DOI QR코드

DOI QR Code

보행경로 너비에 따른 노인의 시 · 공간적 보행 분석

Analysis of Spatio-Temporal Parameters of Gait in Elderly by Various Walking Pathways Width

  • 손호희 (부산가톨릭대학교 물리치료학과) ;
  • 김은정 (마산대학교 물리치료과)
  • 투고 : 2013.07.18
  • 심사 : 2013.08.19
  • 발행 : 2013.10.28

초록

본 연구의 목적은 노인과 정상 성인의 보행경로 너비에 따른 보행 시, 시 공간적 보행 변수의 변화를 알아보기 위함이다. 연구의 대상자는 낙상의 경험이 없는 건강한 노인 20명과 20대 성인 18명으로 하였으며, 3가지 다른 너비의 보행경로(평상시 보행(usual walking), 좁은 너비 보행(narrow base walking), 한줄 보행(centerline-guided walking)에서 보행을 실시하였다. 평상시 보행은 보행경로에 제한을 두지 않았고, 좁은 너비 보행은 각 대상자의 양측 ASIS 사이의 거리를 1/2로 나눈 너비를 보행경로로 설정하였으며, 한줄 보행은 보행경로 중앙에 한 줄을 표시하여 보행을 실시하였다. 보행을 실시하는 동안, GAITRite system을 이용하여 시 공간적 보행 변수의 변화를 비교 분석하였다. 보행경로 너비에 따른 시 공간적 보행 변수 비교에서 20대 성인은 모든 변수에서 유의한 차이를 나타내지 않았으나, 노인의 경우 보행속도, 분속수, 양 뒤꿈치 사이 기저면, 기능적 보행지수가 통계적으로 유의하게 감소하였다(p<.05). 본 연구의 결과를 통해 노인은 20대 성인에 비해 보행경로의 너비가 좁아질수록 낙상에 대한 두려움으로 인해 보행변수에 영향을 미친다는 것을 확인할 수 있었으며, 이를 통해 노인의 낙상 예방 훈련을 위한 적절한 보행너비에 대한 이론적 근거를 제시할 수 있을 것으로 생각된다.

The purpose of this study was to investigate the changes in temporospatial variables in healthy elderly and healthy adults during usual walking, narrow base walking and centerline-guided walking. Twenty healthy elderly and nineteen healthy adults were participated in this study. In each conditions, the subjects were walked on a 6m walkway at comfortable self-selected speeds under three conditions : (1) usual walking, (2) walking within a 50% of the distance between the subject's ASIS (3) walking along a centerline. GAITRite system was used for kinematic analysis to assess the temporospatial variables. There were no significant changes in healthy adults(p>.05), but walking speed, cadence, H-H base support, functional ambulation performance were significantly decreased progressively as pathway narrowed in elderly adults(p<.05). The results show that elderly people had more difficulty with walking on narrow pathway for fear of falling. This study provides data for use in basic research into safe walking and preventing falling for elderly.

키워드

참고문헌

  1. D. Keskin, P. Borman, M. Ersoz, A. Kurtaran, H. Bodur, and M. Akyuz, "The risk factors related to falling in elderly females," Geriatric Nursing, Vol.29, No.1, pp.58-63, 2008. https://doi.org/10.1016/j.gerinurse.2007.06.001
  2. K. A. Hartholt, N. van der Velde, C. W. Looman, E. M. van Lieshout, M. J. Panneman, E. F. van Beeck, and T.,J. van der Cammen, "Trends in fall-related hospital admissions in older persons in the Netherlands," Arch Intern Med, Vol.170, No.10, pp.905-911, 2010. https://doi.org/10.1001/archinternmed.2010.106
  3. M. E. Tinetti, M. Speechley, and S. F. Ginter, "Risk factors for falls among elderly persons living in the community," N Engl J Med, Vol.319, No.26, pp.1701-1707, 1988. https://doi.org/10.1056/NEJM198812293192604
  4. V. S. Stel, J. H. Smit, S. M. Pluijm, and P. Lips, "Consequences of falling in older men and women and risk factors for health service use and functional decline," Age Ageing, Vol.33, No.1, pp.58-65, 2004. https://doi.org/10.1093/ageing/afh028
  5. H. Shimada, A. Tiedemann, S. R. Lord, M. Suzukawa, H. Makizako, K. Kobayashi, and T. Suzuki, "Physical factors underlying the association between lower walking performance and falls in older people: a structural equation model," Arch Gerontol Geriatr, Vol.53, No.2, pp.131-134, 2011. https://doi.org/10.1016/j.archger.2010.11.003
  6. J. Perry, Gait analysis : normal and pathological function. New Jersey : SLACK, 1992.
  7. M. Hanlon and R. Anderson, "Prediction methods to account for the effect of gait speed on lower limb angular kinematics," Gait Posture, Vol.24, No.3, pp.280-287, 2006. https://doi.org/10.1016/j.gaitpost.2005.10.007
  8. C. P. Chen, M. J. Chen, Y. C. Pei, H. L. Lew, P. Y. Wong, and S. F. Tang, "Sagittal plane loading response during gait in different age groups and in people with knee osteoarthritis," Am J Phys Med Rehabil, Vol.82, No.4, pp.307-312, 2003.
  9. N. Shkuratova and N. Taylor, "The influence of age on gait parameters during the transition from a wide to a narrow pathway," Physiother Res Int, Vol.13, No.2, pp.75-83, 2008. https://doi.org/10.1002/pri.397
  10. P. Dunlap, S. Perera, J. M. VanSwearingen, D. Wert, and J. S. Brach, "Transitioning to a narrow path: The impact of fear of falling in older adults," Gait Posture, Vol.35, No.1, pp.92-95, 2012. https://doi.org/10.1016/j.gaitpost.2011.08.013
  11. J. L. Helbostad and R. Moe-Nilssen, "The effect of gait speed on lateral balance control during walking in healthy elderly," Gait Posture, Vol.18, No.2, pp.27-36, 2003. https://doi.org/10.1016/S0966-6362(02)00197-2
  12. N. Ramstrand, A. H. Thuesen, D. B. Nielsen, and D. Rusaw, "Effects of an unstable shoe construction on balance in women aged over 50 years," Clin Biomech, Vol.25, No.5, pp.455-460, 2010. https://doi.org/10.1016/j.clinbiomech.2010.01.014
  13. H. H. Son and K. Kim, "A kinematic analysis of patients with knee osteoarthritis during gait on level ground, ramps and stairs," J Phys Ther Sci, Vol.25, No.3, pp.277-280, 2013. https://doi.org/10.1589/jpts.25.277
  14. W. Sun, M. Watanabe, C. Hirota, Y. Tanimoto, R. Kono, K. Takasaki, and K. Kono, "Obstacle-negotiating gait and related physical measurement indicators for the communitydwelling elderly in Japan," Arch Gerontol Geriatr, Vol.50, No.3, pp.41-45, 2010. https://doi.org/10.1016/j.archger.2009.01.016
  15. M. A. Schrager, V. E. Kelly, R. Price, L. Ferrucci, and A. Shumway-Cook, "The effects of age on medio-lateral stability during normal and narrow base walking," Gait Posture, Vol.28, No.3, pp.466-471, 2008. https://doi.org/10.1016/j.gaitpost.2008.02.009
  16. J. W. Chow, M. E. Hemleben, and D. S. Stokic, "Effect of centerline-guided walking on gait characteristics in healthy subjects," J Biomech, Vol.42, No.8, pp.1134-1137, 2009. https://doi.org/10.1016/j.jbiomech.2009.02.024
  17. C. J. van Uden and M. P. Besser, "Test-retest reliability of temporal and spatial gait characteristics measured with an instrumented walkway system (GAITRite)," BMC Musculoskelet Disord, Vol.17, No.5, p.13, 2004.
  18. S. Studenski, S. Perera, K. Patel, C. Rosano, K. Faulkner, M. Inzitari, and J. Guralnik, "Gait speed and survival in older adults," JAMA, Vol.305, No.1, pp.50-58, 2011. https://doi.org/10.1001/jama.2010.1923
  19. J. Verghese, A. LeValley, C. B. Hall, M. J. Katz, A. F. Ambrose, and R. B. Lipton. "Epidemiology of gait disorders in community-residing older adults," J Am Geriatr Soc, Vol.54, No.2, pp.255-261, 2006. https://doi.org/10.1111/j.1532-5415.2005.00580.x
  20. L. A. Brown, W. H. Gage, M. A. Polych, R. J. Sleik, and T. R. Winder, "Central set influences on gait. Age-dependent effects of postural threat," Exp Brain Res, Vol.145, No.3, pp.286-296, 2002. https://doi.org/10.1007/s00221-002-1082-0
  21. S. D. Lark and S. Pasupuleti, "Validity of a functional dynamic walking test for the elderly," Arch Phys Med Rehabil, Vol.90, No.3, pp.470-474, 2009. https://doi.org/10.1016/j.apmr.2008.08.221
  22. T. Herman, N. Giladi, T. Gurevich, and J. M. Hausdorff, "Gait instability and fractal dynamics of older adults with a "cautious" gait: why do certain older adults walk fearfully?," Gait Posture, Vol.21, No.2, pp.178-185, 2005. https://doi.org/10.1016/j.gaitpost.2004.01.014
  23. M. C. A. Tersteeg, D. E. Marple-Horvat, and I. D. Loram, "Cautious gait in relation to knowledge and vision of height: is altered visual information the dominant influence?," J Neurophysiol, Vol.107, pp.2686-2691, 2012. https://doi.org/10.1152/jn.00875.2011
  24. M. Davis, D. Walker, L. Miles, and C. Grillon, "Phasic vs sustained fear in rats and humans : role of the amygdala in fear and anxiety," Neuropsychopharmacology, Vol.35, pp.105-135, 2010. https://doi.org/10.1038/npp.2009.109
  25. D. C. Blanchard and R. J. Blanchard. "Ethoexperimental approaches to the biology of emotion," Ann Rev Psychol, Vol.39, pp.43-48, 1988. https://doi.org/10.1146/annurev.ps.39.020188.000355
  26. D. C. Lee, Y. W. Ham, and P. S. Sung, "Effect of visual input on normalized standing stability in subjects with recurrent low back pain," Gait Posture, Vol.36, pp.580-585, 2012. https://doi.org/10.1016/j.gaitpost.2012.05.020
  27. A. J. Nelson, L. J. Certo, L. S. Lembo, D. A. Lopez, E. F. Manfredonia, S. K. Vanichpong, and D. Zwick, "The functional ambulation performance of elderly fallers and non-fallers walking at their preferred velocity," NeuroRehabilitation, Vol.13, No.3, pp.141-146, 1999.
  28. A. J. Nelson, "Functional ambulation profile," Phys Ther, Vol.54, No.10, pp.1059-1065, 1974. https://doi.org/10.1093/ptj/54.10.1059
  29. Y. Jian, D. A. Winter, M. G. Ishac, and L. Gilchrist, "Trajectory of the body COG and COP during initiation and termination of gait," Gait Posture, Vol.1, No.1, pp.9-22, 1993. https://doi.org/10.1016/0966-6362(93)90038-3
  30. 이택영, "노인의 감각처리능력과 삶의 질과의 상관관계 연구", 한국콘텐츠학회, 제12권, 제5호, pp.272-279, 2012.