New knowledge gained
There have been very few studies of HSP gait, but two significant studies, one in Italy and one in France, have just been published. The Italian study of 50 HSPers identified three distinctive gait patterns that matched closely with the level of mobility impairment. The critical factor is the range of motion at the hip, knee and ankle joints. The most restricted range of motion matched with highest spasticity and slowest walking speed.
In the French study, 12 HSPers undertook two walking tests. Spasticity and weakness were found to be greatest in the outside part of the calf muscle (gastrocnemius lateralis), with simultaneous contractions of this muscle and the shin muscle (tibialis anterior) on the front of the lower leg found to be significantly increased compared with non-HSP gait.
Italian HSP gait study
Spastic gait is a key feature in patients with hereditary spastic paraparesis, but the gait characterization and the relationship between the gait impairment and clinical characteristics have not been investigated.
To describe the gait patterns in hereditary spastic paraparesis and to identify subgroups of patients according to specific kinematic features of walking.
We evaluated fifty patients by computerized gait analysis and compared them to healthy participants. We computed time-distance parameters of walking and the range of angular motion at hip, knee, and ankle joints, and at the trunk and pelvis. Lower limb joint moments and muscle co-activation values were also evaluated.
We identified three distinct subgroups of patients based on the range of motion values. Subgroup one was characterized by reduced hip, knee, and ankle joint range of motion. These patients were the most severely affected from a clinical standpoint, had the highest spasticity, and walked at the slowest speed. Subgroup three was characterized by an increased hip joint range of motion, but knee and ankle joint range of motion values close to control values. These patients were the most mildly affected and had the highest walking speed. Finally, subgroup two showed reduced knee and ankle joint range of motion, and hip range of motion values close to control values. Disease severity and gait speed in subgroup two were between those of subgroups one and three.
We identified three distinctive gait patterns in patients with hereditary spastic paraparesis that correlated robustly with clinical data. Distinguishing specific features in the gait patterns of these patients may help tailor pharmacological and rehabilitative treatments and may help evaluate therapeutic effects over time.
SOURCE: PLoS One. 2016 Oct 12;11(10):e0164623. doi: 10.1371/journal.pone.0164623. eCollection 2016. PMID: 27732632 PMCID: PMC5061421 DOI: 10.1371/journal.pone.0164623
Gait Patterns in Patients with Hereditary Spastic Paraparesis.
Serrao M1,2, Rinaldi M3, Ranavolo A4, Lacquaniti F5,6,7, Martino G5,6, Leonardi L1, Conte C8, Varrecchia T3, Draicchio F4, Coppola G9, Casali C1, Pierelli F1,10.
1 Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.
2 Rehabilitation Centre, Policlinico Italia, Rome, Italy.
3 Department of Engineering, Roma TRE University, Rome, Italy.
4 Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy.
5 Centre of Space Bio-Medicine, University of Rome Tor Vergata, Rome, Italy.
6 Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Rome, Italy.
7 Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
8 Fondazione Don Gnocchi, Milan, Italy.
9 G.B. Bietti Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Rome, Italy.
10 IRCCS, Neuromed, Pozzilli, Isernia, Italy.
French HSP gait study
Hereditary spastic paraplegia (HSP) designates a rare genetic disorder characterized by the existence of a pyramidal syndrome and/or paresis of the lower limbs, resulting in locomotor disorders. The objective of this study was to investigate the HSP patients walking characteristics during a comfortable walking speed, to determinate the most deleterious impairments and their evolutivity during a prolonged standardized walk. A second goal was to study the co-contraction of targeted muscles during these two walking conditions.
MATERIAL/PATIENTS AND METHODS:
In this prospective study, the spatio-temporal parameters (GAITRITE® electronic walkway) and electromyographics (surface EMG) of twelve HSP patients were compared with those of nine matched subjects, for the walking conditions: « comfortable walk », « Six Minutes Walking Test » (SMWT). The perceived exertion was assessed by the Borg scale. HSP patients received a standardized interrogatory and neuro-orthopedic examination measuring angles, joint values, spasticity (Tardieu scale) and muscle strength (MRC scale). For every subject, muscle activations and co-contractions indices were analyzed for several muscles: semi-tendinosus (ST), rectus femoris (RF), gastrocnemius lateralis (GL) and tibialis anterior (TA) for all walking conditions.
Median gait speed (0.85m/s) and cadence (91steps/min) were significantly lower in the HSP group compared with unaffected subjects. Walking speed was constant over the SMWT for a high level of exertion. Spasticity and weakness were greatest for the GL muscle that had a prolonged activation during the swing phase. Co-contraction indices in the GL/TA couple were significantly increased for the non-dominant lower-limb during swing phase. No significant differences were found for the RF/ST couple. The motor deficit was the only significant parameter found to correlate with walking speed.
HSP patients are characterized by a slow walk explained mainly by a motor deficit. Surface EMG seems to be an interesting tool in the therapeutic reflection to investigate walking disorders in HSP disease.
SOURCE: Ann Phys Rehabil Med. 2016 Sep;59S:e119-e120. doi: 10.1016/j.rehab.2016.07.270. Copyright © 2016. Published by Elsevier Masson SAS. PMID: 27676748 DOI: 10.1016/j.rehab.2016.07.270
Locomotor aspects in the hereditary spastic paraplegia, spatio-temporal and electromygraphic analyzes in a prospective cohort of twelve patients.
Ehny JP1, Sagawa Y2, Tatu L3, Chamard L3, Parratte B4, Decavel P2.
1 CMPR Héricourt, MPR, Héricourt, France. Electronic address: [email protected]
2 CHU, Laboratoire d’exploration fonctionnelle clinique du mouvement, Besançon, France.
3 CHU, neurologie, Besançon, France.
4 CHU, MPR, Besançon, France.