The Effects of Dual Task Cognitive Interference and Fast-Paced Walking on Gait, Turns, and Falls in Men and Women with F
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ORIGINAL ARTICLE
The Effects of Dual Task Cognitive Interference and Fast-Paced Walking on Gait, Turns, and Falls in Men and Women with FXTAS Joan A. O’Keefe 1,2 & Joseph Guan 3 & Erin Robertson 1 & Alexandras Biskis 1 & Jessica Joyce 1 & Bichun Ouyang 2 & Yuanqing Liu 2 & Danielle Carnes 1 & Nicollette Purcell 1 & Elizabeth Berry-Kravis 2,4 & Deborah A. Hall 2 Accepted: 27 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Fragile X–associated tremor/ataxia syndrome (FXTAS) is a genetic neurodegenerative disorder characterized by cerebellar ataxia, tremor, and cognitive dysfunction. We examined the impact of dual-task (DT) cognitive-motor interference and fastpaced (FP) gait on gait and turning in FXTAS. Thirty participants with FXTAS and 35 age-matched controls underwent gait analysis using an inertial sensor–based 2-min walk test under three conditions: (1) self-selected pace (ST), (2) FP, and (3) DT with a concurrent verbal fluency task. Linear regression analyses were performed to assess the association between FXTAS diagnosis and gait and turn outcomes. Correlations between gait variables and fall frequency were also calculated. FXTAS participants had reduced stride length and velocity, swing time, and peak turn velocity and greater double limb support time and number of steps to turn compared to controls under all three conditions. There was greater dual task cost of the verbal fluency task on peak turn velocity in men with FXTAS compared to controls. Additionally, stride length variability was increased and cadence was reduced in FXTAS participants in the FP condition. Stride velocity variability under FP gait was significantly associated with the number of self-reported falls in the last year. Greater motor control requirements for turning likely made men with FXTAS more susceptible to the negative effects of DT cognitive interference. FP gait exacerbated gait deficits in the domains of rhythm and variability, and increased gait variability with FP was associated with increased falls. These data may inform the design of rehabilitation strategies in FXTAS. Keywords Fragile X–associated tremor/ataxia syndrome (FXTAS) . Gait and turns . Inertial sensors . Dual task cognitive interference . Falls
Introduction In the USA, there are approximately 1.1 million carriers of a 55–200 CGG repeat expansion “termed a premutation” in the
* Joan A. O’Keefe [email protected] 1
Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL 60612, USA
2
Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
3
Rush Medical College, Rush University Medical Center, Chicago, IL, USA
4
Departments of Pediatrics and Biochemistry, Rush University Medical Center, Chicago, IL, USA
fragile X mental retardation 1 (FMR1) gene located on the X chromosome. During their lifetime, up to 50% of premutation carrier (PMC) men and 8 to 15% of PMC women develop a progressive neurodegenerative disorder known as fragile X– associated
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