Wang Yajing, Li Yanna, Liu Shoufeng, Liu Peipei, Zhu Zhizhong, Wu Jialing
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China.
Front Neurol. 2023 Jun 6;14:1166151. doi: 10.3389/fneur.2023.1166151. eCollection 2023.
Falls and gait disturbance are significant clinical manifestations of cerebral small vessel disease (CSVD). However, few relevant studies are reported at present. We aimed to investigate gait characteristics and fall risk in patients with CSVD.
A total of 119 patients with CSVD admitted to the Department of Neurology at Tianjin Huanhu Hospital between 17 August 2018 and 7 November 2018 were enrolled in this study. All patients underwent cerebral magnetic resonance imaging scanning and a 2-min walking test using an OPAL wearable sensor and Mobility Lab software. Relevant data were collected using the gait analyzer test system to further analyze the time-space and kinematic parameters of gait. All patients were followed up, and univariate and multivariate logistic regression analyses were conducted to analyze the gait characteristics and relevant risk factors in patients with CSVD at an increased risk of falling.
All patients were grouped according to the presence or absence of falling and fear of falling and were divided into a high-fall risk group ( = 35) and a low-fall risk group ( = 72). Logistic multivariate regression analysis showed that the toe-off angle [odds ratio (OR) = 0.742, 95% confidence interval (CI) 0.584-0.942, < 0.05], toe-off angle coefficient of variation (CV) (OR = 0.717, 95% CI: 0.535-0.962, < 0.05), stride length CV (OR = 1.256, 95% CI: 1.017-1.552, < 0.05), and terminal double support CV (OR = 1.735, 95% CI: 1.271-2.369, < 0.05) were statistically significant ( < 0.05) and were independent risk factors for high-fall risk in patients with CSVD.
CSVD patients with seemingly normal gait and ambulation independently still have a high risk of falling, and gait spatiotemporal-kinematic parameters, gait symmetry, and gait variability are important indicators to assess the high-fall risk. The decrease in toe-off angle, in particular, and an increase in related parameters of CV, can increase the fall risk of CSVD patients.
跌倒和步态障碍是脑小血管病（CSVD）的重要临床表现。然而，目前相关研究报道较少。我们旨在研究CSVD患者的步态特征和跌倒风险。
选取2018年8月17日至2018年11月7日在天津环湖医院神经内科住院的119例CSVD患者纳入本研究。所有患者均接受脑磁共振成像扫描，并使用OPAL可穿戴传感器和Mobility Lab软件进行2分钟步行测试。使用步态分析仪测试系统收集相关数据，以进一步分析步态的时空和运动学参数。对所有患者进行随访，并进行单因素和多因素逻辑回归分析，以分析跌倒风险增加的CSVD患者的步态特征和相关危险因素。
所有患者根据是否跌倒和是否害怕跌倒进行分组，分为高跌倒风险组（n = 35）和低跌倒风险组（n = 72）。多因素逻辑回归分析显示，蹬离角度[比值比（OR）= 0.742，95%置信区间（CI）0.584 - 0.942，P < 0.05]、蹬离角度变异系数（CV）（OR = 0.717，95% CI：0.535 - 0.962，P < 0.05）、步幅长度CV（OR = 1.256，95% CI：1.017 - 1.552，P < 0.05）和终末双支撑CV（OR = 1.735，95% CI：1.271 - 2.369，P < 0.05）具有统计学意义（P < 0.05），是CSVD患者高跌倒风险的独立危险因素。
看似步态和行走正常的CSVD患者仍有较高的跌倒风险，步态时空运动学参数、步态对称性和步态变异性是评估高跌倒风险的重要指标。尤其是蹬离角度的减小以及CV相关参数的增加，会增加CSVD患者的跌倒风险。
