging, chronic disease, and their impact on mobility.