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Falls in paediatric Charcot-Marie-Tooth disease: a 6-month prospective cohort study
Rachel A Kennedy1,2,3, Kate Carroll1,3, Graham Hepworth4
1Neurology Department, The Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Children with Charcot-Marie-Tooth disease (CMT) fall significantly more often than typically developing peers, experiencing 33 times higher fall risk and more frequent injuries. Early age and impaired balance are key risk factors for falls in pediatric CMT patients.
Area of Science:
- Neurology
- Pediatrics
- Orthopedics
Background:
- Charcot-Marie-Tooth disease (CMT) is a progressive, inherited neuromuscular disorder affecting peripheral nerves.
- Falls are a common concern in individuals with neurological impairments, impacting mobility and quality of life.
- Limited data exists on the specific risks and characteristics of falls in pediatric populations with CMT.
Purpose of the Study:
- To prospectively investigate the incidence and characteristics of falls in children and adolescents diagnosed with Charcot-Marie-Tooth disease (CMT).
- To compare fall rates and injury profiles between pediatric CMT patients and typically developing (TD) peers.
- To identify predictors of falls, including age and balance impairments, in the pediatric CMT population.
Main Methods:
- A prospective cohort study was conducted involving 60 children and adolescents (aged 4-18 years) at a tertiary pediatric hospital's neuromuscular clinic.
- The cohort comprised 30 participants with CMT and 30 typically developing (TD) controls.
- Data collected over 6 months included falls rate, falls characteristics via questionnaire, and analysis of impairment-related predictors.
Main Results:
- Children with CMT experienced a significantly higher rate of falls (22/30) compared to TD children (8/30) over 6 months.
- The incidence rate ratio for falls in pediatric CMT patients was 33 times higher than in TD peers.
- Injurious falls were more common in the CMT group, with tripping identified as the primary mechanism; younger age (<7 years) and poorer balance were significant predictors of falls.
Conclusions:
- Children and adolescents with Charcot-Marie-Tooth disease exhibit a substantially elevated risk of falls compared to their typically developing counterparts.
- Falls in pediatric CMT patients are associated with a higher likelihood of injury, necessitating targeted interventions.
- Early identification of fall risk factors, such as age and balance deficits, is crucial for managing pediatric CMT.
Objective:
To prospectively study falls in children and adolescents with Charcot-Marie-Tooth disease (CMT).
Design:
Prospective cohort study.
Setting:
Neuromuscular outpatient clinic of a tertiary paediatric hospital.
Patients:
Sixty children and adolescents ('children') aged 4-18 years, 30 with CMT and 30 typically developing (TD).
Main Outcome Measures:
Falls rate over 6 months and falls characteristics questionnaire.
Results:
Twenty-two children with CMT reported falling at least once in 6 months compared with eight TD children (CMT 2819 (0-1915), TD 31 (0-6) total falls (range)). Detailed falls characteristics were collected from 242 individual falls (CMT 216, TD 26). Injurious falls were reported by 19 children with CMT (74 falls) compared with 2 TD children (3 falls), with cuts, grazes and bruising most common. No fractures were sustained and no child required hospitalisation. However, 12 injuries from falls in children with CMT required management by a healthcare provider, versus none in TD children. Tripping was the most common mechanism of falls in both groups. Age was the strongest predictor of falls (ρ=-0.53, p=0.006) with all children (CMT and TD) aged <7 years falling. Balance was the strongest impairment-related predictor of falls (ρ=-0.47, p=0.02). The conservative estimate of risk of falls in children and adolescents with CMT was 33 times higher than their TD peers (incidence rate ratio=32.8, 95% CI 10.2 to 106.0).
Conclusions:
Children and adolescents with CMT fall more often than TD peers and sustain more injuries when they fall.
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