Charcot-Marie-Tooth Disease: Poor Balance And Rehabilitation
Charcot-Marie-Tooth is an hereditary motor and sensory neuropathy. Although the poor balance presented by most patients is generally considered as the consequence of the involvement of the sensory fibers, with impaired proprioception, in our patients, the sense of position was impaired only at the toes and Romberg sign was positive in only 3% of the cases. Patients with poor balance in stance, were found to have one or more of the following problems: foot rotation in supination, equinus deformity, foot dorsiflexion in presence of weak triceps surae muscles, inversion of the action of the toe extensors, contracture of proximal muscles, pain under the sole. Whereas the disfunction of the sensory fibers, depending on the neuropathy itself, cannot be treated, the other causes of poor balance can be removed by orthotic devices, physiotherapy and surgery. Our protocol of rehabilitation aimed at the improvement of balance includes: 1) foot orthoses in soft polyurethane, with wedges to correct rotation and talus or equinus deformity; 2) proper shoes, with a large sole and a correct amount of heel, varying according to the stage of the diesease and the individual needs; 3) ankle-foot-orthoses, either traditional or incorporated in the boot; 4) stretching of the contractured proximal muscles; 5) postural kinesitherapy, aimed at reducing the need of controlling joints from 3 (hip, knee, ankle) to 1 (hip); 6) proprioceptive kinesitherapy, to improve coordination. After this treatment, patients' stance became more steady and harmonic; also gait presented fewer skiddings and sprains over a six month period dramatically decreased.
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Document Type: Abstract
Affiliations: Dept. of Rehabilitation of Charcot-Marie-Tooth Disease and other neuromuscular disorders, Specialized Rehabilitation Hospital “L.Spolverini,” Ariccia, Rome, Italy
Publication date: March 1, 2001