Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Clinical Biostatistics, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.
J Neurol. 2024 Sep;271(9):6349-6358. doi: 10.1007/s00415-024-12551-6. Epub 2024 Jul 15.
Progressive supranuclear palsy (PSP) is characterized by early onset postural instability and frequent falls. Circular walking necessitates dynamic postural control, which is impaired in patients with PSP. We aimed to explore gait parameters associated with the risk of falls in patients with PSP, focusing on circular walking.
Sixteen drug-naïve patients with PSP, 22 drug-naïve patients with Parkinson's disease (PD), and 23 healthy controls were enrolled. Stride lengths/velocities and their coefficients of variation (CV) during straight and circular walking (walking around a circle of 1-m diameter) were measured under single-task and cognitive dual-task conditions. Correlation analysis was performed between gait parameters and postural instability and gait difficulty (PIGD) motor subscores, representing the risk of falls.
Patients with PSP had significantly higher CVs of stride lengths/velocities during circular walking than those during straight walking, and the extent of exacerbation of CVs in patients with PSP was larger than that in patients with PD under single-task conditions. Stride lengths/velocities and their CVs were significantly correlated with PIGD motor subscores in patients with PSP only during single-task circular walking. In addition, patients with PSP showed progressive decrements of stride lengths/velocities over steps only during single-task circular walking.
Worse gait parameters during circular walking are associated with an increased risk of falls in patients with PSP. Circular walking is a challenging task to demand the compromised motor functions of patients with PSP, unmasking impaired postural control and manifesting sequence effect. Assessing circular walking is useful for evaluating the risk of falls in patients with early PSP.
进行性核上性麻痹（PSP）的特征是早期出现姿势不稳和频繁跌倒。环形行走需要动态姿势控制，而 PSP 患者的这种控制能力受损。我们旨在探索与 PSP 患者跌倒风险相关的步态参数，重点关注环形行走。
纳入 16 名未经药物治疗的 PSP 患者、22 名未经药物治疗的帕金森病（PD）患者和 23 名健康对照者。在单任务和认知双重任务条件下，测量直线和环形行走（绕直径 1 米的圆圈行走）时的步长/速度及其变异性（CV）。对步态参数与姿势不稳和步态困难（PIGD）运动亚评分（代表跌倒风险）之间的相关性进行分析。
PSP 患者在环形行走时的步长/速度 CV 明显高于直线行走时，且在单任务条件下，PSP 患者 CV 的恶化程度大于 PD 患者。仅在单任务环形行走时，PSP 患者的步长/速度及其 CV 与 PIGD 运动亚评分显著相关。此外，PSP 患者仅在单任务环形行走时，步长/速度呈进行性下降。
环形行走时的步态参数较差与 PSP 患者跌倒风险增加相关。环形行走是一项具有挑战性的任务，要求 PSP 患者受损的运动功能，揭示了姿势控制受损和表现出序列效应。评估环形行走有助于评估早期 PSP 患者跌倒的风险。
