Movement Disorders Spotlight: Investigating Stride Length and Cadence to Improve Mobility in Patients With Huntington’s Disease

Patients with Huntington’s disease (HD) often present with gait disturbances, which increase the risk of falls. Gait dysfunction is difficult to remedy because of limited understanding behind the mechanism of these changes in HD. Stride length and cadence (ie, pace, or number of steps per minute) have been used to study gait changes in patients with Parkinson’s disease (PD), with research showing stride length to be related to basal ganglia network dysfunction and cadence to be related to brainstem connection dysfunction. In an Australia-based study, Mary Danoudis, MPhysio, and Robert Iansek, MD, PhD, Clinical Research Center for Movement Disorders and Gait, The National Parkinson Foundation Center of Excellence, Kingston Centre, Monash Health, Australia, conducted a study to see if observations gleaned from PD research regarding stride length and cadence could be applied to understand the mechanism of these gait disturbances in HD. The results were published recently in BMC Neurology (www.ncbi.nlm.nih.gov/pubmed/25265896).

The study included 17 community-dwelling older adults with HD who were cognitively intact (score ≥24 on the Mini Mental State Examination) and were able to walk unassisted for 12 meters, 20 adults with PD, and 21 healthy older adults. Gait speed, stride length, and cadence were recorded at five speeds: (1) preferred; (2) very slow; (3) slow; (4) fast; and (5) very fast. The results of a linear regression analysis revealed the slope and intercept of the relationship, showing how adjustment of stride length and cadence when changing gait speeds compared between the three groups. The results revealed that participants with HD were able to regulate their walking speed by adjusting both stride length and cadence in the same proportion to the healthy group and PD group; however, the range of cadence across speed conditions did not differ between the three groups. These results achieved statistical significance. Based on these findings, the authors asserted that scaling of stride length but not regulation of cadence is disrupted in patients with HD.

The authors said that their study is the first of its kind to investigate stride length and cadence in HD, concluding that their results offer insight to clinicians in the development of effective interventions to improve mobility and function in patients with HD. “The use of strategies shown to normalize stride length in PD have not been investigated in HD,” they wrote. “The difficulty in synchronizing stepping to external cueing devices in HD is reported to be due to [attention] deficits, limiting their clinical usefulness in gait rehabilitation for HD with impaired cognition.”