Invited Review: Approach to Gait Disorders and Orthotic Management in Adult Onset Neuromuscular Diseases-Article

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This review article by Chiou-Tan and Bloodworth examines gait disorders and the use of orthotics in adult-onset neuromuscular diseases. It begins by describing normal gait, where concentric muscle contractions accelerate and eccentric contractions decelerate limb movements. Neuromuscular gait disorders are categorized by the location and type of muscle weakness or sensory disturbance. The paper outlines various orthotic interventions tailored to different types of gait disturbances, emphasizing that not all gait disturbances benefit from orthotics, with some requiring gait aids like walkers for proximal hip weakness, and others requiring specific orthotic devices for distal muscle weaknesses.<br /><br />The review details methods for orthopedic assessment and classification of gait disturbances based on muscle groups affected—proximal, distal, generalized, asymmetric, and sensory. Proximal muscle weakness often presents with hip instability and requires assistive devices rather than orthotics, while distal muscle weakness typically involves the lower leg muscles, benefiting from devices like ankle-foot orthoses (AFOs). Additionally, the study covers abnormal gait patterns resulting from non-length-dependent generalized muscle weakness and asymmetric weaknesses, providing clinical insights into the functional impacts of these conditions on walking.<br /><br />Orthotic management strategies, including the use of different types of AFOs and knee-ankle-foot orthoses (KAFOs), are elaborated upon. The paper discusses the materials and construction of these devices and their role in stabilizing gait, enhancing mobility, and preventing complications like falls and contractures. The authors highlight newer materials like carbon fiber that offer lighter and more functional orthotic solutions. <br /><br />The article also reviews specific neuromuscular conditions such as amyotrophic lateral sclerosis (ALS), post-polio syndrome, polyneuropathies, myasthenia gravis, and various myopathies. Each condition’s unique impact on gait and the subsequent orthotic management options are analyzed, with insights into practical application and limitations of these devices. The review underscores the importance of a multidisciplinary approach in managing gait disturbances and the need for lifelong follow-up to adapt orthotic treatments as conditions evolve. It also acknowledges gaps in current literature and calls for further detailed studies on gait disturbances and orthotic interventions in neuromuscular diseases.

Keywords

gait disorders

orthotics

neuromuscular diseases

muscle weakness

orthotic interventions

ankle-foot orthoses

knee-ankle-foot orthoses

amyotrophic lateral sclerosis

ALS

myopathies

multidisciplinary approach

amyotrophic lateral sclerosis

ALS