Gandolfi Marialuisa, Fiorio Mirta, Geroin Christian, Torneri Paolo, Menaspà Zoe, Smania Nicola, Giladi Nir, Tinazzi Michele
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Italy; Neurorehabilitation Unit, AOUI Verona, Italy.
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Parkinsonism Relat Disord. 2023 Mar;108:105291. doi: 10.1016/j.parkreldis.2023.105291. Epub 2023 Jan 24.
Functional gait disorders (FGDs) are disabling symptoms of Functional Motor Disorders. Clinical observations show improvement with distraction suggesting an association with higher-level control mechanisms. Dual tasking is a valuable tool for exploring the interplay between gait and cognition. Our research question was: how do different dual task paradigms shape spatio-temporal gait parameters in FGDs?.
In all, 29 patients with FGDs (age 43.48 ± 15.42 years; female 75%) and 49 healthy controls (age 43.33 ± 15.41 years; female 62%) underwent spatio-temporal gait analysis during a single task and during performance on a motor, a cognitive, and a visual-fixation dual-task. The dual-task effect was a measure of interference of the concurrent task on gait speed, stride length (a measure of gait performance), and stride time variability (a measure of automaticity and steadiness).
Overall lower gait speed, shorter stride length, and higher stride time variability were noted in FGDs compared to healthy controls (for all, p < 0.019). The was a significant effect of group and Task × Group interaction for the dual-task effect on gait speed (p = 0.023) and stride length (p = 0.01) but not for stride time variability.
Poorer gait performance and less automaticity and steadiness were noted in FGDs. However, dual tasking affected gait performance but, unlike different neurological diseases, not automaticity and steadiness compared to controls. Our findings shed light on higher-level gait control mechanisms in FGDs and suggest stride time variability could be a diagnostic and prognostic biomarker.
功能性步态障碍（FGD）是功能性运动障碍的致残症状。临床观察表明，分心可改善症状，提示其与高级控制机制有关。双重任务是探索步态与认知之间相互作用的有效工具。我们的研究问题是：不同的双重任务范式如何塑造FGD患者的时空步态参数？
共有29例FGD患者（年龄43.48±15.42岁；75%为女性）和49名健康对照者（年龄43.33±15.41岁；62%为女性）在单任务以及执行运动、认知和视觉注视双重任务期间接受了时空步态分析。双重任务效应是指并发任务对步态速度、步幅长度（一种步态表现指标）和步幅时间变异性（一种自动性和稳定性指标）的干扰程度。
与健康对照者相比，FGD患者总体步态速度较低、步幅较短且步幅时间变异性较高（所有指标，p<0.019）。对于双重任务对步态速度（p=0.023）和步幅长度（p=0.01）的影响，存在显著的组效应和任务×组交互作用，但步幅时间变异性不存在这种情况。
FGD患者的步态表现较差，自动性和稳定性较低。然而，与对照组相比，双重任务影响了步态表现，但与不同的神经系统疾病不同，并未影响自动性和稳定性。我们的研究结果揭示了FGD患者的高级步态控制机制，并表明步幅时间变异性可能是一种诊断和预后生物标志物。
