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

Abstract

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.

The therapeutic effects of physical treatment for patients with hereditary spastic paraplegia: a narrative review

“…There are three basic tactics that humans utilize in order to restore their equilibrium throughout the process of walking. (1) The hip approach entails the rotational movement of the upper body segments around the Center of Mass (CoM) ( 26 ); (2) the procedures for adjusting foot location and positioning, and (3) the ankle tactics that are prioritized above hip ways in situations where all three options are available for balance recovery. These scenarios include walking on a narrow beam, executing tasks under time constraints, or being impacted by a neurological condition ( 25 ).…”

A Single-Sensor Approach to Quantify Gait in Patients with Hereditary Spastic Paraplegia

“…Future research should look into the effect of the severity of the disease on the error but also whether there are any genotype–gait phenotype associations. Moreover, since increased trunk movements can be observed also in the early phases of the disease [ 34 , 35 , 36 , 37 ], the adoption of a lower-back sensor will grant the possibility to collect additional trunk information to further characterise mobility in people with HSP.…”