Gait Patterns in Hereditary Spastic Paraplegia

Background: Clinical manifestations of hereditary spastic paraplegia (HSP) are usually progressive. Gait in patients with HSP is impaired and leads to functional deteriorations. Aim of this study is to evaluate these gait deviations by using instrumented three-dimensional gait analysis.

Patients: Gait characteristics of twenty-four patients with a mean age of 19.5 years have been studied using three-dimensional instrumented gait analysis. Typical findings of spastic gait disorders in kinematics, kinetics and time-distance parameters were recorded. Seven out of twenty-four patients (5 males, 2 females) with a mean age of 10.1 years (9.7–36.4 years) underwent at least two consecutive instrumented gait analyses, with an average follow-up time of 2.3 years (1.5–4.1 years).

Results: Two typical pathologic gait patterns could be classified showing either knee recurvation (8/24) or crouch gait (12/24). In comparison, patients with recurvation gait pattern demonstrated an increased knee ROM and decreased knee flexion in swing. In the progression, the pelvic ROM in the sagittal plane remained unchanged whereas the maximum anterior pelvic tilt was increased in the follow-up examination. The hip extension during stance was decreased whereas the knee parameters remained unchanged. The ankle plantar flexion at initial contact and the ankle ROM were increased and the ankle dorsiflexion during stance was reduced while the maximum ankle dorsiflexion during swing remained unchanged.

Conclusions: In the management of spastic gait disorders the treating physician should preserve the ability of the accelerators to generate power. According to our results, in patients with HSP and the ankle plantarflexors (in crouch patients) and hip extensors (in recurvation patients) should not be overlengthened and their propulsive power should be preserved. Long-term studies with larger number of patients using discrete qualitative and quantitative criteria should be employed to study the evolution of gait in HSP patients. Furthermore, outcome studies utilizing such analytical methods may change the approach in treatment planning and disease stabilization.