Three-Dimensional Trunk and Lower Limbs Characteristics during Gait in Patients with Huntington's Disease.

Elzbieta Mirek,Andrzej Szczudlik,Wiesław Chwała,Szymon Pasiut,Jadwiga Szymura,Krzysztof Banaszkiewicz,Monika Rudzinska-Bar,Magdalena Filip

doi:10.3389/fnins.2017.00566

Elzbieta Mirek, Andrzej Szczudlik + Show 6 more

Open Access

https://doi.org/10.3389/fnins.2017.00566

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Abstract

Objective: A number of studies on gait disturbances have been conducted, however, no clear pattern of gait disorders was described. The aim of the study was to characterize the gait pattern in HD patients by conducting analysis of mean angular movement changes the lower limb joints and trunk (kinematics parameters).Methods: The study group consisted of 30 patients with HD (17 women and 13 men). The reference data include the results of 30 healthy subjects (17 women and 13 men). Registration of gait with the Vicon 250 system was performed using passive markers attached to specific anthropometric points directly on the skin, based on the Golem biomechanical model (Oxford Metrics Ltd.). The research group and the control group were tested once.Results: Statistically significant (p < 0.05) angular changes in gait cycle for HD patients were observed in: insufficient plantar flexion during Loading Response and Pre-swing phases; insufficient flexion of the knee joint during Initial Swing and Mid Swing phases; excessive flexion of the hip in Terminal Stance and Pre-swing phases and over-normative forward inclination of the trunk in all gait phases. It should be noted that the group of patients with HD obtained, for all the mean angular movement changes higher standard deviation.Conclusion: A characteristic gait disorder common to all patients with HD occurring throughout the whole duration of the gait cycle is a pathological anterior tilt of the trunk. The results will significantly contribute to programming physiotherapy for people with HD, aimed at stabilizing the trunk in a position of extension during gait.

Highlights

Huntington’s disease (HD) is an autosomal dominant inherited disorder which is characterized by a triad of symptoms: movement disorders, cognitive dysfunctions and behavioral disturbances
Gait disturbances in the early stages of HD—the so-called “choreiform gait,” is a gait pattern mixed of unpredictable accelerations and decelerations in walking speed with superimposed twisting choreatic movements of the trunk, head, arms and legs
Our research shows a broader view at the problem of gait disturbances in HD paying attention to the setting of the trunk relative to the lower limbs

Summary

Introduction

Huntington’s disease (HD) is an autosomal dominant inherited disorder which is characterized by a triad of symptoms: movement disorders (chorea, dystonia, bradykinesia, parkinsonism, impaired gait, and balance), cognitive dysfunctions and behavioral disturbances. The first HD symptoms usually appear between the age of 35 and 44 and gradually progress leading to disability and death. Gait disturbances in the early stages of HD—the so-called “choreiform gait,” is a gait pattern mixed of unpredictable accelerations and decelerations in walking speed with superimposed twisting choreatic movements of the trunk, head, arms and legs. HD Gait is a mixture of chorea, myoclonus, ataxia, and probably most importantly, lack of rhythmic control and usually occurs on a widened base. In the later stages of HD, gait becomes stiff, cautious and slower (Bilney et al, 2005; Collett et al, 2014; Danoudis and Iansek, 2014)

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Conclusion