Patient Reported Falls and Balance Confidence in Individuals with Charcot-Marie-Tooth Disease

Home-based multi-sensory and proximal strengthening program to improve balance in Charcot-Marie-Tooth disease Type 1A: A proof of concept study

INTRODUCTION/AIMS

People with Charcot-Marie-Tooth Disease (CMT) frequently report problems with balance, which lead to an increased risk of falls. Evidence is emerging of training interventions to improve balance for people with CMT, but to date all have relied on clinic-based treatment and equipment. This proof-of-concept study explored whether a multi-modal program of proprioceptive rehabilitation and strength training can be delivered at home, to improve balance performance in people with CMT Type 1A.

METHODS

Fourteen participants with CMT Type 1A were recruited into this randomized, two-arm study. Baseline assessments included measures of disease severity, posturography, physical function, and patient-reported outcome measurements. All participants received one falls education session. Participants were randomized to either 12 weeks of balance training or 12 weeks of usual activities. The intervention comprised a home-based, multi-sensory balance training and proximal strengthening program, supported by three home visits from a physiotherapist.

RESULTS

Thirteen participants completed the study. The intervention was successfully implemented and well tolerated, with high participation levels. Functional measures of balance and walking showed strong effect sizes in favor of the training group. Posturography testing demonstrated moderate improvements in postural stability favoring the intervention group. Inconsistent changes were seen in lower limb strength measures.

DISCUSSION

The intervention was feasible to implement and safe, with some evidence of improvement in balance performance. This supports future studies to expand this intervention to larger trials of pragmatic, home-delivered programs through current community rehabilitation services and supported self-management pathways.

Effects of orthopedic footwear on postural stability and walking in individuals with Hereditary Motor Sensory Neuropathy

BACKGROUND

Orthopedic footwear is often prescribed to improve postural stability during standing and walking in individuals with Hereditary Motor Sensory Neuropathy. However, supporting evidence in literature is scarce. The aim of this study was to investigate the effect of orthopedic footwear on quiet standing balance, gait speed, spatiotemporal parameters, kinematics, kinetics and dynamic balance in individuals with Hereditary Motor Sensory Neuropathy.

METHODS

Fifteen individuals with Hereditary Motor Sensory Neuropathy performed a quiet standing task and 2-min walk test on customized orthopedic footwear and standardized footwear. Primary outcome measures were the mean velocity of the center of pressure during quiet standing and gait speed during walking. Secondary outcome measures included center of pressure amplitude and frequency during quiet standing, and spatiotemporal parameters, kinematics, kinetics, and dynamic balance during walking. Two-way repeated measures ANOVA and paired t-tests were performed to identify differences between footwear conditions.

FINDINGS

Neither quiet standing balance nor dynamic balance differed between orthopedic and standardized footwear, but orthopedic footwear improved spatiotemporal parameters (higher gait speed, longer step length, shorter step time and smaller step width) during walking. Moreover, less sagittal shank-footwear range of motion, more frontal shank-footwear range of motion, more dorsiflexion of the footwear-to-horizontal angle at initial contact and more hip adduction during the stance phase were found.

INTERPRETATION

Orthopedic footwear improved walking in individuals with Hereditary Motor Sensory Neuropathy, whereas it did not affect postural stability during quiet standing or dynamic balance. Especially gait speed and spatiotemporal parameters improved. An improved heel landing at initial contact for all footwear and reduced foot drop during swing for mid and high orthopedic footwear contributed to the gait improvements wearing orthopedic footwear.

Balance impairment in pediatric charcot-marie-tooth disease

INTRODUCTION

Balance impairment contributes to gait dysfunction, falls, and reduced quality of life in adults with Charcot-Marie-Tooth disease (CMT) but has been minimally examined in pediatric CMT.

METHODS

The CMT Pediatric Scale (CMTPedS) was administered to 520 children with CMT. Associations between balance function (Bruininks-Oseretsky Test of Motor Proficiency [BOT-2]) and sensorimotor and gait impairments were investigated.

RESULTS

Daily trips/falls were reported by 42.3% of participants. Balance (BOT-2) varied by CMT subtype, was impaired in 42% of 4-year-olds, and declined with age (P < 0.001). Vibration (P < 0.001), pinprick (P < 0.004), ankle dorsiflexion strength (P < 0.001), and foot alignment (P < 0.004) were associated with BOT-2 balance (adjusted R2 = 0.28). The visual dependence of balance increased with age.

DISCUSSION

Balance impairment occurs from a young age in children with CMT. Balance intervention studies are required in pediatric CMT and should consider the degree of sensorimotor impairment, foot malalignment, and visual dependence. Muscle Nerve, 2019.

Falls in paediatric Charcot-Marie-Tooth disease: a 6-month prospective cohort study

OBJECTIVE

To prospectively study falls in children and adolescents with Charcot-Marie-Tooth disease (CMT).

DESIGN

Prospective cohort study.

SETTING

Neuromuscular outpatient clinic of a tertiary paediatric hospital.

PATIENTS

Sixty children and adolescents ('children') aged 4-18 years, 30 with CMT and 30 typically developing (TD).

MAIN OUTCOME MEASURES

Falls rate over 6 months and falls characteristics questionnaire.

RESULTS

Twenty-two children with CMT reported falling at least once in 6 months compared with eight TD children (CMT 2819 (0-1915), TD 31 (0-6) total falls (range)). Detailed falls characteristics were collected from 242 individual falls (CMT 216, TD 26). Injurious falls were reported by 19 children with CMT (74 falls) compared with 2 TD children (3 falls), with cuts, grazes and bruising most common. No fractures were sustained and no child required hospitalisation. However, 12 injuries from falls in children with CMT required management by a healthcare provider, versus none in TD children. Tripping was the most common mechanism of falls in both groups. Age was the strongest predictor of falls (ρ=-0.53, p=0.006) with all children (CMT and TD) aged <7 years falling. Balance was the strongest impairment-related predictor of falls (ρ=-0.47, p=0.02). The conservative estimate of risk of falls in children and adolescents with CMT was 33 times higher than their TD peers (incidence rate ratio=32.8, 95% CI 10.2 to 106.0).

CONCLUSIONS

Children and adolescents with CMT fall more often than TD peers and sustain more injuries when they fall.