Are clinical tests and biomechanical measures of gait stability able to differentiate fallers from non-fallers in hereditary spastic paraplegia?

Introduction

Balance and gait impairments are common in people with hereditary spastic paraplegia (HSP) and often result in falls. Measures that identify patients at risk of falling are clinically relevant, but relatively unexplored in HSP. Here, we evaluated the potential of different balance and gait constructs to (1) identify differences between healthy controls and people with HSP and (2) discriminate between fallers and non-fallers with HSP.

Methods

We included 33 people with pure-HSP and 15 healthy controls. We assessed balance confidence (six-item Activities-specific Balance Confidence scale), clinical balance capacity (Mini-Balance Evaluation Systems Test) and gait capacity (ten-meter Walk Test). Biomechanical measures included spatiotemporal gait variability, mediolateral Margin of Stability (MoS), Foot Placement Deviation (FPD), and Local Divergence Exponents (LDEs) of trunk and pelvis, derived from treadmill-walking at comfortable and fixed gait speeds. People with HSP logged their falls during a fifteen-week period and were categorized as ‘faller’ (≥1 fall) or ‘non-faller’.

Results

People with HSP had significantly lower balance confidence, balance capacity, and gait capacity compared to age-matched controls. People with HSP also showed reduced gait stability, reflected by increased spatiotemporal gait variability, FPD, and LDEs of trunk and pelvis. Overall, 44 % of people with HSP were categorized as ‘faller’. Balance confidence (AUC:0.84) and balance capacity (AUC:0.75) discriminated fallers from non-fallers, whereas none of the biomechanical measures significantly differed.

Conclusion

Balance confidence, clinical balance and gait capacity, and biomechanical measures are affected in HSP, but clinical measures showed potential to differentiate fallers from non-fallers in people with HSP.