88 research outputs found
Men and women with Down syndrome exhibit different kinematic (but not spatio-temporal) gait patterns
No full textBackground: Gait phenotypes are well documented in people with Down syndrome (pwDS), but sex-related differences are still unexplored. This study investigated the existence of possible differences in spatio-temporal and kinematic parameters of gait between men and women with DS using quantitative three-dimensional gait analysis. Methods: Gait patterns of 117 pwDS (53 F, 64 M) who underwent a computerised gait analysis from 2002 to 2017 were retrospectively analysed to obtain spatio-temporal gait parameters and kinematics in the sagittal plane at hip, knee and ankle joints, as well as foot progression. Results: Overall, when considered as a single group, the gait patterns found for pwDS confirmed the findings of previous studies. However, when analysed by sex, our data revealed that women with DS exhibit a larger hip flexion at late stance (42% to 54% of the gait cycle) and reduced knee flexion at the beginning of the swing phase (61% to 69% of the gait cycle). In contrast, men are characterised by larger foot extra-rotation angles through most of the stance phase (from 0% to 55% of the gait cycle) and at the end of the swing phase (92% to 99% of the gait cycle). No differences between men and women with DS were found concerning ankle dorsi- plantar-flexion or in all spatio-temporal parameters normalised by individuals' anthropometry, excluding cadence (higher in women). Conclusions: The findings of the present study highlight the need to investigate gait dysfunctions in pwDS by taking their sex into consideration. Such an approach may be useful not only in gaining a better understanding of the pathophysiology of gait disturbances associated with DS but also in supporting a better orientation of rehabilitative treatments
Kinetic-based indexes for the functional evaluation of gait in diplegic children: a preliminary report
No full textWe evaluated the feasibility of a set of indexes based on ground reaction forces to discriminate between the degree of severity of spastic diplegia, identified via Gross Motor Function Classification System (GMFCS). A stepwise discriminant ordinal regression analysis performed on a sample of 58 children returned a subset of variables related to the ratio between braking and propulsive vertical forces and anteroposterior timings. Rather, parameters concerning bilateral symmetry were poorly discriminating. The relative simplicity of the selected indexes allows for their easy implementation on existing gait analysis applications for screening purposes
A biomechanical study of gait initiation in Down syndrome
No full textBackground: Gait Initiation (GI) is a functional task that challenges the balance control requiring weight shift and a transition from standing to walking. Individuals with Down Syndrome (DS) walk with low velocity, prolonged stance and shorter steps beside an increased support base. However, no studies performed GI analysis on this population. The aim of this study is to quantitatively characterize the GI task in subjects with DS compared with a typically developed control group. Methods: Seventeen individuals with DS (17 to 40 years) and 19 healthy subjects (17 to 40 years) were enrolled in the study. Data were acquired using an optoelectronic motion capture system and force plates in order to measure the displacement and velocity of Center of Mass (CoM) and the trajectory of Center Of Pressure (CoP). All participants were asked to stand barefoot on the first force platform and received a verbal cue to begin walking for 6 gait initiation trials (three starting with each foot). The CoP duration, velocity, length and excursion were calculated during the anticipatory postural adjustments phases (APAs) and the locomotor (LOC) phase. For the analysis of the CoM, its displacements in antero-posterior (AP) and medio-lateral (ML) during the APAs and LOC phases. Statistical analysis was conducted to compare the two groups. Results: Regarding CoP measures, when compared to control group, individuals with DS presented higher durations, lower velocities, longer lengths during the second APA and total phases, and shorter lengths during the first APA and LOC phases. The group with DS also presented longer CoP excursion during the second APA, whereas a shorter excursion was present during the first APA and LOC phases. The AP excursion in CoM is reduced in the participants with DS. Conclusions: Our results could be useful in the rehabilitation of individuals with DS as they suggest to reinforce exercise programs to improve balance in AP and ML directions, which is demonstrated to be impaired in these subjects
Sex differences in the gait kinematics of patients with Down syndrome: A preliminary report
No full textOBJECTIVE: Sex-specific medicine requires understanding of the specific therapeutic needs and patho-physiology of men and women. In these terms, we investigated sex-related differences in the gait kinematics of patients with Down syndrome. DESIGN: Retrospective observational cohort study. SUBJECTS: A sample of 230 patients (103 females) aged 7-50 years underwent a standard gait-analysis test from 2000 to 2015. METHODS: Spatiotemporal gait parameters and synthetic indexes were computed as Gait Profile Score (GPS) and pelvis/lower limbs as Gait Variable Scores. RESULTS: Although speed, normalized step width, %stance and %swing were similar, in female patients step length was shorter and GPS was higher than in male patients, with no significant effect of age, speed and body mass index. Sex-specific features were found at the pelvis, hip and knee level (sagittal plane), and at the ankle level (transverse plane). CONCLUSION: Overall, in people with Down syndrome, the gait function of females tends to be more impaired than in males, with the exception of foot progression. Therapists should consider these differences when evaluating the severity of gait impairment and designing rehabilitation strategies
Anticipatory postural adjustments and kinematic analysis of step ascent and descent in adults with Down syndrome
No full textBackgroundStep ascent and descent is one of the most common daily tasks. Although it is generally considered a rather simple movement, it may not be so easy for participants with Down syndrome. MethodsA kinematic analysis of step ascent and descent was conducted, and a comparison between 11 adult participants with Down syndrome and 23 healthy participants was carried out. This analysis was accompanied by a posturographic analysis with the aim of evaluating aspects relating to balance. The principal aim of postural control was to investigate the trajectory of the centre of pressure, while the kinematic analysis of movement included the following: (1) the analysis of anticipatory postural adjustments, (2) the calculation of spatiotemporal parameters and (3) the evaluation of articular range of motion. ResultsA general instability for participants with Down syndrome, highlighted in the postural control by an increased anteroposterior and mediolateral excursion, when the test was conducted with both open and closed eyes, was found out. Regarding anticipatory postural adjustments, this deficit in balance control was revealed by the execution of small steps before completing the movement and by a much longer preparation time anticipating the movement. In addition, the kinematic analysis reported a longer ascent and descent time and a lower velocity, accompanied by a greater rising of both limbs in ascent, which indicates an increased perception of the obstacle. Finally, a wider trunk range of motion in both the sagittal and frontal planes was revealed. ConclusionsAll the data confirm a compromised balance control that could be associated with damage to the sensorimotor centre
Mechanical work and power analysis in the joints of the lower extremity of adults with down syndrome during plane walking
No full textIndividuals with Down syndrome (DS) use a different motor gait strategy than healthy people. This study aims at analyzing plane walking differences between two groups of normally developed (ND) subjects and subjects with DS in terms of the generated mechanical power and work in the joints of the lower limb. Thirty-nine adults including two groups of 21 subjects with DS (age: 21.6 ± 7 years (mean ± SD)) and 18 ND subjects (age: 25.1 ± 2.4 years) participated in this study. Gait data and ground reaction forces were acquired using a quantitative movement analysis system composed of an optoelectronic motion analyzer (Elite2002, BTS) with eight infrared cameras, and two force platforms mounted in the middle of walkway. Mechanical power and work exchanges were computed during the stance phase by dedicated software, and then compared between the two groups (significance level: p-value = 0.05). Results showed that the mechanical power at the ankle joint was significantly larger in ND subjects compared to subjects with DS (0.084 ± 0.015 vs 0.027 ± 0.010 W/kg). The mechanical work of the ankle joint and the knee joint was significantly lower in ND compared to DS (0.015 ± 0.013 vs 0.028 ± 0.008 kJ/kg.m, and 0.066 ± 0.031 vs 0.109 ± 0.023 kJ/kg.m, respectively). For both groups, the mechanical work done by knee was less than that performed at the ankle and hip level, which might indicate that the knee muscles mainly absorb the energy, rather than generate it. Our results suggest that the subjects with DS walk with a different motor strategy than normal subjects in terms of mechanical power and work in the joints of the lower extremity. Further investigations are warranted to study the relation between these parameters and gait strategy in subjects with DS, which can lead to better rehabilitative strategies
Impulse oscillometry and nitrogen washout test in the assessment of small airway dysfunction in asthma: correlation with quantitative computed tomography
No full textObjective. Small airway dysfunction (SAD) and airway remodeling influence the disease control and progression in asthma. We investigated whether impulse oscillometry (IOS) and single breath nitrogen washout (SBN2W) could be reliable tests in evaluating SAD and airway remodeling by correlating their data with radiological parameters derived from quantitative chest multidetector computed tomography (MDCT) imaging. Methods. Lung function tests were performed before and after bronchodilator. The MDCT lung scans were acquired at full inspiration and expiration using a portable spirometer to control the respiratory manoeuvres. Symptom control was assessed using the Asthma Control Test (ACT) questionnaire. Results. Twenty six patients were enrolled. The bronchial lumen area (LA) measured with MDCT lung scan, correlated inversely with airway resistance (Raw, p < 0.001) and with total and large airway oscillometric resistance (R5, p = 0.002 and R20, p = 0.006, respectively). However these two last correlations became non-significant after Bonferroni correction for multiple comparisons. The radiological quantification of air trapping correlated with Raw (p < 0.001), residual volume (RV, p < 0.001), and the slope of phase III of SBN2W (DeltaN2, p < 0.001) whereas the correlation with small airway oscillometric resistance (R5-20) was non-significant after Bonferroni adjustment. Finally, air trapping was significantly higher in patients with a fixed bronchial obstruction in comparison to patients with reversible obstruction. Conclusions. Plethysmographic method remains the main tool to investigate SAD and airway remodeling in asthmatic patients. The integration with the SBN2W test proved useful to better evaluate the small airway involvement whereas IOS showed a weaker correlation with both radiological and clinical dat
A Study on the Intersection of Ground Reaction Forces during Overground Walking in Down Syndrome: Effects of the Pathology and Left–Right Asymmetry
No full textMotor dysfunctions in patients with Down Syndrome (DS) result in poor locomotion and an altered gait phenotype, characterized by compromised stability management and frequent bilateral asymmetries. Directing ground reaction forces to a point above the center of mass, referred to as the virtual pivot point (VPP), is one means of maintaining stability during walking. This cross-sectional observational study compared the dynamic gait function of 33 individuals with DS (mean age: 17.7 ± 6.4 years, 13 females) to a group of 36 healthy controls (mean age: 15.5 ± 6.1 years, 15 females), using the concept of the VPP. Results showed that the VPP was located more anteriorly in individuals with DS compared to healthy controls, with no differences in the variability (R2) or symmetry of VPP coordinates. This anterior VPP position is likely due to the larger hip moments observed in patients with DS during the propulsive phase of stance. High R2 values in DS suggest that the VPP is strongly related to dynamic stability during walking
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