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Relationship between proprioception at the knee joint and gait ataxia in HSAN III.

ABSTRACT: Hereditary sensory and autonomic neuropathy type III features marked ataxic gait that progressively worsens over time. We assessed whether proprioceptive disturbances can explain the ataxia.Proprioception at the knee joint was assessed using passive joint angle matching in 18 patients and 14 age-matched controls; 5 patients with cerebellar ataxia were also studied. Ataxia was quantified using the Brief Ataxia Rating Score, which ranged from 7 to 26 of 30.Neuropathy patients performed poorly in judging joint position: mean absolute error was 8.7° ± 1.0°, and the range was very wide (2.8°-18.1°); conversely, absolute error was only 2.7° ± 0.3° (1.6°-5.5°) in the controls and 3.0° ± 0.2° (2.1°-3.4°) in the cerebellar patients. This error was positively correlated to the degree of ataxia in the neuropathy patients but not the cerebellar patients.These results suggest that poor proprioceptive acuity at the knee joint is a major contributor to the ataxic gait associated with hereditary sensory and autonomic neuropathy type III.

SUBMITTER: Macefield VG

PROVIDER: S-EPMC3694996 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Relationship between proprioception at the knee joint and gait ataxia in HSAN III.

Macefield Vaughan G VG Norcliffe-Kaufmann Lucy J LJ Axelrod Felicia B FB Kaufmann Horacio H

Movement disorders : official journal of the Movement Disorder Society 20130516 6

<h4>Background</h4>Hereditary sensory and autonomic neuropathy type III features marked ataxic gait that progressively worsens over time. We assessed whether proprioceptive disturbances can explain the ataxia.<h4>Methods</h4>Proprioception at the knee joint was assessed using passive joint angle matching in 18 patients and 14 age-matched controls; 5 patients with cerebellar ataxia were also studied. Ataxia was quantified using the Brief Ataxia Rating Score, which ranged from 7 to 26 of 30.<h4>Re ...[more]

PMID: 23681701

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Project description:BACKGROUND:As lumbar spinal stenosis commonly occurs between the L2 and L5 segments, hip abductors are easily affected. However, studies regarding the gait pattern in these patients from the coronal plane have not yet been conducted. PURPOSE:To determine the effects of lumbar spinal stenosis on the gait pattern (stride width and femorotibial angle) and hip abductor surface electromyography in varied stride widths compared with healthy individuals. STUDY DESIGN:Prospective case-control study. METHODS:Seventeen patients and 20 healthy individuals were enrolled. Each participant completed three gait assessments in their normal gait, adducted gait and abducted gait. The femorotibial angle and surface electromyography signals were measured. Pain scores was used to quantify the degree of discomfort in the gluteal area and medial side of the knee. RESULTS:When the hip abductors' surface electromyography signals were normalized by quadriceps femoris, patients group showed significantly higher activation ratios throughout all gait patterns. Generally, surface electromyography signals and ratios were significantly higher during abducted gait compared with a normal gait. Femorotibial angle became significantly closer to the varus in healthy individuals during abducted gait. When femorotibial angle during normal gait was compared between the two groups, patients group exhibited slightly wider stride width and FTA significantly closer to the varus. Pain scores were significantly higher in the patient group and during abducted gait. CONCLUSION:Wider stride widths indicated increased relative activation of the hip abductors, closer proximity between femorotibial angle and varus, and increased pain scores for discomfort. The same tendency was observed in patients group when compared with healthy individuals. Widening of stride width in patients group despite abductor weakness suggests that additional muscle recruitment may be needed to maintain balance. Furthermore, such a distinctive gait pattern exerts increased loading on the medial knee, relating to the escalated risk of degenerative knee osteoarthritis.

Project description:BackgroundTo investigate (1) the association of specific biomechanical factors with knee osteoarthritis and knee osteoarthritis development, and (2) the impact of other relevant risk factors on this association.MethodsMEDLINE, EMBASE, CINAHL and SPORTDiscus were searched up until April 2017. Studies were included if they fulfilled the following criteria: the study 1) assessed the association of a biomechanical factor with knee osteoarthritis, or knee osteoarthritis development; 2) reported on skeletal malalignment, muscular dysfunction, impaired proprioception, laxity and abnormal loading during gait; 3) was a cohort study with participants developing knee osteoarthritis and participants not developing knee osteoarthritis, or a case-control or cross-sectional study with participants with knee osteoarthritis and without knee osteoarthritis. Risk of bias was assessed with the QUIPS tool and meta-analyses were performed using random effects models.ResultsOf 6413 unique studies identified, 59 cross-sectional studies were eligible for meta-analyses (9825 participants, 5328 with knee osteoarthritis). No cohort studies fulfilled the inclusion criteria. Compared with healthy controls, patients with knee osteoarthritis have higher odds of having lower muscle strength, proprioception deficits, more medial varus-valgus laxity and less lateral varus-valgus laxity. Patients with medial knee osteoarthritis have higher odds of having a higher knee adduction moment than healthy controls. Level of evidence was graded as 'very low' to 'moderate' quality. Due to large between study differences moderation of other risk factors on biomechanical risk factors could not be evaluated.ConclusionsPatients with knee osteoarthritis are more likely to display a number of biomechanical characteristics. The causal relationship between specific biomechanical factors and the development of knee osteoarthritis could not be determined as no longitudinal studies were included. There is an urgent need for high quality, longitudinal studies to evaluate the impact of specific biomechanical factors on the development of knee osteoarthritis.Trial registration(PROSPERO ID: CRD42015025092 ).

Dataset Information

Relationship between proprioception at the knee joint and gait ataxia in HSAN III.

Publications

Relationship between proprioception at the knee joint and gait ataxia in HSAN III.

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