Trunk movement and balance in HSP

How they are related and why

Increased trunk movements go hand-in-hand with reduced balance capacity in people with HSP. Those with markedly increased trunk movements were more often toe walkers.

With disease progression and the ability to correct for impaired gait decreases, trunk movements are likely employed as a balance correcting strategy.

Objective: Hereditary spastic paraplegia (HSP) is characterized by a bilaterally spastic gait pattern. During gait, increased trunk movements are often observed. People with HSP likely generate trunk movements to improve foot clearance and step length, but there may be additional explanations. Here, we investigate whether there is an association between reduced balance performance and increased trunk movements, as an increase in trunk movements may partly reflect balance correcting strategies.

Methods: We analyzed an historic cohort of 86 people with HSP who underwent gait analysis and balance examination. Two researchers reviewed gait analyses videos and classified the observed trunk movement as (1) normal, (2) moderately increased, or (3) markedly increased, and categorized participants as ‘toe walkers’ (yes/no). Balance performance and spatiotemporal gait parameters were collected from the medical files. Parameters were compared between people with normal vs. moderately increased trunk movements, moderately vs. markedly increased trunk movements, and normal vs. markedly increased trunk movements.

Results: Patients with moderately increased trunk movements during gait scored lower on the Berg Balance Scale (p = 0.002) and/or the Mini Balance Evaluation Test (p = 0.043) than patients with normal trunk movements. Likewise, patients with markedly increased trunk movements performed worse on the BBS (p = 0.037) and/or the Mini-BESTest (p = 0.004) than patients with moderately increased trunk movements. Patients with markedly increased trunk movements were more often toe walkers than patients with moderately increased (68% vs. 6%; p < 0.001).

Conclusions: We found an association between increased trunk movements and reduced balance capacity. This may have several-not mutually exclusive-explanations. One of these explanations is that trunk movements, at least partly, reflect balance correcting strategies. With the disease progression, ankle strategies and foot placement strategies become impaired and insufficient to restore balance after intrinsic perturbations. Hip strategies are then potentially recruited to maintain balance, resulting in increased trunk movements.

SOURCE:  J Neurol. 2022 Mar 20. doi: 10.1007/s00415-022-11054-6. Online ahead of print. PMID: 35307753 © 2022. The Author(s).

Increased trunk movements in people with hereditary spastic paraplegia: do these involve balance correcting strategies?

Lotte van de Venis  1 Vivian Weerdesteyn  2 Aletta Konijnenburg  2 Bart P C van de Warrenburg  3 Alexander C H Geurts  2   4 Jorik Nonnekes  2   4

1. Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. [email protected]                 

2. Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.                                                                          

3. Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.                                                                                        

4. Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.

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