Effects of Assistive Device Use on Lower Limb Kinematics during Gait in Individuals with Huntington's Disease

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The Ohio State University

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Physical therapists typically prescribe ambulatory assistive devices (ADs) for people with Huntington's Disease (HD) to improve their stability and prevent falls. Little is known, however, about how using these ADs affect gait patterns. This study was conducted to determine the effects of using ADs on lower extremity joint kinematics (i.e., peak angular excursions) during gait. Nineteen individuals with HD (mean age=49.8±11) who were able to ambulate 10 meters without assistance participated in the study. Subjects with reflective silver markers placed on body landmarks were videotaped while they ambulated 20 ft for 4 trials under each of six conditions using: 1) No AD; 2) a cane; 3) a standard walker; 4) a two-wheeled walker (2WW); 5) a three-wheeled walker (3WW); and 6) a 4-wheeled walker (4WW). The film was analyzed using Peak Motus motion analysis system and peak angular excursions were calculated for the swing and stance phases at the knee and hip. Data was analyzed using repeated measures ANOVA and post hoc pairwise comparisons. The devices did not have a significant impact on the knee peak angular excursions during stance nor swing phase. At the hip during the stance phase, peak excursions were significantly increased for the 3WW compared to no AD. The 4WW also had a larger peak excursion at the hip, however the improvements were not significant compared to no AD. The standard walker in all cases had a significantly decreased excursion compared to no AD. Across all phases for both the knee and the hip, the 3WW and 4WW performed significantly better than the standard walker. Our results indicate that the use of the 3WW and 4WW produced greater knee and hip motions during walking. These findings may explain improved velocity and stride length measures with use of the 3WW and 4WW in the same subjects that were previously reported by our lab. Due to its greater stability and better maneuverability, we recommend that clinicians prescribe the 4WW over a 3WW and standard walker for fall prevention in individuals with HD.



Huntington's Disease, Assistive Devices, Gait Changes, Peak Excursion