Gait Characteristics and Fall Risk in Amyotrophic Lateral Sclerosis: A 12-Month Prospective Cohort Study.

BACKGROUND: Gait impairment in amyotrophic lateral sclerosis (ALS) substantially increases fall risk and accelerates functional decline. However, prospective data linking quantitative gait parameters to fall outcomes remain scarce. We aimed to identify gait parameters associated with falls and functional decline in ALS. METHODS: In this single-center prospective cohort study, we enrolled 256 ALS patients and 256 matched healthy controls. Nineteen spatiotemporal gait parameters were captured using a 3D vision-based system at baseline. Falls, time to wheelchair use, and ALSFRS-R decline were recorded over 12 months. Multivariable logistic regression was used to identify independent fall predictors. RESULTS: During follow-up, 129 of 224 patients (57.6%) experienced at least one fall. Prolonged Timed Up and Go (TUG) time (OR=1.083 per second, 95%CI 1.036-1.133, p<0.001), younger age (OR=0.968 per year, 95%CI 0.940-0.996, p=0.024), and lower MRC sum score (OR=0.976 per point, 95%CI 0.954-0.998, p=0.035) independently predicted falls. The model showed moderate discrimination (AUC=0.665, 95%CI 0.594-0.736). Gait speed (rₛ=0.366) and TUG time (rₛ=-0.381) correlated most strongly with time to wheelchair use (both p<0.001), whereas no gait parameters correlated with ALSFRS-R decline rate. CONCLUSIONS: TUG time, younger age, and lower MRC score independently predict falls in ALS, though with modest predictive accuracy. The modest model performance underscores the multifactorial nature of falls and the need for multi-domain risk assessment. Gait speed and TUG time may warrant further investigation as candidate surrogate markers for functional decline. Future studies integrating cognitive evaluation, continuous monitoring, and attention to psychosocial factors may improve prediction and fall prevention strategies.