Development of a gait assessment protocol for elderly Veterans with cognitive decline, using an instrumented walkway

Abstract

Introduction: Gait decline with aging may be exacerbated by cognitive decline. These gait changes can lead to increased fall risk, but they can be difficult to measure through clinical observation. The objective of this study was to develop a clinical testing protocol for spatial and temporal gait parameters for the inpatient population at Ste. Anne's Hospital (previously Ste. Anne's Veterans' Hospital) who show signs of cognitive decline but are still functionally ambulatory. Methods: Twenty-nine seniors (average age 93 y), with questionable to moderate cognitive impairment, completed two testing sessions, separated by approximately 1 week. They performed 10 walking trials on an instrumented walkway at each session. Generalizability theory was used for data analysis, making use of both empirical and extrapolated data. Results: Empirical data, using six trials from both sessions (generalizability study), showed excellent measurement reliability for all gait parameters (ϕ = 0.75 to 0.97), with clinically attainable minimal detectable change (MDC) values. Extrapolated data (decision study) showed that both the ϕ coefficient and the MDC values showed little added improvement when using data from more than two sessions and five trials. Using this protocol resulted in MDC values that were generally less than 37% of the population mean. Discussion: Gait assessment for the patient population with cognitive decline at Ste. Anne's Hospital appears to be optimized by using data from two testing sessions, with five walking trials per session.