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Spine kinematics during gait in paediatric Hereditary Spastic Paraparesis
V Farinelli1, C Palmisano2, C Dosi3
1Human Physiology Section of the DePT, Università degli Studi di Milano, Milano, Italy.
Insights
Hereditary Spastic Paraparesis (HSP) alters spinal kinematics during gait, increasing trunk tilt and abnormal spinal curvature. This highlights the importance of viewing the trunk as an articulated system for treating gait issues.
Area of Science:
- Biomechanical analysis of human locomotion.
- Pediatric orthopedics and neurology.
- Gait analysis and motor control.
Background:
- Previous studies on Hereditary Spastic Paraparesis (HSP) gait abnormalities often simplified trunk and pelvis movement.
- A novel method for detailed spinal kinematics was recently developed.
- This study applies this advanced method to investigate spinal motion in children with HSP.
Purpose of the Study:
- To investigate how Hereditary Spastic Paraparesis (HSP) influences detailed spinal kinematics during gait.
- To compare spinal motion patterns between children with HSP and healthy children.
Main Methods:
- Ten children with HSP and twelve healthy children (HC) were enrolled.
- An optoelectronic system with a full-body marker set, including spinal markers, was used for kinematic data collection.
- Spinal length, kyphosis, lordosis, trunk tilt, pelvic, and shoulder-pelvis angles were calculated and compared between groups.
Main Results:
- Children with HSP exhibited significantly increased range of motion (ROM) of spinal length and kyphosis angle, along with increased average trunk tilt compared to HC.
- Pathologic "double bump" patterns were observed in pelvic tilt, lordosis, and kyphosis.
- Increased pelvic tilt ROM and reduced lower limb joint ROM were noted in the HSP group.
Conclusions:
- Spinal kinematics are significantly altered in children with HSP, characterized by increased trunk mobility and anterior trunk tilt.
- The trunk should be modeled as an articulated system, not a rigid body, for a comprehensive understanding of gait abnormalities.
- This articulated trunk perspective may inform improved therapeutic strategies for gait disorders in HSP.
Background:
Many studies already addressed specific gait abnormalities in children affected by Hereditary Spastic Paraparesis (HSP). Some authors investigated the contribution of the upper body to walking pattern, but simplifying trunk and pelvis as two hinged rigid bodies. Recently, we developed a method to detail spinal kinematics in terms of anatomic curvatures and length; we were thus interested in applying such protocol to HSP.
Research Question:
how HSP influences spinal kinematics during gait?
Methods:
we enrolled ten HSP patients (5-17 years, 8 males) and twelve Healthy Children (HC, 8-16 years, 4 males). Kinematic data were recorded with an optoelectronic system using the LAMB full body marker set, which included three physical markers placed on the spine, supplemented with a virtual one reconstructed on the coccix. Calculations included the spinal length (linear distance from C7 to coccix), the kyphosis and lordosis angles, the trunk tilt and obliquity, the pelvis and the shoulder-pelvis angles, as well as the joint angles of the lower limbs. For each variable, the average value and the range of motion (ROM) were extracted and compared between groups.
Results:
the ROM of spinal length, the average value and ROM of kyphosis angle and the average value of trunk tilt significantly increased in HSP vs HC. A pathologic "double bump" pattern characterized the pelvic tilt traces, the lordosis angles and, with opposite sign, the kyphosis. Both the average value and ROM of pelvic tilt significantly increased in HSP, while ROM of lower limb angles was reduced.
Conclusion:
spine kinematics were altered in HSP, who also showed an anterior trunk tilt. Therefore, the trunk should be considered an articulated system and not simplified to a rigid body, a perspective that could be also used in treating gait abnormalities.
