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Hi All

I have a patient, female of 45.

She has Asperger's syndrome and has always been 'told' she walks unusually, but this have never been formally assessed until my first appt with her.

On exam, she has clearly weak Tib Ant muscle strength bilaterally.

My question is, whether anyone knows if this could be related to her clinical/neurologic history in view of the Aspergers?

Many thanks

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Yes. See some of the threads on autism, especially the one on Gait analysis to identify autism

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Craig Payne
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The second link that Craig popped in is a great resource.
The study: http://www.abc.net.au/catalyst/stories/2389736.htm
is an excellent visual example.

I don't think you can rule out Aspgers having an effect on the tib ant. If she toe walks in times of anxiety or excitement then that muscle won't be as strong due to the adopted gait pattern. She may also have an increased foot slap due to a decreased proprioceptive feedback which will change the way muscles fire.

Classic upper body posturing of increased primative reflexes, high guard or lack of arm swing is always present in children with autism. You don't just learn to hide these as an adult, it remains even if you are high functioning.

The trick is, can you change something local when it is controlled at the brain level? I'm not sure we have even scratched the surface with gait and autism yet.

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Cheers,
Cylie.... in a permanent state of confusion

Cylie

Thanks for the fascinating post. I've loved reading through Craig's previous link too.

she has all the clinical features you mentioned - in fact the foot slap has caused lifelong bilateral plantar fasciitis (unrelated to the human leucoyte antigen as found in recent serology I requested).

You hit it on the head when you say: "The trick is, can you change something local when it is controlled at the brain level? I'm not sure we have even scratched the surface with gait and autism yet."

I'm going to treat the local - lower limb - symptoms presenting with this lady, and will keep you posted as to how the cerebral control rides with it or over-rides it!

Isn't it a shame too that she's been asking about her walking issues for decades, but not really been helped by the 'system' until she sought a comprehensive, (private), biomechanical assessment?

Cheers
Pete

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Our clinics grow by feet daily

Glad to see your comments on this Cylie, thank you.

For my two bobs worth I agree with Cylie's comments above. I see it everyday with Aspergers kids, and their toe walking is very much more resistant to the types treatment we treat our non austistic spectrum disorder (ASD) kids with. Cylie is the one to comment more on this. The ASD toe walkers especially will toe walk in a state of heightened emotion as mentioned above, I've seen this lifelong in ASD patients. ASD toe walkers are typically persistant toe walkers for a lot lot longer (possible lifelong) than any other persistant toe walking group. I think it essential to retrain tib ant in the rehab of any toe walker to introduce proper patterning of tib ant activity in gait, even more so in ASD patients due to the long-term persistance.

My other comment is on sensory stimulation. It is a very strong feature of ASD to have some form of sensory processing difficulty and if this is never addressed then the patterning will persist. I suspect that it is primarily for sensory reasons that people on the autstic spectrum toe walk. Once adequate ankle dorsiflexion is acheived (stretching/serial casting), then clinically we see them come down after a series of joint compressions and/or tubi grip almost immediately. This effect only lasts a few hours though. Cylie, I'd love to hear yours and Brett's perspective on this?

Thirdly, plantar fasciitis would not be unusual in a gait that has weak tib ant, I see it too in young dancers who walk in a dainty, very slight toe-heel gait, as shock is not being attenuated by the mechanisms designed for it, namely heel strick and STJ pronation. By strengthening tib ant and re-training it's firing patterns to create a heel-toe gait pattern will help. Must address sensory feedback needs too (since they're proabably the underlying cause for the patterning anyway - try a sensory trained OT) and it should help enormously.

Good luck, nice to see you thinking outside the box

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