Groot, M. de (Maartje) (2011) The influnece of vertebral fractures and thoracic kyphosis on variability and stability of walking among geriatric patients. thesis, Human Movement Sciences.
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Abstract
INTRODUCTION About 50% of the patients visiting a geriatric outpatient clinic is diagnosed with ;;::: 1 vertebral fractures (VFs). It was hypothesized that VFs would increase the thoracic kyphosis (TK), bringing the body's centre of mass towards the limits of stability, and thereby increasing the likelihood that any perturbation to balance would require a greater correcting response to maintain equilibrium. The aim of the present cross-sectional study was to examine whether the presence and severity ofVFs and the degree ofTK influences the variability and stability during walking. METHODS Patients were recruited at the geriatric outpatient clinic of the Slotervaart Hospital. At lateral X-rays of the thoracic and lumbar vertebral column, VFs were judged with the method ofGenant and the degree ofTK was measured by the Cobb angle between T2-T12. Medication use, co-morbidities, presence of frailty and cognitive status were registered. Patients walked about 160-meter at self-selected speed, wearing an ambulant tri-axial accelerometer recording trunk accelerations. Beside walking speed, mean and variability of stride times, media-lateral (ML) and anterior-posterior (AP) trunk acceleration patterns were analyzed by calculating the Detrended Fluctuations Analysis (DFA), Root Mean Square (RMS), Sample Entropy (SEn), and Short Term Exponent (STE), quantifying gait stability and variability. RESULTS Forty-three patients (31 female) participated in the study. Mean age was 80 ± 5.5 years, 72% had;;::: 1 co-morbid disease, 65% had polypharmacy, 16% was frail, 49% was pre-frail, and the median MMSE score was 24. Twenty-three patients had;;::: 1 VFs, whereof 20 patients had an increased kyphosis (Cobb angle T2-T12 > 40°). Patients without VFs showed lower PVI values than patients with grade I or grade II/III VFs. Other variables did not differ between these groups. Group effects between patients with normal (Cobb angle T2-T12 ~ 40°), increased ( 40° > Cobb angle T2-T12 ~ 50°), or hyper TK (Cobb angle > 50°) were found for stride variability (CV of stride time and PVI), ML RMS, ML DFA, and ML STE. DISCUSSION The degree of thoracic kyphosis seems to influence the variability and stability of walking more than the presence and severity ofVFs. Though, the geriatric population is very heterogeneous and other factors might influence the variability and stability of walking as well. Therefore, future large cross-sectional studies should investigate the influence of many factors characterizing the geriatric population on gait variability and stability.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Lamoth, dr. C.J.C. and Assistant Professor and Researcher and University of Groningen and University Medical Centre Groningen and Centre for Human Movement Sciences |
| Supervisor name: | Jagt-Willems, drs. H.C. van der and Campen, drs. J.P .C.M. van and Clinical Geriatricians and Slotervaart Hospital, Amsterdam and Department of Clinical Geriatrics |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/289 |
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