September 2019

Postural instability in Charcot-Marie-Tooth 1A disease

A study entitled “Postural instability in Charcot-Marie-Tooth 1A disease” published in the July 2016 issue of Gait & Posture set out to evaluate the influence of somatosensory impairment, distal muscle weakness, and foot deformities on the balance in 21 Charcot-Marie-Tooth 1A patients. The study used a baropodometric platform as a means of evaluation.

In the study, stabilometric analysis was performed via the measurement of sway area and velocity of a centre of pressure (CoP). This measurement was performed on the subjects both at eyes open and eyes closed. This was done to assess postural imbalance. Static analysis was also measured. In this case, the load and plantar surface of the forefoot, midfoot, and hindfoot were measured to define the footprint shape and assess whole foot deformities.

Once data was culled, stabilometric and static results between a control group and the CMT1A subject group.  In the CMT1A group, stabilometric findings were correlated with static parameters, Achilles’ tendon retraction, distal muscle strength, and CMT examination score (CMTES). The comparison between the subject group and the control group found that the CMT1A patients had lower plantar surface and load on midfoot, and higher load on a forefoot. Further, CMT1A patients had a higher C0P velocity with both open and closed eyes, leading to the conclusion that CMT1A patients had greater postural instability compared to the control group. In addition, there was an inverse correlation between the CoP velocity and the strength of ankle dorsi-flexion muscles. Conversely, there was a direct correlation with CMTES as whole and with the item “motor symptoms legs.” Static analysis and Achilles’ tendon retraction showed that postural imbalance was not correlated with sensory impairment and foot deformities.

The researchers concluded that the study proved that there was a demonstrated altered balance in CMT1A patients during upright standing. It was also found that the imbalance in CMT patients was related to the weakness of ankle dorsi-flexor muscles, and not due to sensory impairment or foot deformities. The study concluded that the results could be due to mildly affected CMT1A population, evaluated in an early stage of the disease.

 

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