Sensorimotor and Psychosocial Correlates of Adaptive Locomotor Performance in Older Adults

Deshpande N, Metter EJ, Ferrucci L. Sensorimotor and psychosocial correlates of adaptive locomotor performance in older adults. Arch Phys Med Rehabil 2011;92: 1074-9. Objective: To identify sensorimotor and psychosocial factors independently associated with an inability to perform adaptive walking tasks in older adults. Design: Cross-sectional cohort study. Setting: Population-based older cohort. Participants: Community-living elderly (N=720; age >= 65y) who could walk 7m at self-selected normal speed. Interventions: Not applicable. Main Outcome Measures: Walking performance was assessed in 4 walking tests: fast walking, obstacle crossing, narrow-based walking, and walking while talking. Possible correlates of the inability to perform the walking test included knee extensor strength, lower limb coordination, Cumulative Somatosensory Impairment Index (CSII), visual acuity and contrast sensitivity, cognition, depression, personal mastery, social support, and years of education. Results: The results of binary logistic regression analyses, adjusted for demographics and self-selected normal speed, demonstrated that poor knee extensor strength was associated with an inability to perform tasks demanding an increase in walking speed (fast walking and obstacle crossing). Both poor lower limb coordination and higher CSII were significantly associated with failure in tests that demanded precise control over foot placement (obstacle crossing and narrow-based walking). Higher CSII was associated with failure in all tests except in the walking while talking. In contrast, poor cognition was associated with an inability to perform walking while talking. Poor personal mastery was the only variable that was associated with failure in all walking tests. Conclusions: The results demonstrated a systematic and coherent pattern in these associations and indicated possible sensorimotor and psychological parameters that should be specifically investigated and should be intervened if a patient reports a difficulty/inability in walking in certain situations.