Multimodal compensation of postural control in demyelinating neuropathies:better visual integration in CMT1A than in CIDP

Introduction: Demyelinating neuropathies, such as Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and Charcot-Marie-Tooth type 1A (CMT1A), significantly impair postural control. While both conditions affect sensory integration, differences in compensatory mechanisms remain poorly understood. This study aims to explore how visual, proprioceptive, and cognitive perturbations influence postural stability in CIDP and CMT1A patients. Methods: A single-center, prospective study was conducted with 25 CIDP and 24 CMT1A patients. Posturographic recordings were used to assess postural stability under standard conditions and during visual tracking, proprioceptive perturbation (Achilles tendon vibration), and cognitive dual-tasking (backward counting). Center of Pressure (CoP) parameters, including area, velocity, and body sway, were analyzed to evaluate postural control. Results: CMT1A patients demonstrated improved postural stability during visual tracking tasks, suggesting better visual integration and long-term compensatory adaptations. In contrast, CIDP patients showed greater postural instability and reliance on static visual cues. Both groups experienced increased postural sway during proprioceptive and cognitive perturbations, with no significant differences between them in dual-tasking performance. Conclusion: The study highlights distinct postural control mechanisms in CIDP and CMT1A patients. CMT1A patients exhibit better adaptation to visual disturbances while CIDP patients struggle with visual integration and rely more on static visual cues. This difference reflects the progressive nature of CMT1A, which may facilitate better development of compensatory strategies over time. These findings underscore the need for personalized rehabilitation approaches, focusing on visual integration for CIDP patients and reinforcing compensatory mechanisms in CMT1A patients to enhance balance and reduce fall risk.