Vježbe za nasljednu spastičnu paraplegiju (HSP) — istezanje + ravnoteža + aerobik (Bonardi 2024) smanjuje spasticitet

Bonardi 2024 + Margetis 2022 + Schüle 2016 SPG classification framework. Hereditary spastic paraplegia is a family of >80 genetic subtypes (SPG1-SPG80+) characterised by progressive spastic paraparesis of the lower limbs. SPG4 (spastin mutation) is the most common autosomal-dominant form, ~40% of pure HSP cases. The distinction matters: PURE HSP = isolated spastic paraparesis with mild sensory + bladder symptoms; COMPLICATED HSP = additional cerebellar ataxia, peripheral neuropathy, dementia, retinal degeneration, or deafness depending on subtype. Pharmacological scaffold: oral baclofen (start 5 mg TID, titrate), tizanidine, intrathecal baclofen pump for severe spasticity, botulinum toxin for focal spasticity hotspots, dantrolene rarely. The exercise framework — Bonardi 2024 + Schniepp 2016 RCTs — establishes that stretching + range-of-motion + aerobic training + balance work REDUCES spasticity + improves gait parameters + reduces falls. This overturns the historic 'avoid strenuous activity' advice that left HSP patients deconditioned. Practical priorities: daily stretching (hamstrings + hip flexors + calves — the chronic-spasticity hotspots), graduated aerobic (recumbent bike, water-walking, treadmill with handrail), balance training in safe environment, sit-to-stand functional work. AVOID overheating + dehydration (both trigger spasticity flares).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain + glute activation (spasticity-related glute inhibition), supine-knee-to-chest for low-back + hip stretch, supine-piriformis-stretch for chronic hip rotator spasticity, cat-cow for spinal mobility, diaphragmatic-breathing for parasympathetic regulation (calming the spinal stretch reflex), supine-hip-abduction for adductor spasticity counter-balance, single-leg-stance for balance progression, sit-to-stand for functional + bone-loading, ankle-pump for circulation + distal-spasticity counter-activation. The AI coach also knows the nutrition side — Mediterranean backbone, calcium 1000-1200 + vit D + weight-bearing within mobility limits for BMD (reduced weight-bearing → reduced BMD), protein 1.2-1.4 g/kg for muscle preservation, omega-3 1-3 g/day, B12 + folate + B6 NOT mega-doses (complicated subtypes may have peripheral neuropathy), baclofen + tizanidine sedation AVOID combining with alcohol/sedatives, intrathecal baclofen pump infection prevention + wound healing nutrition if revision, hydration ≥2.5 L/day (dehydration triggers spasticity), constipation common from immobility + medication so soluble fibre + adequate hydration + Mediterranean produce, complicated HSP with retinal/cognitive features lutein + zeaxanthin (food-first leafy greens). CRITICAL: Spastic Paraplegia Foundation (SPF) + Tom Wahlig Foundation + MDA + neurology (HSP-experienced) + PT (spasticity-focused) + orthotist if AFO + urology if bladder + genetic counselling. This is NEVER a replacement for HSP-experienced neurology + multispecialty care.