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Title: Compensatory strategies while walking in Charcot-Marie-Tooth disease : impact and intervention
Author: Ramdharry, Gita Mary
ISNI:       0000 0004 2719 7309
Awarding Body: University of London
Current Institution: University College London (University of London)
Date of Award: 2008
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Charcot-Marie-Tooth disease (CMT) is a peripheral neuropathy presenting with distal weakness and sensory loss. This thesis examines the role that proximal activity plays in compensating for distal weakness to maintain functional walking. Comparative 3D gait analysis showed reduced range of ankle motion kinetics in people with CMT. Additionally, swing phase hip flexion increased, moments and power around the knee altered during preswing and trunk motion increased. These changes were related to the degree of distal weakness. Proximal adaptations were also observed in healthy control subjects following isolated bilateral fatigue of the plantarflexors but did not resemble those of people with CMT. The role the hip flexors play in compensating for plantarflexor weakness to maintain walking was examined in two studies. When walking on a treadmill people with CMT took an average of 48 minutes to reach level 17 on the Borg perceived exertion scale whereas matched control subjects reached level 8 while walking at the same speed and cadence. After prolonged walking the maximum voluntary contraction of the hip flexors reduced by 20% in the CMT group. Additionally, hip flexor velocity reduced during swing phase and trunk motion increased. A separate study specifically fatigued the hip flexors by 20% resulting in similar kinematic changes to the first study, plus a reduction in walking time to reach Borg level 17 in people with CMT. The effect of ankle foot orthoses (AFO) was investigated in people with CMT. A variation in the stiffness of the three splints was observed when worn with footwear. During walking all AFOs reduced footdrop during swing phase but did not reduce hip flexion. One of the more rigid devices also reduced the total ankle power generation during preswing. These studies suggest that proximal compensations are present, they maintain functional walking and may be influenced by orthotics intervention.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Allied health professions and studies