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E9 Impairment in gait speed modulation associated with functional mobility in huntington’s disease
  1. Ashwini K Rao1,2,
  2. Franchino Porciuncula2,
  3. Karen S Marder3
  1. 1Rehabilitation and Regenerative Medicine (Physical Therapy), GH Sergievsky Centre, Columbia University, New York, NY, USA
  2. 2Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
  3. 3Neurology, Psychiatry, Taub Institute, GH Sergievsky Centre, Columbia University, New York, NY, USA

Abstract

Background Gait speed modulation is impaired in manifest Huntington’s disease (mHD) due to reduced stride length. Speed modulation impairments and their functional correlates have not been examined in prodromal HD (pHD).

Aims (1) To examine speed modulation (stride length-cadence relationship) in pHD and mHD; and (2) To evaluate the association between speed modulation and functional mobility.

Method We tested 20 pHD (mean = 41.75 y), 19 mHD (mean = 44 y), and 20 controls (mean = 42.45 y). Experiment I (internal cues): subjects walked at self-selected preferred, fast, and slow speeds. Experiment II (external cues): subjects walked in time with a metronome. To examine stride length-cadence relationship, we used linear regression analysis. Slope and intercept were each assessed using one-way ANOVA. Clinical tests included Tinetti Mobility Test (TMT) and the HD Activities of Daily Living (HD-ADL) Scale. Pearson correlations between speed modulation (slope, intercept) and function (TMT, HD-ADL scores) were performed.

Results pHD and mHD groups modified gait speed similar to controls; however the intercept of stride length-cadence was lower than controls (p < 0.05). With external auditory cues, pHD and mHD successfully adjusted cadence to match target cadence similar to controls. However, the intercept of stride length-cadence was significantly lower in mHD (p < 0.05) but not pHD (p > 0.05) relative to controls. Slope was comparable across groups. Intercept and TMT had moderate to strong correlations during internally (p < 0.05) and externally cued gait (p < 0.001). HD-ADL was not associated with slope or intercept.

Conclusion Both pHD and mHD subjects are capable of modifying gait speed by adjusting stride length and cadence; however stride length in pHD and mHD was dampened at different cadences. When given external cues, stride length regulation improved in pHD, but not in mHD. Thus, stride length regulation is impaired well before diagnosis of HD, and may be partly aided by the use of external cues. Deficits in speed modulation are associated with loss of functional mobility in very early HD.

  • prodromal
  • early manifest HD
  • gait
  • functional mobility

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