Background. Gait disorders, a highly prevalent condition in older adults, are associated with several adverse health consequences. Gait analysis allows qualitative and quantitative assessments of gait that improves the understanding of mechanisms of gait disorders and the choice of interventions. This manuscript aims 1) to give consensus guidance for clinical and spatiotemporal gait analysis based on the recorded footfalls in older adults aged 65 years and over, and 2) to provide reference values for spatiotemporal gait parameters based on the recorded footfalls in healthy older adults free of cognitive impairment and multi-morbidities. Methods. International experts working in a network of two different consortiums (i.e.; Biomathics and Canadian Gait Consortium) participated in this initiative. First, they identified items of standardized information following the usual procedure of formulation of consensus findings. Second, they merged databases including spatiotemporal gait assessments with GAITRite® system and clinical information from the “Gait, cOgnitiOn & Decline” (GOOD) initiative and the Generation 100 (Gen 100) study. Only healthy - free of cognitive impairment and multi-morbidities (i.e.; ≤3 therapeutics taken daily) - participants aged 65 and older were selected. Age, sex, body mass index, mean values and coefficients of variation (CoV) of gait parameters were used for the analyses. Results. Standardized systematic assessment of three categories of items, which were demographics and clinical information, and gait characteristics (clinical and spatiotemporal gait analysis based on the recorded footfalls), were selected for the proposed guidelines. Two complementary sets of items were distinguished: a minimal data set and a full data set. In addition, a total of 954 participants (mean age 72.8 ± 4.8 years, 45.8% women) were recruited to establish the reference values. Performance of spatiotemporal gait parameters based on the recorded footfalls declined with increasing age (mean values and CoV) and demonstrated sex differences (mean values only). Conclusions. Based on an international multicenter collaboration, we propose consensus guidelines for gait assessment and spatiotemporal gait analysis based on the recorded footfalls, and reference values for healthy older adults.

The ability of subjects with multidirectional shoulder instability to use proprioception to complete a series of upper limb repositioning tasks was investigated. Twelve subjects with multidirectional instability and 12 control subjects were blindfolded and instructed to use proprioception to reproduce a self-selected target position as accurately as possible. Subjects completed 10 repetitions for each limb using three distinct upper limb movements: overhead reaching, scapular plane pointing, and humeral external rotation with abduction. A three-dimensional video motion analysis system tracked limb position and determined spatial hand position error. Subjects with multidirectional shoulder instability showed significantly greater hand position error than control subjects. No hand position error differences were found between the symptomatic and the asymptomatic limbs of subjects in the instability group. Inter-repetition error for subjects in both groups improved significantly during the first three movement cycles. These results suggest that after movement initiation, dynamic proprioception was a factor in improving hand position accuracy in both groups, but to a lesser degree in subjects with multidirectional instability. Consequently, subjects with multidirectional instability may have a reduced capacity to use proprioception to refine and control the motor output of the upper limb.

According to traditional conceptualizations of the relationship between fear of falling and falls in older adults, fear of falling is considered to be predictive of falls because it leads to activity avoidance which, in turn, leads to de-conditioning that increases fall risk. The recent literature has begun to challenge such conceptualizations. Specifically, it has been argued that fear of falling and anxiety, in and of themselves, have a direct negative effect on balance. In this study we manipulated anxiety level by asking older research participants to walk either on the floor (low anxiety condition) or an elevated platform (high anxiety condition). Half the time participants carried a tray (dual tasking) and half the time they did not. Manipulation checks (involving heart rate, galvanic skin response, and self-reported anxiety measurement) confirmed that the experimental manipulation was successful in affecting anxiety level. The results demonstrate that the experimental manipulation (platform vs. floor) affected balance parameters and dual tasking performance with the platform condition resulting in a less stable gait. In addition, increased task demand (i.e., dual tasking) also had a negative effect on balance performance. Finally, the results demonstrate that the paper and pencil measures of fear can also predict balance performance (although the variance accounted for is small) even after controlling for medical risk factors for falling. Implications for models of fear of falling are discussed.