Measures of gait stability: Performance on adults and toddlers at the beginning of independent walking

Background: Quantifying gait stability is a topic of high relevance and a number of possible measures have been proposed. The problem in validating these methods is the necessity to identify a-priori unstable individuals. Since proposed methods do not make any assumption on the characteristics of the subjects, the aim of the present study was to test the performance of gait stability measures on individuals whose gait is a-priori assumed unstable: toddlers at the onset of independent walking. Methods. Ten toddlers, ten adults and ten elderly subjects were included in the study. Data from toddlers were acquired longitudinally over a 6-month period to test if the methods detected the increase in gait stability with experience, and if they could differentiate between toddlers and young adults. Data from elderly subjects were expected to indicate a stability value in between the other two groups. Accelerations and angular velocities of the trunk and of the leg were measured using two tri-axial inertial sensors. The following methods for quantifying gait stability were applied: stride time variability, Poincaré plots, harmonic ratio, short term Lyapunov exponents, maximum Floquet multipliers, recurrence quantification analysis and multiscale entropy. An unpaired t-test (level of significance of 5%) was performed on the toddlers and the young adults for each method and, for toddlers, for each evaluated stage of gait development. Results: Methods for discerning between the toddler and the adult groups were: stride time variability, Poincaré plots, harmonic ratio, short term Lyapunov exponents (state space composed by the three linear accelerations of the trunk), recurrence quantification analysis and multiscale entropy (when applied on the vertical or on the antero-posterior L5 accelerations). Conclusions: Results suggested that harmonic ratio and recurrence quantification analysis better discern gait stability in the analyzed subjects, differentiating not only between unstable toddlers and stable healthy adults, but also evidencing the expected trend of the toddlers towards a higher stability with walking experience, and indicating elderly subjects as stable as or less stable than young adults.