Full body gait analysis may improve diagnostic discrimination between hereditary spastic paraplegia and spastic diplegia: a preliminary study.
Arm and trunk motion during gait give quick, visible cues that help separate hereditary spastic paraplegia from spastic diplegia.
01Research in Context
What this study did
Doctors filmed people walking and tracked how their arms and trunk moved.
They compared two rare groups: hereditary spastic paraplegia (HSP) and spastic diplegia (SD).
The goal was to see if upper-body motion could help tell the two conditions apart.
What they found
Each group showed its own arm-swing and trunk-lean pattern.
These patterns were clear enough that a clinician might use them for a faster, cheaper diagnosis.
How this fits with other research
Laugeson et al. (2014) saw the same idea work inside cerebral palsy alone: hemiplegic and diplegic kids move their arms differently when they walk.
Heyrman et al. (2014) looked at the trunk instead of the arms and found that wobbly torso motion in diplegia comes from weak trunk control, not just leg problems. Together these studies say: watch the whole body, not just the legs.
O'Sullivan et al. (2018) remind us that diplegic gait can worsen over time; catching the right diagnosis early matters if we want to slow crouch gait progression.
Why it matters
If you assess gait with only lower-limb angles, you can miss clues written in the arms and trunk. Adding a quick upper-body check—shoulder swing size, trunk lean, arm symmetry—may speed up differential diagnosis between HSP and SD without extra labs or cost. Next time you video a client for gait, keep the camera high enough to catch the arms; note which side moves more and how much the trunk sways. These cheap data points can guide referrals and save months of trial-and-error treatment.
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Join Free →When you next film gait, frame the camera to include the shoulders and elbows; score arm symmetry and trunk lean as extra data points.
02At a glance
03Original abstract
Hereditary spastic paraplegia (HSP) and spastic diplegia (SD) patients share a strong clinical resemblance. Thus, HSP patients are frequently misdiagnosed with a mild form of SD. Clinical gait analysis (CGA) has been highlighted as a possible tool to support the differential diagnosis of HSP and SD. Previous analysis has focused on the lower-body but not the upper-body, where numerous compensations during walking occur. The aim of this study was to compare the full-body movements of HSP and SD groups and, in particular, the movement of the upper limbs. Ten HSP and 12 SD patients were evaluated through a CGA (VICON 460 and Mx3+; ViconPeak(®), Oxford, UK) between 2008 and 2012. The kinematic parameters were computed using the ViconPeak(®) software (Plug-In-Gait). In addition, the mean amplitude of normalised (by the patient's height) arm swing was calculated. All patients were asked to walk at a self-selected speed along a 10-m walkway. The mean kinematic parameters for the two populations were analysed with Mann-Whitney comparison tests, with a significant P-value set at 0.05. The results demonstrated that HSP patients used more spine movement to compensate for lower limb movement alterations, whereas SD patients used their arms for compensation. SD patients had increased shoulder movements in the sagittal plane (Flexion/extension angle) and frontal plane (elevation angle) compared to HSP patients. These arm postures are similar to the description of the guard position that toddlers exhibit during the first weeks of walking. To increase speed, SD patients have larger arm swings in the sagittal, frontal and transversal planes. Upper-body kinematics, and more specifically arm movements and spine movements, may support the differential diagnosis of HSP and SD.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2012.09.005