112 Chapter 7 2 by STROLLL Limited) is of particular interest. Visual projections of objects (i.e., holograms) are projected into the real world such that the perception is comparable to real objects. Different games have already been created, such as a boxing exercise where people have to walk around and punch holograms (e.g., a microwave, vase, or pillar). 34,35 Whether such home-based interventions are feasible for people with HSP has yet to be evaluated. Furthermore, the need for supervision, the appropriate dose intensity, and the likelihood of retention of training effects should all be investigated, in addition to the continuous need to ensure safety as the disease progresses. Any gait adaptability training can be complemented with exercises or other interventions that are aligned with specific gait problems that people with HSP may experience. For example, people with HSP often have a narrow-based gait due to spasticity of the hip adductor muscles. Such hip adductor spasticity may hinder gait adaptability and increase fall risk, as it limits the capacity to make lateral side steps upon expected or unexpected gait perturbations. People may even stumble over their own feet due to hooking of the feet. In these instances, it is important to include exercises that focus on maintaining or increasing the existing step width. For those people with severe hip adductor spasticity, this can be extremely difficult, which can be a reason to combine gait training with intramuscular botulinum toxin injections in the hip adductors. In this way, gait adaptability training is facilitated and the chance that the narrow-based gait becomes habitual is attenuated. In addition to regular gait, several other tasks are essential for community ambulation. These include turning, initiating gait, or maintaining balance while having to stand still (e.g., waiting for a traffic light to turn green or standing in line at the supermarket). It is known that people with HSP experience great difficulties while standing still. A common method to train static balance control is to progress the execution of balance tasks from a solid surface with eyes opened to standing on a foam surface with eyes closed (i.e., creating situations of limited sensory input). For people with HSP, however, proprioception is often impaired due to degeneration of the dorsal columns, which is not amendable by training with limited sensory information. Hence, it is probably more beneficial to train static balance control with eyes opened while standing on a variety of firm (e.g., inclines) and uneven (e.g., cobblestones or sand) surfaces so that adequate and safe compensation strategies (e.g., taking a step or using the trunk) can be trained. Irrespective of the training methods, it is important to set realistic goals. 36 To this end, it is essential to keep in mind that HSP is a progressive condition. As a result, people with HSP continuously need to adapt to a decline in physical functioning, activities, and participation, while the rate of progression and the endpoint are
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