1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-40
SAGITTAL PLANE LOWER EXTREMITY KINEMATICS IN CHILDREN WITH
HEREDITARY SPASTIC PARAPLEGIA
Nichols, Molly, MPT 1 , Dorociak, Robin, BS 1 , and Aiona, Michael, MD 1
1 Shriners Hospitals for Children, Portland, Oregon, United States
Summary/conclusions
Children with Hereditary Spastic Paraplegia (HSP) demonstrate one of four sagittal plane gait
patterns distinct from children with spastic diplegic cerebral palsy as revealed by computerized
gait analysis of the lower extremities. Further analysis with additional subjects and upper
extremity kinematics will substantiate these patterns.
Introduction
Hereditary Spastic Paraplegia refers to a group of more than 30 inherited neurologic disorders
in which the predominant characteristic is lower extremity spasticity resulting in an atypical
gait pattern [1]. Since the first clinical descriptions of HSP by Strümpell in 1880, few studies
have been published describing the gait patterns of HSP [2] and to date minimal kinematic
information exists for the pediatric population.
Statement of clinical significance
Defining sagittal plane gait patterns specific to children with HSP will allow the clinician to
differentiate between this population and children with spastic diplegic cerebral palsy, better
directing diagnosis and treatment. The use of computerized gait analysis for children with HSP
reveals patterns that cannot be distinguished by visual gait inspection.
Methods
A retrospective chart review was performed for 18 patients (10 female, 8 male; mean age 12.7
yrs, range 3.9 to 18.7 yrs) with HSP who underwent routine clinical gait analysis. The
diagnosis of HSP was confirmed by family history (14 patients) or clinically confirmed by a
neurologist (4 patients). Patients included were independent ambulators without orthoses or
prior surgical intervention. Computerized gait analysis was performed using a VICON motion
system. Patient gait trials were processed using Vicon Clinical Manager. One representative
trial for each of the right and left sides was chosen for analysis. Because it was noted that the
patients had symmetric patterns, a representative side was chosen for illustration. Utilizing the
gait classification system described by Rodda [3], six clinicians experienced in gait analysis
attempted to classify the HSP patients into the diplegic gait patterns. As 11/18 HSP patients did
not fit into any of these categories, the purpose of this study was to determine whether patterns
specific to HSP could be differentiated.
Results
Sagittal plane kinematic profiles of HSP patients grouped into four patterns where the primary
differences were at the knee and pelvis (fig.1). Ankle position did not present as a
distinguishing characteristic. Group A consists of 6 patients (2 female, 4 male) with a mean age
of 11.4 ± 2.7 yrs and is characterized by an exaggerated double-bump pattern at the pelvis and
a triple-bump pattern at the knee (an additional flexion peak in late stance). Group B includes 4
patients (all female, mean age 5.4 ± 2.2 yrs) with primary characteristics of increased peak
knee flexion in loading and swing as well as knee hyperextension in midstance. Group C
consists of 4 patients (1 female, 3 male) with a mean age of 17.7 ± 1.0 yrs. This group has a
moderate double bump pelvic pattern in anterior tilt, hip flexion in terminal stance, a
crouched/stiff knee pattern and peak ankle dorsiflexion near norms. Group D includes 4
patients (3 female, 1 male) with a mean age of 17.0 ± 2.4 yrs. This group is the mildest pattern
with a slight double-bump pelvic pattern, hip extension to neutral in terminal stance and knee
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