Article

Foot drop and plantar flexion failure determine different gait strategies in Charcot-Marie-Tooth patients

Department of Physical Medicine and Rehabilitation, Movement Analysis Laboratory, La Sapienza University of Rome, Italy.
Clinical Biomechanics (Impact Factor: 1.97). 11/2007; 22(8):905-16. DOI: 10.1016/j.clinbiomech.2007.06.002
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ABSTRACT

To describe the temporal, kinetic, kinematic, electromyographic and energetic aspects of gait in Charcot-Marie-Tooth patients with foot drop and plantar flexion failure.
A sample of 21 patients fulfilling clinical, electrodiagnostic and genetic criteria for Charcot-Marie-Tooth disease were evaluated by computerized gait analysis system and compared to a group of matched healthy subjects. Patients were classified as having isolate foot drop (group 1) and association of foot drop and plantar flexion failure (group 2).
While it was impossible to detect a reliable gait pattern when the group of patients was considered as a whole and compared to healthy subjects, we observed two distinctive gait patterns when patients were subdivided as group 1 or 2. Group 1 showed a gait pattern with some characteristics of the "steppage pattern". The complex motor strategy adopted by this group leads to reduce the swing velocity and to preserve the step length in spite of a high energy consumption. Group 2 displayed a "clumsy pattern" characterized by very slow gait with reduced step length, a broader support area and great reduction in the cadence. This group of patients is characterized by a low energy consumption and greater energy recovery, due above all to the primary deficit and the various compensatory mechanisms.
Such between-group differences in gait pattern can be related to both primary motor deficits and secondary compensatory mechanisms. Foot drop and plantar flexion failure affect the overall gait strategy in Charcot-Marie-Tooth patients.

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Available from: Alberto Ranavolo, Sep 17, 2014
    • "); mid-stance (MS) (11–30% of GC); terminal stance (TS) (31–50% of GC); pre-swing (PSw) (51–60% of GC); initial swing (InSw) (61–73% of GC); mid-swing (MSw) (74–86% of GC); and terminal swing (TSw) (87–100% of GC) (Don et al., 2007; Perry and Burnfield, 2010 "
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    ABSTRACT: Background: Studies revealed that pelvis and shoulder girdle kinematics is impaired in children with the diplegic form of bilateral cerebral palsy while walking. The features of 3D coordination between these segments, however, have never been evaluated. Methods: The gait analyses of 27 children with bilateral cerebral palsy (18 males; mean age 124months) have been retrospectively reviewed from the database of a Movement Analysis Laboratory. The spatial-temporal parameters and the range-of-motions of the pelvis and of the shoulder girdle on the three planes of motion have been calculated. Continuous relative phase has been calculated for the 3D pelvis-shoulder girdle couplings on the transverse, sagittal and frontal planes of motion to determine coordination between these segments. Data from 10 typically developed children have been used for comparison. Findings Children with bilateral cerebral palsy walk with lower velocity (P=0.01), shorter steps (P<0.0001), larger base of support (P<0.01) and increased duration of the double support phase (P=0.005) when compared to typically developed children. The mean continuous relative phase on the transverse plane has been found lower in the cerebral palsy group throughout the gait cycle (P=0.003), as well as in terminal stance, pre-swing and mid-swing. The age, gait speed and pelvis range-of-motions on the transverse plane have been found correlated to continuous relative phase on the transverse plane. Interpretation Compared with typically developed children, children with bilateral cerebral palsy show a more in-phase coordination between the pelvis and the shoulder girdle on the transverse plane while walking.
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    • "Therefore, we expected to record a higher daily energy expenditure in CMT1A patients as they covered the same distance and spent the same time in walking activities with respect to the healthy controls. It is likely that this unexpected result can be attributed to the inaccuracy of the IDEEA device in estimating daily energy expenditure as it does not take into account the effects of altered walking patterns in CMT1A patients (Mazzaro et al. 2005; Don et al. 2007; Newman et al. 2007). Charcot–Marie–Tooth 1A patients showed lower isometric strength of the knee extensor muscles with respect to healthy individuals, which is consistent with previous results of other authors (Lindeman et al. 1999; Kalkman et al. 2005). "
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