Article

Gait pattern classification may assist in clinical decision making and cluster
analysis (CA) has been often adopted to this aim. The goal of this study was to
identify, through CA, typical walking patterns in a group of 21 young subjects
with CMT1A, a hereditary progressive neuropathy, and to study possible
correlation with the disease's clinical status. The protocol included
kinematic/kinetic analysis of natural walking and more demanding locomotor tasks,
i.e. toe- and heel-walking. Hierarchical cluster analysis was carried out on
parameters related to primary signs (foot-drop and push-off deficit) and,
separately, to compensatory mechanisms at proximal (pelvis, hip and knee) or
distal (ankle) level. CA on primary signs during natural walking identified three
clusters: (1) pseudo-normal patients (PN), not significantly different from
controls; (2) patients showing only foot-drop (FD); (3) patients with foot-drop
and push-off deficit (FD&POD). Patients belonging to the PN subgroup showed
distal abnormalities during heel-walking. The FD&POD subgroup was associated to a
significantly worse clinical score (CMTES, p<0.05). The main compensatory
strategies, which occurred independently from primary clusterization, included
augmented hip/knee flexion in swing (steppage) and early ankle plantarflexion at
mid stance (vaulting). We concluded that, although a number of young CMT1A
patients do not show typical primary deviations during natural walking, they do
show significant abnormalities in more demanding locomotor tasks that should be
therefore considered. It is also hypothesized that progression of this
degenerative condition may be associated to the migration of patients to more
severe clusters, with possible appearance of compensatory strategies.
CI - Copyright (c) 2011. Published by Elsevier B.V.

Langue : ANGLAIS