72 Chapter 5 combined with clinical inheritance pattern and/or proven molecular defect. In the presence of disabling gait impairments, 3D-instrumented gait analysis is performed in our movement laboratory. For the current study, an historic cohort of patients was included, based on the following inclusion criteria: (i) established diagnosis of HSP, (ii) the availability of a gait analysis performed between October 2013 and May 2021, and (iii) the availability of documented balance scores (Berg Balance Scale (BBS) and/or Mini Balance Evaluation System Test (Mini-BESTest)). As some participants performed multiple gait analyses during the selected time period, the first gait analysis with a documented balance score was included for analysis. If both Berg Balance Scale and Mini-BESTest scores were available, both scores were included for analysis. Exclusion criteria consisted of concomitant neurological or orthopedic conditions, inability to walk eight meters barefoot without walking aids, and age below 18 years. Prior to the gait analysis, 16 retroreflective markers were placed on the lower extremities according to the standard Plug-In Gait marker model for lower body. Patients then walked barefoot over an eight-meter walkway at a self-selected speed. The gait pattern was recorded with an eight-camera motion analysis system (VICON, Oxford UK) and two video cameras, one capturing the frontal plane and the second the sagittal plane. Two researchers (LV, JN) reviewed videos from the gait analyses in both the frontal (i.e., trunk lateroflexion) and sagittal plane (i.e. trunk flexion and extension) and classified the observed trunk movement as i) normal, ii) moderately increased, or iii) markedly increased. In addition, patients who walked without plantigrade (heel touching the floor) contact during the stance phase were classified as ‘toe-walkers’. Cohen’s kappa coefficients were calculated to determine the inter-rater reliability between the two raters for the classification of trunk movements during gait. Any initial disagreements between the raters were discussed and resolved in consensus. Spatiotemporal gait parameters (walking velocity, cadence, step length, step width) were calculated based on marker data in Vicon Polygon. Data were checked for normality. Independent samples t-tests or Mann-Whitney U tests were used where appropriate to assess differences between groups on balance scores and spatiotemporal parameters. Comparisons were made between persons with normal vs. moderately increased trunk movements, between persons with moderately vs. markedly increased trunk movements, and between persons with normal vs. markedly increased trunk movements. Differences in the percentage of toe-walkers between the three categories was assessed using Chi-Square Tests.
RkJQdWJsaXNoZXIy MjY0ODMw