Date Published: October 10, 2018
Publisher: Public Library of Science
Author(s): Cyntia Rogean de Jesus Alves de Baptista, Adriana Nascimento-Elias, Tenysson Will Lemos, Beatriz Garcia, Paula Domingues Calori, Ana Claudia Mattiello-Sverzut, Andrea Martinuzzi.
Charcot Marie Tooth disease (CMT) has negative functional impact on postural control of children; however, it has not been widely studied. Stabilometry can provide insights about postural control and guide preventive interventions in immature perceptual and musculoskeletal systems as those seen in children with CMT. This cross-sectional study aimed to identify and interpret stabilometric variables that reflect the postural control of children with CMT. 53 subjects (age 6–17) were assigned to one of the two groups: CMT (15 males and 14 females with CMT) or Control (13 males and 11 females healthy). Quiet standing was tested in different conditions: with open and closed eyes on regular surface (open-regular, closed-regular) and foam surface (open-foam, closed-foam) using a force platform. The minimum of 2 and maximum of 3 trials of 30 seconds for each test condition provided the classical stabilometric variables and Romberg Quotient (RQv). CMT group showed increase of confidence ellipse area, mean velocity, mediolateral and anteroposterior velocities associated with decreased mean body oscillation frequency, as the complexity of tasks increased. CMT postural deficit was identified by greater and faster sway associated with these lower frequencies, when compared to Control.
Adequate static and dynamic balance depend on the normal mechanisms of postural control, biomechanical factors and neuromuscular factors, including the integration of visual sensory, vestibular and somatosensory information. From childhood to adulthood, postural control improves with internal and /or external destabilizing forces[3–9]. The critical period for the development of postural control seems to be between 7 and 11 years of age, although studies in the literature have described that an adult-like postural control is reached only after the age of 14 [10–12]
This cross-sectional study was composed of 53 children and adolescents from 6 to 17 years of age. Of the 53, 29 had hereditary sensory-motor neuropathy (HNSM), specifically Charcot Marie Tooth (CMT group) and 24 were healthy (Control group) (Table 1). Inclusion criteria for the CMT group were: a) medical diagnosis, b) independent standing c) independent gait. Inclusion criteria for the Control group was age and gender match with CMT. Exclusion criteria for the CMT group were: a) diagnosis under investigation and b) presence of comorbidities such as diabetes mellitus and hypothyroidism. Exclusion criteria for Control were: a) athletes b) presence of balance disorders, neurological or psychiatric pathology. Exclusion criteria for both groups were: a) previous orthopedic surgeries in the lower limbs, b) cognitive inability to understand and perform the tests and c) presence of respiratory diseases. Participants with vision impairment corrected by glasses were not excluded.
Table 1 shows Anthropometric data of participants and no statistical differences between groups.
The present study aimed to identify and interpret stabilometric variables that assess the static postural control of children and adolescents with CMT and shows ways of using CoP to maintain postural stability, in the presence of distal weakness and somatosensory impairments. Studies in the literature have shown that stabilometric assessment is capable of distinguishing poor and appropriate balance in children[9,49–52] and adults[23–25,53,54]. To the extent of our knowledge, this is the first original study focused on classical stabilometric parameters, in children and adolescents with CMT. Kaya et al explored only the percentage of oscillation of CoP in children with Duchenne muscular dystrophy and different polyneuropathic diseases, while others have studied balance impairment in adults with neuropathies[23–25].
The study shows that low postural control in children with hereditary sensory motor neuropathy can be identified by greater and faster sway, when compared to their controls. Children with CMT choose to reduce the frequency of body oscillation to deal with their standing position, especially when the sensory references are restricted.