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Changes in walking velocity and stride parameters with age in children with Charcot-Marie-Tooth disease
Sylvia Õunpuu1, Kristan A Pierz2, Gyula Acsadi3
1Center for Motion Analysis, Connecticut Children's Medical Center, 399 Farmington Ave. Farmington, CT, USA.
Insights
Children with Charcot-Marie-Tooth disease exhibit slower walking velocity due to reduced stride length and cadence compared to peers. Interventions targeting stride length may enhance gait function in pediatric Charcot-Marie-Tooth disease.
Area of Science:
- Neurology
- Gait Analysis
- Pediatric Research
Background:
- Charcot-Marie-Tooth disease (CMT) is a group of inherited peripheral neuropathies causing progressive distal muscle weakness.
- Gait disturbances, including reduced walking velocity, are common in children with CMT.
- Understanding the temporal progression of gait deficits is crucial for effective management.
Purpose of the Study:
- To assess the impact of Charcot-Marie-Tooth disease on walking velocity over time in children.
- To compare gait parameters between children with CMT and age-matched controls.
- To identify factors influencing gait velocity and progression in pediatric CMT.
Main Methods:
- Gait analysis was performed on 57 children with CMT and 76 age-matched controls.
- Key gait parameters including walking velocity, stride length, and cadence were measured.
- Subgroup analyses were conducted for CMT types 1 and 2, and based on muscle strength.
Main Results:
- Children with CMT demonstrated significantly slower walking velocity, shorter stride length, and diminished cadence compared to controls.
- Higher walking velocity, stride length, and cadence were observed in patients with adequate dorsiflexor and plantar flexor strength.
- While walking velocity increased with age in controls, it did not significantly increase in children with CMT types 1 or 2. Stride length increased at a slower rate in CMT subtypes compared to controls, leading to progressively worsening gait deficits with age, particularly in type 2.
Conclusions:
- Slower walking velocity in pediatric Charcot-Marie-Tooth disease is primarily attributed to reduced stride length.
- Age-related gait deterioration is evident in CMT types 1 and 2, with deficits appearing earlier in type 2.
- Therapeutic strategies focusing on improving stride length, such as plantar flexor strengthening and bracing, hold promise for enhancing walking velocity and overall gait function in children with CMT.
Abstract:
The purpose of this study is to assess how Charcot-Marie-Tooth disease, a group of inherited peripheral neuropathies that result in distal weakness, affects walking velocity over time in comparison to age-matched controls. Comprehensive gait analysis of 57 children (mean age 12.0, SD 3.7 years) compared to 76 age-matched controls (mean age 10.1, SD 3.4 years) demonstrated slower walking velocity (p<0.001) due to both shorter stride length (p<0.001) and diminished cadence (p=0.01). There was higher walking velocity (p<0.001), stride length (p=0.002) and cadence (p<0.001) in patients with dorsiflexor strength ≥3 and higher walking velocity (p=0.001) and cadence (p=0.03) in patients plantar flexor strength ≥4. Analysis of Charcot-Marie-Tooth type 1 and type 2 subgroups showed that walking velocity increased significantly with age in controls (p=0.001) but did not increase in children with either subtype (p>0.54). Stride length increased significantly with age in all groups (p<0.001) but at a slower rate in type 1 and 2 compared to controls. These differences contributed to increasing deficits in walking velocity and stride length with age in type 1 and 2 in comparison to controls, with deficits appearing earlier in type 2. Since the slower walking velocity in children with Charcot-Marie-Tooth disease is primarily due to short stride length, treatments that enable improved stride length, such as plantar flexor strengthening and bracing, may improve walking velocity and associated gait function.
