51 Results: gait-adaptability training in people with HSP Introduction Hereditary spastic paraplegia (HSP) is a heterogenous group of neurodegenerative disorders. It is caused by retrograde axonal degeneration of the corticospinal tract, posterior spinal columns, and spinocerebellar fibres.1, 2 Pure forms of HSP are clinically characterized by progressive bilateral spasticity, muscle weakness, and a reduced proprioception of the lower extremities.1, 2 These symptoms result in disabling gait and balance impairments, including difficulties adapting the walking pattern to meet environmental demands (e.g. stepping over an obstacle or speeding up walking to cross the street). This hinders safe and independent ambulation in the community.3, 4 Previous uncontrolled studies with pre-post assessments reported beneficial effects on balance and/or gait performance following task-specific gait training in people with HSP. The interventions consisted of 18 sessions of robotic Lokomat training (n=13),5 a combined intervention of botulinum toxin type-A injections followed by 10 sessions of physical therapy (n=18),6 25 sessions of robot-assisted exoskeleton and overground walking exercises (n=1),7 or a low-intensity 12-week physical therapy program (n=1).8 Although the results of these studies are promising, none of these studies included outcome measures aimed at evaluating gait adaptability, nor did the applied gait training interventions include context-specific tasks that specifically targeted gait adaptability. Context-specific gait-adaptability training can be provided on the C-Mill, a treadmill equipped with augmented reality. Via visual projections on the treadmill, participants can train several domains of gait adaptability (e.g., obstacle negotiation and precision stepping) in a safe environment. Previous studies have demonstrated feasibility and efficacy of gait-adaptability training on the C-Mill in chronic stroke patients,9-11 people with cerebellar degeneration,12 and persons with Parkinson’s disease.13 So far, the potential effectiveness of gait-adaptability training has not been studied in people with HSP. Therefore, we designed and conducted the Move-HSP trial14: a randomized clinical trial to compare the effect of gait-adaptability training added to usual care, with usual care alone. We hypothesized that the addition of gaitadaptability training would result in greater improvements of gait-adaptability performance as evaluated with the obstacle subtask of the Emory functional ambulation profile (E-FAP).15 In addition, clinical balance and gait measures, balance confidence, spatiotemporal gait parameters, and level of physical activities in daily life were evaluated, and hypothesized to improve more by the addition of gait-adaptability training. 4
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