AUTHOR=Faccioli Silvia , Cavalagli Angela , Falocci Nicola , Mangano Giulia , Sanfilippo Irene , Sassi Silvia 

TITLE=Gait analysis patterns and rehabilitative interventions to improve gait in persons with hereditary spastic paraplegia: a systematic review and meta-analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1256392

DOI=10.3389/fneur.2023.1256392

ISSN=1664-2295

ABSTRACT=Background: Hereditary Spastic Paraplegia (HSP) are a group of inheritance diseases resulting in gait abnormalities, which may be detected by means of instrumented gait analysis. The aim of this systematic review is twofold: to identify specific gait analysis patterns and interventions improving gait in HSP subjects.
Methodsː A systematic review was conducted in PubMed, Cochrane Library, Rehabdata, PEDro databases, in accordance with reporting guidelines of PRISMA statement and Cochrane’s recommendation. The review protocol was recorded on PROSPERO register. Patients with pure and complicated HSP of any age were included. All types of studies were included. Risk of bias, quality assessment, and a meta-analysis were performed. 
Resultsː Forty-two studies were included: 19 related to gait analysis patterns and 24 were intervention studies. The latter ones were limited to adults. HSP gait patterns were similar to cerebral palsy in younger subjects and stroke in adults. Knee hyperextension, reduced range of motion at knee, ankle and hip, reduced foot lift, increased rapid trunk and arms movements were reported. Botulinum injections reduced spasticity but uncovered weakness, improved gait velocity at follow up. Weak evidence supported intrathecal baclofen, active intensive physical therapy (i.e., robot-assisted gait training, functional exercises, hydrotherapy) and functional electrical stimulation. Some improvements but adverse events were reported after transcranial magnetic stimulation, transcutaneous spinal direct current stimulation and spinal cord stimulation implant. 
Conclusions: Knee hyperextension, non-sagittal pelvic movements and reduced ROM at knee, ankle and hip, represent the most peculiar patterns in HSP, compared to diplegic cerebral palsy and stroke. Botulinum improved comfortable gait velocity after two months. Nonetheless, interventions reducing spasticity might result ineffective on functional outcomes unveiling weakness. Intensive active physical therapy and FES might improve gait velocity in the very short term.