Gait Patterns in Patients with Hereditary Spastic Paraparesis.

Mariano Serrao,Carmela Conte,Tiwana Varrecchia,Alberto Ranavolo,Martina Rinaldi,Gianluca Coppola,Carlo Casali,Francesco Lacquaniti,Francesco Pierelli,Francesco Draicchio,Luca Leonardi,Giovanni Martino

doi:10.1371/journal.pone.0164623

Abstract

BackgroundSpastic 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.ObjectivesTo describe the gait patterns in hereditary spastic paraparesis and to identify subgroups of patients according to specific kinematic features of walking.MethodsWe 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.ResultsWe 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.ConclusionsWe 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.

Highlights

Hereditary spastic paraparesis is a heterogeneous group of inherited neurodegenerative disorders characterized by retrograde degeneration of the corticospinal axonal fibers [1]
We identified three distinctive gait patterns in patients with hereditary spastic paraparesis that correlated robustly with clinical data
Our aims were as follows: i) to perform a comprehensive analysis of kinematics, kinetics and sEMG in adult patients with hereditary spastic paraparesis, and ii) to identify specific gait patterns in subgroups of patients categorized according to their kinematic behavior

Summary

Introduction

Hereditary spastic paraparesis is a heterogeneous group of inherited neurodegenerative disorders characterized by retrograde degeneration of the corticospinal axonal fibers [1]. Usually more prominent than muscle weakness, is the key clinical feature in patients with hereditary spastic paraparesis [2] and impairs walking ability, autonomy, and quality of life [3,4]. Quantifying and typifying the specific gait disorder in hereditary spastic paraparesis is crucial to designing individual pharmacological and rehabilitative treatments. We hypothesized that the individual kinematic behavior of patients with hereditary spastic paraparesis could be used to identify distinct subgroups of patients, and that these subgroups would exhibit different levels of limb spasticity. 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

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Conclusion