Motor behavior characteristics in various phases of bipolar disorder revealed through biomechanical analysis: Quantitative measures of activity and energy variables during gait and sit-to-walk

Abnormal motor behaviors influenced by high or low energy states are key signs and symptoms for mania/hypomania or depression, respectively. Clinical evaluation is currently based on qualitative, subjective self-reports. We aimed to objectively quantify activity and energy variables during gait and sit-to-walk in bipolar disorder. Gait and sit-to-walk were analyzed in 31 individuals with bipolar disorder (five hypomanic, 14 euthymic and 12 depressed)'and 14 healthy controls using a motion capture system and two force platforms. The 9-item Patient Health Questionnaire and Altman Self Rating Mania Scale were administered to evaluate mood symptoms. During gait and sit-to-walk, the hypomanic group had 20-30% greater movement speed and produced 10-60% greater peak force, and 40-140% greater peak power in the knee or ankle compared to the euthymic, depressed and healthy groups. Biomechanical measures of activity and energy correlated with clinically defined hypomania. Our findings suggest that movement speed and force production could serve as objective activity and energy markers for hypomanic symptoms in individuals with bipolar disorder, but this study was based on a relatively small sample size, and the laboratory-based assessments are not directly transferable to a clinical setting.