Compensatory mechanisms during walking in response to muscle weakness in spinal muscular atrophy, type III

Our knowledge on altered neurological control of walking due to weakness of various muscle groups of the lower extremities is limited. The aim of this study was to assess kinematic, kinetic and electromyographic (EMG) walking patterns in a functionally homogeneous group of seven subjects with spinal muscular atrophy, type III (SMA group) and compare them with normal data obtained from nine healthy subjects (CONTROL group) in order to identify characteristic compensatory changes. Muscle strength at the ankle and knee joints was assessed using isokinetic dynamometry to determine variability in muscle strength: this was found to be similar in the two groups. Kinematic, kinetic and EMG patterns were assessed during walking in the SMA and CONTROL groups. The results showed changes in the activity of ankle plantarflexors and associated control of the center of pressure during loading response and midstance, which facilitated minimization of the external flexion moment acting on the knee and hip in the SMA group. Additionally, we identified distinct and consistent changes in the control of hip rotators that act to rapidly extend the hip early in stance phase and in the control of contralateral hip abductors that act delay weight shift onto the leg entering the stance phase. From these results we can conclude that the most important muscle groups compensating for reduced strength in knee and hip muscles are the ankle plantarflexors, hip rotators and hip abductors. This finding would have direct application in rehabilitation treatment programs.