Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.
Rehabilitation Centre, Policlinico Italia, Rome, Italy.
PLoS One. 2016 Oct 12;11(10):e0164623. doi: 10.1371/journal.pone.0164623. eCollection 2016.
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.
To describe the gait patterns in hereditary spastic paraparesis and to identify subgroups of patients according to specific kinematic features of walking.
We 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.
We 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.
We 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.
痉挛步态是遗传性痉挛性截瘫患者的一个重要特征，但步态特征以及步态障碍与临床特征之间的关系尚未得到研究。
描述遗传性痉挛性截瘫患者的步态模式，并根据行走时特定运动学特征识别患者亚组。
我们通过计算机步态分析评估了 50 名患者，并将其与健康参与者进行了比较。我们计算了行走的时间-距离参数以及髋关节、膝关节和踝关节以及躯干和骨盆的角度运动范围。还评估了下肢关节力矩和肌肉协同激活值。
我们根据运动范围值确定了三个不同的患者亚组。亚组一的特点是髋关节、膝关节和踝关节的运动范围减小。这些患者从临床角度来看受影响最严重，痉挛程度最高，行走速度最慢。亚组三的特点是髋关节运动范围增加，但膝关节和踝关节运动范围接近对照值。这些患者受影响最轻微，行走速度最快。最后，亚组二表现出膝关节和踝关节运动范围减小，髋关节运动范围接近对照值。亚组二的疾病严重程度和行走速度介于亚组一和三之间。
我们在遗传性痉挛性截瘫患者中发现了三种不同的步态模式，这些模式与临床数据密切相关。区分这些患者步态模式的特定特征可能有助于针对药物治疗和康复治疗进行个体化治疗，并有助于随着时间的推移评估治疗效果。
