Fatigue related to severity
A research study has now quantified what has been known for a long time – that it takes a lot more energy to walk when you have HSP, and the worse are the HSP symptoms, the higher the fatigue caused by walking.
Limited studies have reported on gait characteristics of children with Hereditary Spastic Paraplegia (HSP). Previous research has shown this to be a heterogeneous patient population in terms of gait function. Children with gait disorders have been shown to have a higher energy cost of walking compared to age-matched children without disabilities. To date, there are no studies looking at the relationship between gait dysfunction and energy cost in patients with HSP. The purpose of this investigation is to evaluate the association between gait deficiencies and energy efficiency in patients with HSP. It is hypothesized that a lower quality of gait will be related to a higher energy cost.
Study Participants and Setting:
Twenty-seven participants (average age 14.0 ± 5.4yrs) with a clinical diagnosis of HSP tested in a clinical and research based motion analysis laboratory.
Gait analysis at a self-selected speed. A 6-minute walk test (6MWT) was performed to determine functional ability and exercise capacity. Oxygen consumption data was collected simultaneously, along with heart rate. The gait deviation index (GDI), highly applicable to neurologic populations, is a kinematic based derivation of gait analysis that provides a quantitative method of describing the overall gait pattern relative to healthy individuals. GDI was calculated by averaging scores from 3 representative trials from gait for the left and right sides. Pearson’s correlation coefficient was used to determine the relationship between GDI score and distance traveled during the 6MWT, average walking velocity, and energy cost.
Moderate correlations were found between gait deviation scores and performance during the 6MWT. Lower GDI scores were correlated with shorter distances walked (r = 0.65), decreased walking velocity (r = 0.64), and higher energy cost (r = −0.68) during the 6MWT. This can be inferred that there is more of a demand on the body during longer periods of walking in those patients with increased gait deviations. During the 6MWT, some patients had to pause to take a break due to fatigue.
Results from this study indicate that abnormal gait patterns (lower GDI scores) are correlated with reduced exercise capacity in patients with HSP. Future work should be focused on which specific gait deviations (i.e. increased knee flexion, ankle equinus, internal foot progression, etc.) have the greatest effect on energy cost.
SOURCE: Developmental Medicine & Child Neurology Volume 57, Issue Supplement S5, pages 70–71, October 2015 Article first published online: 30 SEP 2015 DOI: 10.1111/dmcn.114_12887 © 2015 The Authors. Development Medicine & Child Neurology © 2015 Mac Keith Press
Gait outcomes and energy efficiency in patients with hereditary spastic paraplegia
A Anderson1, K Tulchin-Francis1, L Smith1, M Delgado2
1Texas Scottish Rite Hospital for Children, Dallas, TX, USA; 2Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA