Elsevier

Gait & Posture

Volume 81, September 2020, Pages 73-77
Gait & Posture

Full length article
Re-evaluating the measurement and influence of conscious movement processing on gait performance in older adults: Development of the Gait-Specific Attentional Profile

https://doi.org/10.1016/j.gaitpost.2020.07.008Get rights and content

Highlights

  • The MSRS lacks sensitivity to detect conscious movement processing during gait.

  • The current study validates the 11-item Gait-Specific Attentional Profile (G-SAP).

  • MSRS score is not associated with gait characteristics.

  • G-SAP CMP subscale predicts gait velocity, step length and double limb support.

Abstract

Background

Recent decades have seen increased interest in how anxiety–and associated changes in conscious movement processing (CMP)–can influence the control of balance and gait, particularly in older adults. However, the most prevalent scale used to measure CMP during gait (the Movement-Specific Reinvestment Scale (MSRS)) is generic (i.e., non-gait-specific) and potentially lacks sensitivity in this context.

Methods

In a preliminary study, we first sought to evaluate if MSRS scores associated with the number of CMP-related thoughts self-reported by older adults while walking. The next aim was to develop and validate a new questionnaire (the Gait-Specific Attentional Profile, G-SAP) capable of measuring gait-specific CMP, in addition to other attentional processes purported to influence gait. This scale was validated using responses from 117 (exploratory) and 107 (confirmatory factor analysis) older adults, resulting in an 11-item scale with four sub-scales: CMP, anxiety, fall-related ruminations, and processing inefficiencies. Finally, in a separate cohort of 53 older adults, we evaluated associations between scores from both the G-SAP CMP subscale and the MSRS, and gait outcomes measured using a GAITRite walkway in addition to participants’ fall-history.

Results

MSRS scores were not associated with self-reported thoughts categorised as representing CMP. In regression analyses that controlled for functional balance, unlike the MSRS, the G-SAP subscale of CMP significantly predicted several gait characteristics including velocity (p = .033), step length (p = .032), and double-limb support (p = .015).

Significance

The G-SAP provides gait-specific measures of four psychological factors implicated in mediating the control of balance and gait. In particular, unlike the MSRS, the G-SAP subscale of CMP appears sensitive to relevant attentional processes known to influence gait performance. We suggest that the G-SAP offers an opportunity for the research community to further develop understanding of psychological factors impacting gait performance across a range of applied clinical contexts.

Introduction

Research demonstrates the profound influence that increased fall-related anxiety—and associated changes in attentional focus—can have on postural control and locomotion [[1], [2], [3]]. For example, fall-related anxiety is associated with increased muscular co-contraction and reduced movement in the knees, hips and ankles [4], and slower gait during both clinical assessments [5] and experimental tasks [3,6]. Researchers have proposed that these anxiety-related outcomes may be underpinned by heightened conscious processing of walking movements [2,3,5]. The applied interest in this topic relates largely to older adults or patients with neurological disorders displaying a fear of falling and/or deficits in balance control; factors that are independently associated with increased fall-risk [2,7].

Consciously processing gait can occur in a variety of contexts, particularly when balance is threatened, but also manifests following injury or disease (e.g., Parkinson’s or Stroke) [8,9]. This motor control strategy has been shown to directly influence locomotion, resulting in slower, less-efficient (e.g., shorter steps and increased muscular activation) and more unstable patterns of gait [10,11]. Conscious movement processing (CMP) also leads to impaired motor planning [12,13], reduced retention of visual spatial information [9], reduced attentional processing efficiency [8] and greater stepping errors [13]. This evidence is largely accrued from studies experimentally manipulating anxiety and/or attentional focus. However, in apparent contradiction, results from cross-sectional studies provide very little supporting evidence for CMP-related differences [14,15].

One potential explanation for this discrepancy may relate to the measure commonly used to assess a walker’s propensity to consciously monitor and/or control their movements: the generic (non-gait-specific) Movement Specific Reinvestment Scale (MSRS) [16]. The MSRS has been instrumental in highlighting how shifts (typically anxiety-related) toward CMP can influence performance in motor tasks; especially in ontogenetic motor skills, such as sporting actions [17]. However, recent work suggests that the way anxious performers engage in CMP may differ considerably in phylogenetic tasks, such as walking [2]. This leads to the suggestion that the MSRS lacks sensitivity to measure CMP during gait-specific tasks and, as a consequence, researchers in this field may have been drawing misleading conclusions from extant literature.

The current study comprised three central aims: i) to scrutinise the MSRS by determining if the nature of self-reported thoughts related to CMP during gait are more evident in older adults reporting high MSRS scores (MSRS Verbal reports protocol – Study 1), ii) develop and validate a short (time-efficient) tool—the Gait-Specific Attentional Profile (G-SAP)—capable of reliably measuring self-reported levels of CMP during gait (in addition to other attentional processes purported to influence gait), and iii) evaluate associations between both the MSRS and the CMP subscale of the G-SAP and functional gait performance (G-SAP validation and evaluation – Study 2). We predicted a lack of association between MSRS and both self-reported CMP-related thoughts and gait performance. In contrast, we predicted that the CMP sub-scale of the G-SAP would be significantly associated with gait performance.

Section snippets

Participants

Twenty one community-dwelling older adults were recruited from local authority housing schemes in West London (mean age = 75.3 ± 7.8 years, mean score on Berg Balance Scale (BBS) [18] = 50/56 ± 3.1, 7/21 reported falling in the previous 12 months).

Protocol and analysis

Participants completed the MSRS as a trait measure [16]. They were then asked to walk at a self-selected pace along an 8 m walkway, and step over two raised obstacles (obstacle height above walkway =23 cm, distance between obstacles =300 cm).

Scale development

While the primary focus of the present study is the measurement of gait-specific CMP, questionnaire items were produced to measure several emotional and attentional processes relevant to the control of gait in older adults. These items were informed by the contents of the MSRS (e.g., “I am aware of the way my body moves” [16]), State-Trait Anxiety Inventory (e.g., “I feel calm” [21]), and Reinvestment Scale (e.g., “I get angry with myself for not walking/moving better” [22]).

To assess face

Conclusions

Our results show that the MSRS may not be sensitive to detect CMP (or related behaviours) during gait-specific tasks, thus providing a rationale for the lack of association between MSRS scores and altered gait performance (Table 2). We developed and validated a new self-reported measure (the ‘G-SAP’) of four psychological constructs implicated in influencing the control of balance and gait. Our results show that G-SAPcmp is associated with gait velocity, step length and double limb support,

Declaration of Competing Interest

The authors declare that they have no competing interests.

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      Motor assessment involved fall history and Timed-Up-and-Go (TUG [48]). All participants also completed the Gait-Specific Attentional Profile (G-SAP [49]) to determine their gait-related anxiety and propensity to consciously control gait-related movements. The 11-item G-SAP consists of three 3-item subscales (anxiety [e.g., “I feel tense”], conscious movement processing [e.g., “I consciously try to control my [walking] movements”] and fall-related ruminations [e.g., “Worrisome thoughts about falling run through my mind”) and one 2-item subscale (processing inefficiency [e.g., “I find it difficult to concentrate on two things at once”).

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