Objective

To uncover possible impairments of walking and dynamic postural stability in patients with primary orthostatic tremor (OT).

Methods

Spatiotemporal gait characteristics were quantified in 18 patients with primary OT (mean age 70.5 ± 5.9 years, 10 females) and 18 age-matched healthy controls. One-third of patients reported disease-related fall events. Walking performance was assessed on a pressure-sensitive carpet under seven conditions: walking at preferred, slow, and maximal speed, with head reclination or eyes closed, and while performing a cognitive or motor dual-task paradigm.

Results

Patients exhibited a significant gait impairment characterized by a broadened base of support (p = 0.018) with increased spatiotemporal gait variability (p = 0.010). Walking speed was moderately reduced (p = 0.026) with shortened stride length (p = 0.001) and increased periods of double support (p = 0.001). Gait dysfunction became more pronounced during slow walking (p < 0.001); this was not present during fast walking. Walking with eyes closed aggravated gait disability as did walking during cognitive dual task (p < 0.001).

Conclusion

OT is associated with a specific gait disorder with a staggering wide-based walking pattern indicative of a sensory and/or a cerebellar ataxic gait. The aggravation of gait instability during visual withdrawal and the normalization of walking with faster speeds further suggest a proprioceptive or vestibulo-cerebellar deficit as the primary source of gait disturbance in OT. In addition, the gait decline during cognitive dual task may imply cognitive processing deficits. In the end, OT is presumably a complex network disorder resulting in a specific spino-cerebello-frontocortical gait disorder that goes beyond mere tremor networks.

中文翻译：

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原发性体位性震颤的步态障碍。

目的

为了发现原位体位性震颤（OT）患者的步行和动态姿势稳定性可能受到的损害。

方法

定量分析了18例原发性OT患者（平均年龄70.5±5.9岁，女性10例）和18例年龄相匹配的健康对照者的时空步态特征。三分之一的患者报告了与疾病相关的跌倒事件。在以下七个条件下评估了在压敏地毯上的行走性能：以优选，缓慢和最大速度行走，头部倾斜或闭着眼睛，同时执行认知或运动双重任务范式。

结果

患者表现出明显的步态障碍，其特征是支持基础扩大（p  = 0.018），时空步态变异性增加（p  = 0.010）。步行速度为中度降低（p  = 0.026）具有缩短的步长（p = 0.001）和增加的双载体（周期p  = 0.001）。慢速行走时步态障碍更为明显（p  <0.001）；快速行走时不存在。闭眼行走与认知双重任务期间行走一样，加剧了步态障碍（p  <0.001）。

结论

OT与特定的步态障碍有关，其步态宽阔的步行模式表明感觉和/或小脑共济失调步态。视力退缩期间步态不稳定性的加重和更快的步行正常化进一步表明，本体感觉或前庭小脑缺损是OT步态障碍的主要来源。另外，在认知双重任务期间步态下降可能暗示认知加工缺陷。最后，OT可能是一种复杂的网络障碍，导致了一种特定的脊髓-脑-额叶步态障碍，而不仅仅是单纯的震颤网络。