Local Dynamic Stability of Trunk During Gait is Responsive to Rehabilitation in Subjects with Primary Degenerative Cerebellar Ataxia.

Abstract

This study aimed to assess the responsiveness to the rehabilitation of three trunk acceleration-derived gait indexes, namely the harmonic ratio (HR), the short-term longest Lyapunov's exponent (sLLE), and the step-to-step coefficient of variation (CV), in a sample of subjects with primary degenerative cerebellar ataxia (swCA), and investigate the correlations between their improvements (∆), clinical characteristics, and spatio-temporal and kinematic gait features. The trunk acceleration patterns in the antero-posterior (AP), medio-lateral (ML), and vertical (V) directions during gait of 21 swCA were recorded using a magneto-inertial measurement unit placed at the lower back before (T0) and after (T1) a period of inpatient rehabilitation. For comparison, a sample of 21 age- and gait speed-matched healthy subjects (HS_matched) was also included. At T1, sLLE in the AP (sLLE_AP) and ML (sLLE_ML) directions significantly improved with moderate to large effect sizes, as well as SARA scores, stride length, and pelvic rotation. sLLE_ML and pelvic rotation also approached the HS_matched values at T1, suggesting a normalization of the parameter. HRs and CV did not significantly modify after rehabilitation. ∆sLLE_ML correlated with ∆ of the gait subscore of the SARA scale (SARA_GAIT) and ∆stride length and ∆sLLE_AP correlated with ∆pelvic rotation and ∆SARA_GAIT. The minimal clinically important differences for sLLE_ML and sLLE_AP were ≥ 36.16% and ≥ 28.19%, respectively, as the minimal score reflects a clinical improvement in SARA scores. When using inertial measurement units, sLLE_AP and sLLE_ML can be considered responsive outcome measures for assessing the effectiveness of rehabilitation on trunk stability during walking in swCA.