AUTHOR=Casey Hannah L. , Shah Vrutangkumar V. , Muzyka Daniel , McNames James , El-Gohary Mahmoud , Sowalsky Kristen , Safarpour Delaram , Carlson-Kuhta Patricia , Rummey Christian , Horak Fay B. , Gomez Christopher M. 

TITLE=Gait characteristics in people with Friedreich ataxia: daily life versus clinic measures

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1544453

DOI=10.3389/fneur.2025.1544453

ISSN=1664-2295

ABSTRACT=IntroductionGait assessments in a clinical setting may not accurately reflect mobility in everyday life. To better understand gait during daily life, we compared measures that discriminated Friedreich ataxia (FRDA) from healthy control (HC) subjects in prescribed clinic tests and free, daily-life monitoring.MethodsWe recruited 9 people with FRDA (median age: 20, IQR [12, 48] years). A comparative healthy control (HC) subject cohort of 9 was sampled using propensity matching on age (median age: 18 [13, 22] years). Subjects wore 3 inertial sensors (one each foot and lower back) in the laboratory during a 2-min walk at a natural pace, followed by 7 days of daily life. For daily life analysis, a total of 99,216 strides across 1,008 h of recording were included. Mann–Whitney U test and area under the curve (AUC) compared gait differences between FRDA and HC when assessed in the laboratory and daily life. Pairwise Wilcoxon tests also compared if participants exhibited different metric values between the two environments.ResultsThe FRDA group exhibited lower levels of daily activity. Measures that best discriminated gait characteristics of FRDA from HC differed between environments. Variation in elevation of the feet at midswing best discriminated in-clinic (Clinic AUC = 1, Home AUC = 0.69), whereas slow gait speed performed best in daily life (Home AUC = 1, Clinic AUC = 0.64). Of the 17 measures tested, 11 had an AUC > 0.8 in-clinic and 8 had an AUC >0.8 at home. Variability of swing time (Clinic AUC = 0.97, Home AUC = 0.94) and double-support time (Clinic AUC = 0.94, Home AUC = 0.94) were the most sensitive and specific for FRDA in both environments.ConclusionDigital gait characteristics from inertial sensors are sensitive and specific for FRDA in both environments. However, different gait measures were more sensitive and specific during free-living versus prescribed gait, suggesting that in-clinic gait does not reflect daily life gait.