NL
DE
People with hereditary spastic paraplegia (HSP) – a rare progressive neurological disorder affecting neurons in the spinal cord - experience disabling walking impairments. These impairments gradually deteriorate over time and are the consequence of progressive spasticity, muscle weakness and reduced proprioception in both legs. Although the trunk is not affected in people with HSP, patients typically show increased trunk movements when walking. In a recent study, researchers from the department of rehabilitation and neurology, part of the Radboudumc Center of Expertise for Rare and genetic movement disorders, explored the underlying mechanisms.
‘Previous studies indicated that increased trunk movements in people with HSP are likely generated to improve foot clearance and step length. We investigated whether there may be additional explanations’, explains first author and PhD-candidate Lotte van de Venis. ‘We hypothesized that increased trunk movements may also reflect balance correcting strategies.’
Humans have three strategies to maintain balance when standing or walking: by activation of muscles around the ankle joints (i.e., the ankle strategy), by taking a step (i.e., the stepping strategy), or by making movements or the trunk and arms (i.e., hip strategy). Healthy people prefer to maintain balance by using the ankle strategy or stepping strategy, but over time, these strategies become affected in people with HSP. Lotte van de Venis: ‘As a result, the hip strategies may become pivotal in HSP, resulting in increased trunk movements’.
Instrumented gait analysis in the movement laboratory of the Radboudumc
To investigate their hypothesis, a historic cohort of 86 people with HSP who underwent instrumented gait analysis and clinical balance examination were analyzed. Using these data, it was found that there is indeed an association between increased trunk movements and reduced balance capacity: people with more balance impairments showed more trunk movements during walking. Last author and consultant in rehabilitation medicine Jorik Nonnekes: ‘This is valuable information as it helps to better relate gait patterns observed in daily clinical practice to balance capacities, and thus, to select an optimal treatment approach for people with HSP.’
Publication
van de Venis, L., Weerdesteyn, V., Konijnenburg, A. et al. Increased trunk movements in people with hereditary spastic paraplegia: do these involve balance correcting strategies?. J Neurol (2022). https://doi.org/10.1007/s00415-022-11054-6.
