PL-LBA-2165

S. Browning¹, S. Holland¹, I. Wellwood¹, B. Bilney¹

¹Australian Catholic University, School of Allied Health, Faculty of Health Sciences, Ballarat, Victoria, Australia

Background: Huntington’s Disease (HD) is an inherited neurodegenerative disorder of the central nervous system, characterised by decline in motor functioning and cognitive, behavioural and metabolic impairments. Involuntary choreatic movements, bradykinesia and rigidity, postural instability and cognitive changes may contribute to people with HD’s changes to footstep patterns. HD has a long premanifest period (average age of onset 40 years).
A reliable means of assessment is needed to aid health professionals in the identification of motor decline and changes in people with premanifest (Pre-HD) and manifest HD. Spatiotemporal gait analysis has demonstrated high reliability in recognising symptom onset in people carrying the HD mutation, and footstep parameter changes may also be reliable biomarkers of HD progression. Although spatiotemporal footstep changes in people with premanifest and manifest HD have been documented, generalising findings is difficult, due to limitations in the literature.

Purpose: This study aimed to systematically review and critically evaluate literature on spatiotemporal gait deviations in adults with premanifest and manifest Huntington’s Disease (HD) and determine whether these changes could be used to identify symptom onset or disease progression.

Methods: A systematic review was conducted, guided by the Joanna Briggs Institute’s (JBI) Manual for Evidence Synthesis. The protocol was pre-registered. Key electronic databases were searched to March 2022: CINAHL, Medline, PubMed, Cochrane, Web of Science, Embase, Scopus and PEDro. Using Covidence software, studies comparing spatiotemporal footstep parameters in adults with premanifest and manifest HD to healthy controls were selected and critically appraised by independent reviewers. Included studies were critically appraised using the JBI’s Checklist for Analytical Cross-Sectional Studies. Data on spatiotemporal gait changes and variability were extracted and synthesised. Meta-analysis was performed using a random effects model to analyse gait speed, cadence, stride length and stride length variability measures.

Results: 25 studies with a total of 1,088 participants were included. Strong evidence was found supporting the presence of spatiotemporal gait deviations in participants with HD compared to healthy controls, commencing in the premanifest stage. Meta-analysis found individuals with premanifest HD walk significantly slower (-0.17m/s; 95% confidence interval (CI) [-0.22,-0.13]), with reduced cadence (-6.63 steps/min; 95%CI [-10.62, -2.65]) and stride length (-0.09m; 95%CI [-0.13, -0.05]). Stride length variability was also found to be increased in premanifest cohorts by 2.18% (95% CI [0.69, 3.68]), with these changes exacerbated in participants with manifest disease.

Conclusions: Quantitative synthesis of studies included in this carefully conducted systematic review identifies the presence of significant spatiotemporal footstep deviations and variability in people with HD, compared to healthy cohorts. Findings also outline the key spatiotemporal gait changes that present in the premanifest stage of HD; including reduced gait speed, cadence and stride length and increased spatiotemporal variability, and their relevance as sensitive biomarkers of motor decline in individuals with HD. Further research into how spatiotemporal gait analysis can inform the classification and monitoring of HD or potential therapeutic interventions is recommended.

Implications: Clinicians should monitor individuals in the premanifest stage of disease for gait changes to identify the onset of Huntington’s symptoms earlier than other biomarkers currently in use.

Funding acknowledgements: This unfunded study was supported by Australian Catholic University's Bachelor of Physiotherapy Hons programme. Authors declare no conflicts of interest.

Keywords:
Huntington’s Disease
Gait analysis
Spatiotemporal parameters

Topics:
Neurology
Disability & rehabilitation

Did this work require ethics approval? No

Reason: This is a systematic review using publicly available data. As such, Ethical review and approval is not routinely required by Australian Catholic University's HREC.