Afferent control of walking: are there distinct deficits associated to loss of fibres of different diameter?
OBJECTIVE
To compare the gait pattern in patients affected by different types of neuropathy.


METHODS
We recruited healthy subjects (HS, n=38), patients with Charcot-Marie-Tooth disease type 1A (CMT1A) (n=10) and patients with diabetic neuropathy (DNP) (n=12). Neuropathy impairment score and neuropathy score were assessed. Body sway during quiet stance, and spatio-temporal gait parameters were recorded.


RESULTS
Most patients had reduced or absent tendon-tap reflexes. Strength of foot dorsiflexor muscles (p<0.05) and conduction velocity (CV) of leg nerves (p<0.0001) were more impaired in CMT1A than DNP, whereas joint-position sense was more affected (p<0.05) in DNP. Body sway while standing was larger in DNP compared to CMT1A and HS (p<0.01 and p<0.0001 respectively). During gait, the distribution of foot sole contact pressure was abnormal in CMT1A (p<0.05) but not in DNP. Velocity and step length were decreased, and foot yaw angle at foot flat increased, in DNP with respect to CMT1A and HS (both variables, p<0.001). Gait velocity and step length were decreased (p<0.005) also in CMT1A, but to a smaller extent than in DNP, so that the difference between patient groups was significant (p<0.0005). Duration of the double support was protracted in DNP compared to CMT1A and HS (p<0.0005). For DNP only, velocity of gait and duration of single support were correlated (p<0.05) both to sway path and lower limb muscle strength.


CONCLUSIONS
Changes in both body sway and stance phase of gait were larger in DNP than CMT1A, indicating more impaired static and dynamic control of balance when neuropathy affects the small in addition to the large afferent fibres. Diminished somatosensory input from the smaller fibres rather than muscle weakness or foot deformity plays a critical role in the modulation of the support phase of gait.


CONCLUSIONS
The analysis of balance and gait in patients with neuropathy can offer a tool for understanding the nature and functional impact of the neuropathy and should be included in their functional evaluation.
Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy; Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy. Electronic address: antonio.nardone@fsm.it.
Antonio
A
Nardone
Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy.
Stefano
S
Corna
Posture and Movement Laboratory, Division of Physical Medicine and Rehabilitation, Scientific Institute of Veruno (NO), Fondazione Salvatore Maugeri (IRCCS), Veruno (NO), Italy.
Anna Maria
AM
Turcato
Centro Studi Attività Motorie, Fondazione Salvatore Maugeri (IRCCS), Scientific Institute of Pavia, Italy; Department of Public Health, Experimental Medicine and Forensic Medicine, University of Pavia, Italy.
Marco
M
Schieppati
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002607:Charcot-Marie-Tooth Disease / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000503:physiopathology; D005684:Gait / Q000502:physiology*; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D009475:Neurons, Afferent / Q000502:physiology*; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D011187:Posture / Q000502:physiology*; D011434:Proprioception / Q000502:physiology; D012018:Reflex / Q000502:physiology; D016138:Walking / Q000502:physiology*
Balance; Charcot–Marie–Tooth type 1A disease; Diabetic polyneuropathy; Locomotion; Posture