Gait-Adaptability Training in People With Hereditary Spastic Paraplegia: A Randomized Clinical Trial

Abstract

Background and objectives In people with hereditary spastic paraplegia (HSP), reduced gait adaptability is common and disabling. Gait impairments result from lower extremity spasticity, muscle weakness, and impaired proprioception. The aim of this study was to assess the efficacy of a 5-week gait-adaptability training in people with pure HSP. Method We conducted a randomized clinical trial with a cross-over design for the control group, and a 15-week follow-up period after training. Thirty-six people with pure HSP were randomized to 5 weeks of (i) gait-adaptability training (10 hours of C-Mill training—a treadmill equipped with augmented reality) or (ii) a waiting-list control period followed by 5 weeks gait-adaptability training. Both groups continued to receive usual care. The primary outcome was the obstacle subtask of the Emory Functional Ambulation Profile. Secondary outcome measures consisted of clinical balance and gait assessments, fall rates, and spatiotemporal gait parameters assessed via 3D motion analysis. Results The gait-adaptability training group (n = 18) did not significantly decrease the time required to perform the obstacle subtask compared to the waiting-list control group (n = 18) after adjusting for baseline differences (mean: −0.33 seconds, 95% CI: −1.3, 0.6). Similar, non-significant results were found for most secondary outcomes. After merging both groups (n = 36), the required time to perform the obstacle subtask significantly decreased by 1.3 seconds (95% CI: −2.1, −0.4) directly following 5 weeks of gait-adaptability training, and this effect was retained at the 15-week follow-up. Conclusions We found insufficient evidence to conclude that 5 weeks of gait-adaptability training leads to greater improvement of gait adaptability in people with pure HSP.

The evolution of augmented reality to augment physical therapy: A scoping review

“… 41 ( Tables 2 and 5 ) In one study of people with hereditary spastic paraplegia, people who received C-mill treadmill with AR did not show any improvements in balance, gait or falls. 44 ( Tables 2 and 5 ) Sample sizes ranged from 16 to 68 and were relatively similar between studies that found between group differences and those that did not. Intervention intensity generally ranged from 20 min 3x/week to 60 min 5x/week for four to 8 weeks.…”

“… 12 , 18 , 19 , 25 – 27 ( Table 1 ); 22 studies included adults with chronic neurological conditions (15 pilot case or observational studies studies; 9 – 11 , 28 – 39 7 experimental studies. 16 , 17 , 40 – 44 ) (See Table 2 ) Four articles were of orthopedic populations, (1 pilot study 45 3 experimental studies). 46 – 48 ( Table 3 ) One study examined clinical outcomes of pulmonary function after knee surgery, 49 one study was among women recovering from breast cancer surgery, 50 one study of older women with sarcopenia, 51 and one patient with burns.…”

“…28 Between 2005 and 2015, 10 studies were published: eight studies of chronic neurological patients 9 , 11 , 16 , 17 , 28 – 30 , 40 and two studies of general adult populations. 19 , 21 Between 2016 and 2023, 30 additional articles were published: 14 studies of chronic neurological patients, 10 , 31 – 39 , 41 – 44 ; eight studies of general adults, 12 , 18 , 22 – 27 ; four studies of orthopedic patients, 45 – 48 ; one study of pulmonary function among surgical patients, 49 ; one study of patients recovering from breast cancer surgery, 50 ; one study of older women with sarcopenia, 51 ; and one study of patients with burns. 52 Of the 30 studies, 14 were published between 2022–2023.…”

“…Of the seven experimental studies of chronic neurological adult populations, six studies were of subjects with strokes, 16 , 17 , 40 – 43 and one study was of subjects with spastic paresis ( n = 1)., 44 ( Table 2 ) AR improved stride length compared to control group in two studies examining gait outcome. 16 , 40 One study showed between group differences in gait velocity.…”

Hereditary spastic paraplegia: Novel insights into the pathogenesis and management

“… 126 Although there was speculation that rTMS could be paired with gait training to achieve greater functional improvements, an RCT on gait-adaptability training for HSP patients did not show significant benefits. 128 Notably, an RCT on transcutaneous spinal direct current stimulation (tsDCS), a non-invasive method for modulating spinal cord function, demonstrated reductions in spasticity and is proposed as a complementary strategy for patients not responding to alternative treatments ( Table 4 ). 129 …”