Gait analysis patterns and rehabilitative interventions to improve gait in persons with hereditary spastic paraplegia: a systematic review and meta-analysis

Silvia Faccioli; Angela Cavalagli; Nicola Falocci; Giulia Mangano; Irene Sanfilippo; Silvia Sassi

doi:10.3389/fneur.2023.1256392

Gait analysis patterns and rehabilitative interventions to improve gait in persons with hereditary spastic paraplegia: a systematic review and meta-analysis

Front Neurol. 2023 Sep 20:14:1256392. doi: 10.3389/fneur.2023.1256392. eCollection 2023.

Authors

Silvia Faccioli^#^{1

2}, Angela Cavalagli^#³, Nicola Falocci⁴, Giulia Mangano⁵, Irene Sanfilippo⁶, Silvia Sassi¹

Affiliations

¹ Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy.
² Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
³ Children Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy.
⁴ Office of Policy Evaluation and Statistical Studies, Umbria Legislative Assembly, Perugia, Italy.
⁵ Department of Physical Medicine and Rehabilitation, Azienda Sanitaria Provinciale 3 (ASP 3), Acireale Hospital, Catania, Italy.
⁶ Rehabilitation Center CMR, Adrano, Catania, Italy.

^# Contributed equally.

Abstract

Background: Hereditary spastic paraplegias (HSPs) are a group of inheritance diseases resulting in gait abnormalities, which may be detected using instrumented gait analysis. The aim of this systematic review was 2-fold: to identify specific gait analysis patterns and interventions improving gait in HSP subjects.

Methods: A systematic review was conducted in PubMed, Cochrane Library, REHABDATA, and PEDro databases, in accordance with reporting guidelines of PRISMA statement and Cochrane's recommendation. The review protocol was recorded on the PROSPERO register. Patients with pure and complicated HSP of any age were included. All types of studies were included. Risk of bias, quality assessment, and meta-analysis were performed.

Results: Forty-two studies were included: 19 were related to gait analysis patterns, and 24 were intervention studies. The latter ones were limited to adults. HSP gait patterns were similar to cerebral palsy in younger subjects and stroke in adults. Knee hyperextension, reduced range of motion at knee, ankle, and hip, reduced foot lift, and increased rapid trunk and arm movements were reported. Botulinum injections reduced spasticity but uncovered weakness and improved gait velocity at follow-up. Weak evidence supported intrathecal baclofen, active intensive physical therapy (i.e., robot-assisted gait training, functional exercises, and hydrotherapy), and functional electrical stimulation. Some improvements but adverse events were reported after transcranial magnetic stimulation, transcutaneous spinal direct current stimulation, and spinal cord stimulation implant.

Conclusion: Knee hyperextension, non-sagittal pelvic movements, and reduced ROM at the knee, ankle, and hip represent the most peculiar patterns in HSP, compared to diplegic cerebral palsy and stroke. Botulinum improved comfortable gait velocity after 2 months. Nonetheless, interventions reducing spasticity might result in ineffective functional outcomes unveiling weakness. Intensive active physical therapy and FES might improve gait velocity in the very short term.

Keywords: botulinum toxins; gait analysis; gait disorders; physical therapy modalities; rehabilitation; spastic paraparesis; spasticity; walking.

Publication types

Systematic Review

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.