Alcock Lisa, Galna Brook, Hausdorff Jeffrey M, Lord Sue, Rochester Lynn
Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom.
Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom; School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
Gait Posture. 2018 Mar;61:368-374. doi: 10.1016/j.gaitpost.2018.01.030. Epub 2018 Jan 31.
Gait impairment places older adults and people with Parkinson's disease (PD) at an increased risk of falls when walking over obstacles. Increasing the height of obstacles results in greater challenge to balance however little is known about the demands encountered when negotiating obstacles of greater depth which may be greater for PD who often walk with a short, shuffling gait.
To describe gait adaptation in older adults and people with PD when walking over long and tall obstacles.
20 people with PD and 13 older adults with a history of falls walked across an instrumented walkway under four conditions: level walking, and over a small, long and tall obstacle. Differences due to group, step and obstacle type were evaluated using General Linear Models.
An increased step duration, longer single limb support and a wider step (p < .033) were observed when crossing the tall obstacle for both older adults and PD. The PD group completed the crossing steps more slowly than controls, with a shorter step and longer single limb support (p < .043). Obstacle type did not significantly influence step length.
The greatest temporal-spatial adaptations were elicited when participants negotiated the tall obstacle. Electing a wider step when crossing the tall obstacle was a strategy common to both faller groups (older adults and PD). The tall obstacle presented added challenge for PD who spent longer in single limb support during the crossing steps compared to controls. The long obstacle did not cause a disproportionate change in step length in people with PD, and we suggest that the obstacle may have acted as a visual cue in this group.
步态障碍使老年人和帕金森病（PD）患者在跨越障碍物行走时跌倒风险增加。增加障碍物高度会给平衡带来更大挑战，然而对于跨越深度更大的障碍物时所面临的需求却知之甚少，而这对于经常以短小、拖曳步态行走的PD患者可能更具挑战性。
描述老年人和PD患者在跨越长而高的障碍物时的步态适应性。
20名PD患者和13名有跌倒史的老年人在四种条件下走过一条装有仪器的通道：平路行走，以及跨越一个小的、长的和高的障碍物。使用一般线性模型评估因组别、步幅和障碍物类型导致的差异。
老年人和PD患者在跨越高障碍物时均观察到步幅持续时间增加、单腿支撑时间延长和步幅变宽（p<0.033）。PD组完成跨越步骤的速度比对照组慢，步幅更短且单腿支撑时间更长（p<0.043）。障碍物类型对步长没有显著影响。
当参与者跨越高障碍物时，引发了最大的时空适应性变化。在跨越高障碍物时选择更宽的步幅是两个跌倒组（老年人和PD患者）共有的策略。高障碍物给PD患者带来了额外挑战，与对照组相比，他们在跨越步骤中花费在单腿支撑上的时间更长。长障碍物并未导致PD患者步长出现不成比例的变化，我们认为该障碍物在这组人群中可能起到了视觉提示的作用。
