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Massó-Ortigosa N, Rey-Abella F, Gutiérrez-Vilahú L, Milà R, Guerra-Balic M, Oviedo GR. Analysis of the centre of pressure in bipedal stance among individuals with and without intellectual disabilities, individuals with Down syndrome and dancers with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:524-536. [PMID: 38350666 DOI: 10.1111/jir.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 10/25/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Individuals with intellectual disabilities (IDs) often present deficiencies in motor, balance and postural control. On the other hand, the practice of physical activity and dance usually reduces these deficiencies. Therefore, in this study, we aimed to compare the control of the centre of pressure (COP) in people with Down syndrome (DS) or other causes of ID in relation to people without disabilities and to observe the influence of vision and the practice of dance. METHODS This cross-sectional study analyses the COP in a static standing position with open and closed eyes in four study groups. A total of 273 people were recruited (80 adults without ID, 46 adults with DS, 120 adults with other causes of ID and 27 dancers with DS). RESULTS A greater area of oscillation and path of the COP was observed in the participants with ID compared with the participants without ID, especially in the sway area of the COP. The oscillation speed of the COP was also higher. When analysing the displacement of the COP, anteroposterior and mediolateral components, there were also differences, except when comparing the group of dancers with DS with respect to the group without ID. The visual condition only influenced the group of participants without disabilities. CONCLUSIONS The results of our study show that there is a less efficient static postural control in people with ID, as greater displacements were observed in the COP of the participants with ID. The differences in some specific variables that analyse the displacement of the COP were smaller when comparing the group of dancers with DS and the individuals without ID.
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Affiliation(s)
- N Massó-Ortigosa
- Blanquerna School of Health Science, University Ramon Llull, Barcelona, Spain
| | - F Rey-Abella
- Blanquerna School of Health Science, University Ramon Llull, Barcelona, Spain
| | - L Gutiérrez-Vilahú
- Blanquerna School of Health Science, University Ramon Llull, Barcelona, Spain
| | - R Milà
- Blanquerna School of Health Science, University Ramon Llull, Barcelona, Spain
| | - M Guerra-Balic
- Blanquerna Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, Barcelona, Spain
| | - G R Oviedo
- Blanquerna School of Health Science, University Ramon Llull, Barcelona, Spain
- Blanquerna Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, Barcelona, Spain
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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2
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Beerse M, Alam T, Wu J. Dynamic gait stability in children with and without Down syndrome during overground walking. Clin Biomech (Bristol, Avon) 2024; 111:106163. [PMID: 38154438 DOI: 10.1016/j.clinbiomech.2023.106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Challenging children with Down syndrome to walk fast and with external ankle load has demonstrated acute adjustments, such as increased step length and decreased step width, and improved joint stability. However, it is unknown to what extent these task constraints affect gait stability. Assessing dynamic gait stability through margin-of-stability not only quantifies adjustments related to balance control, but also informs safety considerations. METHODS Twenty-four children with and without Down syndrome participated in this study. Subjects walked overground at two speed conditions: self-selected (normal) and as fast as possible (fast); and two ankle load conditions: no load and ankle load of 2% body mass. We assessed margin-of-stability in the anteroposterior and mediolateral directions, separately, at three gait events of toe-off, mid-swing, and heel strike. FINDINGS Children with Down syndrome walked with greater mediolateral margin-of-stability than typically developing children. Children with Down syndrome demonstrated less anteroposterior margin-of-stability than typically developing children only before heel-strike at normal speed but increased anteroposterior margin-of-stability at fast speed. The ankle load increased the mediolateral margin-of-stability in both groups but did not impact the anteroposterior margin-of-stability. In addition, children with Down syndrome took shorter and wider steps for more lateral placement of mediolateral margin-of-stability. INTERPRETATION Children with Down syndrome were capable of adjusting their margin-of-stability for fast walking and ankle-load conditions. However, children with Down syndrome walked with less mediolateral stability and anteroposterior mobility than typically developing children. Children with Down syndrome overcompensate the mediolateral foot placement to recapture their margin-of-stability and maintain gait stability.
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Affiliation(s)
- Matthew Beerse
- Department of Health and Sport Science, University of Dayton, Dayton, OH, USA
| | - Tasnuva Alam
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA; Center for Movement and Rehabilitation Research, Georgia State University, Atlanta, GA, USA
| | - Jianhua Wu
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA; Center for Movement and Rehabilitation Research, Georgia State University, Atlanta, GA, USA.
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3
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Ferrario C, Condoluci C, Tarabini M, Manzia CM, Galli M. Anticipatory postural adjustments and kinematic analysis of step ascent and descent in adults with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:475-487. [PMID: 36808671 DOI: 10.1111/jir.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Step 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. METHODS A 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. RESULTS A 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. CONCLUSIONS All the data confirm a compromised balance control that could be associated with damage to the sensorimotor centre.
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Affiliation(s)
- C Ferrario
- Dipartimento di Meccanica, Politecnico di Milano, Milan, Italy
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | | | - M Tarabini
- Dipartimento di Meccanica, Politecnico di Milano, Milan, Italy
| | | | - M Galli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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4
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Ferrario C, Condoluci C, Tarabini M, Manzia CM, Di Girolamo G, Pau M, Galli M. Influence of Foot Morphology on the Center of Pressure Pattern in Patients with Down Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2769. [PMID: 36833467 PMCID: PMC9957500 DOI: 10.3390/ijerph20042769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The primary aim of this study was to assess how different conformations of the foot in individuals with Down syndrome affected the CoP during walking, and the secondary aim was to evaluate the effect of an excess of mass in young adults and children with Down syndrome and flat foot. The greater investigation of these aspects will allow for more targeted rehabilitation treatments to improve a patient's quality of life. METHODS The tests were carried out on 217 subjects with Down syndrome, 65 children and 152 young adults, and on 30 healthy individuals, 19 children and 11 young adults. All subjects underwent gait analysis, and the group with Down syndrome was also assessed with baropodometric tests to evaluate foot morphology. RESULTS The statistical analysis showed that within both the young adult and child groups, the CoP pattern in the anterior-posterior direction reflected a difficulty in proceeding in the walking direction compensated by a medio-lateral swing. The gait of children with Down syndrome was more impaired than that of young adults. In both young adults and children, a higher severity of impairment was found in overweight and obese female individuals. CONCLUSIONS These results suggest that the sensory deficits and the development of hypotonic muscles and lax ligaments of the syndrome lead to morphological alterations of the foot that, combined with the physical characteristics of short stature and obesity, negatively impact the CoP pattern of people with Down syndrome during walking.
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Affiliation(s)
- Cristina Ferrario
- Department of Mechanical Engineering, Politecnico di Milano, 20133 Milano, Italy
- Department of Electronics, Information of Bioengineering, Politecnico di Milano, 20133 Milano, Italy
| | | | - Marco Tarabini
- Department of Mechanical Engineering, Politecnico di Milano, 20133 Milano, Italy
| | | | | | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Manuela Galli
- Department of Electronics, Information of Bioengineering, Politecnico di Milano, 20133 Milano, Italy
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Xu L, Gu H, Zhang Y, Sun T, Yu J. Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148247. [PMID: 35886097 PMCID: PMC9319536 DOI: 10.3390/ijerph19148247] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 02/05/2023]
Abstract
Background: This study aimed to explore the risk factors for flatfoot in children and adolescents to provide a reference basis for studying foot growth and development in children and adolescents. Methods: We examined the cross-sectional research literature regarding flatfoot in children and adolescents published in the past 20 years, from 2001 to 2021, in four electronic databases: PubMed, Web of Science, EBSCO, and Cochrane Library. Two researchers independently searched the literature according to the inclusion and exclusion criteria and evaluated the literature quality of the selected research; from this, a total of 20 articles were included in our review. After the relevant data were extracted, the data were reviewed using Manager 5.4 software (The Cochrane Collaboration, Copenhagen, Denmark), and the detection rate and risk factors for flatfoot in children were analyzed. Results: In total, 3602 children with flatfoot from 15 studies were included in the analysis. The meta-analysis results showed that being male (OR = 1.33, 95% CI: 1.09, 1.62, p = 0.005), being aged <9 years (age <6, OR = 3.11, 95% CI: 2.47, 3.90, p < 0.001; age 6−9 years, OR = 0.54, 95% CI: 0.41, 0.70, p < 0.001), joint relaxation (OR = 4.82, 95% CI: 1.19, 19.41, p = 0.03), wearing sports shoes (OR = 2.97, 95% CI: 1.46, 6.03, p = 0.003), being a child living in an urban environment (OR = 2.10, 95% CI: 1.66, 2.64, p < 0.001) and doing less exercise (OR = 0.25, 95% CI: 0.08, 0.80, p = 0.02) were risk factors for the detection of flatfoot. Conclusion: In summary, the detection rate of flatfoot in children in the past 20 years was found to be 25% through a meta-analysis. Among the children included, boys were more prone to flatfoot than girls, and the proportion of flatfoot decreased with age.
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Affiliation(s)
- Liya Xu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing 100084, China; (L.X.); (H.G.)
| | - Hongyi Gu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing 100084, China; (L.X.); (H.G.)
| | - Yimin Zhang
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
- Correspondence: ; Tel.: +86-13641108252
| | - Tingting Sun
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
| | - Jingjing Yu
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
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Gutiérrez-Vilahú L, Guerra-Balic M. Footprint measurement methods for the assessment and classification of foot types in subjects with Down syndrome: a systematic review. J Orthop Surg Res 2021; 16:537. [PMID: 34452620 PMCID: PMC8393714 DOI: 10.1186/s13018-021-02667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Musculoskeletal disorders, especially in the feet, are common in people with Down syndrome (DS). Evaluation of podiatric footprints is important to prevent and manage orthopedic symptoms. The reliability of a wide variety of footprint measurement methods has been evaluated in healthy people, but few studies have considered the specific morphotype features of the feet in subjects with DS. The aim of this systematic review was to identify the podometric measurement tools used to typologically classify the footprints in the population with DS. Methods The following electronic databases were searched for studies describing footprint measurement tools to assess and classify the foot types in patients with DS published from inception to December 2020: PubMed, Web of Science, CINAHL, and Scopus. Articles were initially searched by screening titles and abstracts. Potentially relevant studies were then further screened by reviewing full texts. Studies that met the inclusion criteria were included in the review. Results Of the 122 articles identified by the search strategy, 14 full texts were retained to assess for eligibility, of which 11 studies met the inclusion criteria and were included. All the studies used footprint measurement methods to classify the foot types in subjects with DS, but only two studies assessed the reliability of those methods for the population with DS. The footprint measurement tools identified were a podoscope, a pressure-sensitive mat, a PressureStatTM carbon paper, and a 3D scanner. The Arch Index was the most common footprint measurement analyzed (seven studies). Two studies used the “gold standard” indexes that include Hernández-Corvo Index, Chippaux-Smirak Index, Staheli Index, and Clarke Angle to measure footprints. Conclusions There is a need to determine the reliability and validity of the footprint measurement methods used for clinical classification of the foot types in subjects with DS. This can contribute to an early diagnosis of foot abnormalities that would help to reduce mobility impairments, improving the quality of life of patients with DS.
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Affiliation(s)
- Lourdes Gutiérrez-Vilahú
- Research group on Health, Physical Activity and Sport, Faculty of Psychology, Education and Sport Sciences-Blanquerna, University Ramon Llull, C/ Císter 34, 08022, Barcelona, Spain.
| | - Myriam Guerra-Balic
- Research group on Health, Physical Activity and Sport, Faculty of Psychology, Education and Sport Sciences-Blanquerna, University Ramon Llull, C/ Císter 34, 08022, Barcelona, Spain
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7
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Hassan NM, Buldt AK, Shields N, Landorf KB, Menz HB, Munteanu SE. Differences in foot dimensions between children and adolescents with and without Down syndrome. Disabil Rehabil 2021; 44:3959-3966. [PMID: 33705670 DOI: 10.1080/09638288.2021.1895897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study compared the differences in foot dimensions between children with and without Down syndrome using three-dimensional (3D) foot scans. METHODS 51 children with and 51 children without Down syndrome had a 3D scan taken of their right foot to compare the absolute and normalised (for height or foot length) measurements. RESULTS Normalised foot length was shorter in children with Down syndrome (MD -11.62 mm, 95% CI -15.06 to -8.18, p < 0.001). When normalised for foot length, ball of foot length (MD 2.87 mm, 95% CI 1.17 to 4.58, p = 0.001), diagonal and horizontal foot width (MD 3.65 mm, 95% CI 1.65 to 5.66, p < 0.001; MD 4.80 mm, 95% CI 2.88 to 6.72, p < 0.001, respectively), ball and instep girth (MD 10.60 mm, 95% CI 5.96 to 15.25, p < 0.001; MD 7.92 mm, 95% CI 3.02 to 12.82, p = 0.002, respectively) and fifth toe height (MD 3.14 mm, 95% CI 2.22 to 4.07, p < 0.001) were greater in children with Down syndrome. CONCLUSIONS Children with Down syndrome have shorter, wider feet with greater girth and fifthtoe height measurements relative to children without Down syndrome. These findings have implications for footwear fit and the manufacturing of population-specific footwear.IMPLICATIONS FOR REHABILITATIONFootwear-fitting issues arise as a result of the unique foot shape of children with Down syndrome.There are substantial variations in the foot shape of children with and without Down syndrome.Children with Down syndrome require wider, deeper footwear at a given length to accommodate their foot dimensions.These findings have implications for the manufacturing of population-specific footwear.
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Affiliation(s)
- Nirmeen M Hassan
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.,Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - Andrew K Buldt
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - Nora Shields
- Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.,Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
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8
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Khallaf ME, Fayed E, Sweif RE, Alsalem A. Relationship between dynamic foot-ground contact area and balance impairments in adolescents with down syndrome. J Pediatr Rehabil Med 2021; 14:425-432. [PMID: 34511516 DOI: 10.3233/prm-200764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Down Syndrome (DS) is characterized by intellectual disability, hypotonia, and joint laxity. Physical disability can be an additional problem and manifests as reduced lower limb muscle strength and impaired balance. The objectives of this study were to characterize DS dynamic foot-ground contact area and to study its relationship with balance impairment among adolescents with DS. METHODS Twenty-eight children and adolescents with DS and 28 non-DS adolescents/children were matched for age and sex. The Oxford Ankle Foot Questionnaire (parents' version) was used to measure disability related to ankle/foot problems in all subjects. A pressure-sensitive mat was used to assess the contact area and arch index. Also, a Biodex balance system was used for measuring postural stability. RESULTS There were significant differences between both groups in all domains of the Oxford Ankle Foot Questionnaire, overall contact area, and arch index (p < 0.05). Overall postural stability index was significantly decreased in subjects with DS (p < 0.05). There was a nonsignificant correlation between contact area and postural stability (p > 0.05). CONCLUSION Adolescents with DS exhibited larger mid-foot and forefoot contact areas with respect to non-DS matched children. Impairment of balance in adolescents with DS is a multifactorial problem not related to changes in the foot contact area.
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Affiliation(s)
- Mohamed E Khallaf
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,University of St. Augustine for Health Sciences, Austin, Texas, USA
| | - Eman Fayed
- Department of Physical Therapy for Cardio-Pulmonary Dysfunctions & Geriatrics, Misr University for Science and Technology, 6th of October City, Egypt.,Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Radwa E Sweif
- Department Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Abdulkarem Alsalem
- Department Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Bilateral Foot Orthoses Elicit Changes in Gait Kinematics of Adolescents with Down Syndrome with Flatfoot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144994. [PMID: 32664499 PMCID: PMC7400424 DOI: 10.3390/ijerph17144994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
Background: Subjects with Down Syndrome (DS) are characterized by specific physiological alterations, including musculoskeletal abnormalities. Flat Foot (FF), caused by hypotonia and ligament laxity, represents one of the most common disabling disorders in this population. Conservative treatments promote the use of orthopaedic insoles and plantar supports. The aim of this study was to evaluate the impact of Foot Orthoses (FOs) on the gait pattern of subjects with DS, assessing the biomechanical effects associated with their use. Methods: Twenty-nine subjects were screened under two conditions-walking barefoot (WB); with shoes and insoles (WSI), during three trials for each. Assessments were performed through the 3D gait analysis, using an optoelectronic system, force platforms, and video recording. Specifically, synthetic indices of gait kinematics, i.e., gait profile score (GPS) and gait variable score (GVS) were calculated and compared with Wilcoxon signed-rank test, to evaluate between-conditions. Results: Significant variations were found in GVS foot progression index, representative of foot rotation during walking, in adolescents only. Conclusions: Bilateral FOs has a positive immediate impact on gait quality in adolescents with DS, as confirmed by quantitative analysis. FOs prescription is an evidence-based early approach to slow down biomechanical abnormalities and prevent relative symptoms.
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10
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Endo Y, Kanai Y, Yozu A, Kobayashi Y, Fukaya T, Mutsuzaki H. Influence of a Foot Insole for a Down Syndrome Patient with a Flat Foot: A Case Study. ACTA ACUST UNITED AC 2020; 56:medicina56050219. [PMID: 32384597 PMCID: PMC7279166 DOI: 10.3390/medicina56050219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Patients with Down syndrome have many orthopedic problems including flat foot. Insertion of an insole for a flat foot provides support to the medial longitudinal arch; thus, insole therapy is often used to treat a flat foot. However, the influence of an insole insertion on the knee joint kinematics for a patient with Down syndrome is unknown. This study aimed to elucidate the influence of an insole for a flat foot on the knee kinematics during gait for a patient with Down syndrome. Materials and Methods: The subject was a 22-year-old male with Down syndrome who had a flat foot. The knee joint angle during the gait was measured using a 3D motion capture system that consisted of eight infrared cameras. Results: The gait analysis demonstrated a reduction in the knee flexion angle during double knee action. The knee valgus and tibial internal rotation angles also decreased during the loading response phase while wearing shoes that contained the insole. Conclusions: As the angle of the knee joint decreased during the gait, it was considered that the stability of the knee joint improved by inserting the insole. In particular, there was a large difference in the tibial internal rotation angle when the insole was inserted. It is thus hypothesized that the insole contributes to the rotational stability of the knee joint. This study suggests that knee stability may improve and that gait becomes more stable when a Down syndrome patient with a flat foot wears an insole.
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Affiliation(s)
- Yusuke Endo
- Department of Physical Therapy, Faculty of Health Science, Health Science University, 7187 Kodachi, Fujikawaguchiko-machi, Minamitsuru-gun, Yamanashi 401-0380, Japan
- Correspondence: ; Tel.: +81-555-83-5299; Fax: +81-555-83-5298
| | - Yoshihide Kanai
- Department of Physical Therapy, Saitama Medical University, 981 Kawakado, Moroyama-machi, Iruma-gun, Saitama 350-0496, Japan;
| | - Arito Yozu
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan; (A.Y.); (H.M.)
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Yasuto Kobayashi
- Department of Sports Management, Faculty of Business and Public Administration, Sakushin Gakuin University, 908 Takeshita-machi, Utsunomiya-shi, Tochigi 321-3295, Japan;
| | - Takashi Fukaya
- Department of Physical Therapy, Tsukuba International University, 6-8-33, Manabe, Tsuchiura-shi, Ibaraki 300-0051, Japan;
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan; (A.Y.); (H.M.)
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
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11
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Erdeo F, Salcı Y, Uca AU, Armutlu K. Examination of the effects of coordination and balance problems on gait in ataxic multiple sclerosis patients. ACTA ACUST UNITED AC 2020; 24:269-277. [PMID: 31872805 PMCID: PMC8015554 DOI: 10.17712/nsj.2019.4.20190038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effects of coordination and balance problems on gait and plantar pressure distribution in multiple sclerosis patients. METHODS This was an observational, cross-sectional study. It was conducted at Necmettin Erbakan University between March and December 2017. Twenty-four individuals with coordination problems, 36 individuals with balance problems and 32 healthy individuals were included in the study. The EDSS, Functional Reach Test, Dynamic Gait Index, baropodometry and stabilometry evaluations were performed. RESULTS There were significant differences between the groups (velocity p=0.000, cadence p=0.000, step width p=0.018, step length p=0.000, foot angle p=0.000). Multiple comparisons demonstrated that the velocities and cadences of the coordination group were lower, while their step widths were found to be higher, compared to the balance group (p=0.012, p=0.004, p=0.017, respectively). In static plantar pressure distribution, lateral forefoot pressure, lateral hindfoot pressure and medial hindfoot pressure were significantly different between the groups (p=0.002, p=0.000, respectively) Multiple comparisons showed that the pressure on the lateral part of the hindfoot in the coordination group was found to be significantly higher compared to the balance group (p=0.002). According to the dynamic plantar pressure distribution, lateral forefoot, medial forefoot, lateral hindfoot and medial hindfoot pressures were significantly different between the groups (p<0.05). CONCLUSION Coordination and balance problems affect gait and plantar pressure distribution. The identification of these changes will help physiotherapists determine specific therapeutic targets.
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Affiliation(s)
- Fatma Erdeo
- Department of Physiotherapy, Faculty of Health Science, Necmettin Erbakan University, Konya, Turkey. E-mail:
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12
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Abstract
Joint hypermobility refers to the ability that a joint has to move beyond its normal range of motion. It is common in the general population, particularly in children. While many individuals manifesting joint hypermobility are healthy, this feature can accompany a wide range of symptoms and systemic disorders, whose management can be influenced by their prompt recognition. Given the increasing attention that joint hypermobility is attracting in various fields of medicine, many practitioners are asked to approach more carefully joint hypermobility, in order to avoid over- and under-diagnosis of related disorders. Among the most common conditions featuring joint hypermobility there are hypermobility spectrum disorders and hereditary connective tissue disorders, in particular, the Ehlers-Danlos syndromes. In children, joint hypermobility also accompany a variety of disorders affecting neurodevelopment. The nature of such an association is protean, as joint hypermobility may occur in selected congenital neuromuscular disorders, monogenic multiple malformation/intellectual disability syndromes, and well-known and emerging genomic syndromes. In addition, joint hypermobility seems strongly associated with developmental coordination disorders. This review offers an overview on definitions, assessment procedures, patterns of associated manifestations and disorders related to joint hypermobility, as well as treatment principles of associated musculoskeletal pain for practitioners that are not familial with this issue but encounter people featuring this physical attribute in their daily activity.
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Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy -
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13
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Zago M, Duarte NAC, Grecco LAC, Condoluci C, Oliveira CS, Galli M. Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review. J Phys Ther Sci 2020; 32:303-314. [PMID: 32273655 PMCID: PMC7113426 DOI: 10.1589/jpts.32.303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/21/2020] [Indexed: 12/26/2022] Open
Abstract
[Purpose] To describe (1) the current knowledge on gait and postural control in
individuals with Down syndrome in terms of spatiotemporal, kinematics and kinetics, and
(2) relevant rehabilitation strategies. [Methods] Randomized and non-randomized clinical
trials published between January 1997 and October 2019 were selected by searching four
scientific databases. We included studies on patients with Down syndrome involving gait
analysis or postural control. A custom data-extraction and appraisal form was developed to
collect the key features of each article. The PEDro Scale was used to evaluate the
methodological quality of the studies. [Results] A total of 37 out of 146 cross-sectional
and longitudinal studies were included in the review. The main abnormalities included:
reduction of gait velocity and step length, poor static balance with increased
anteroposterior and mediolateral oscillations and a larger step width. [Conclusion] A
number of compensatory patterns during movement was observed, with a direct influence on
improvements in stability and postural control throughout daily life. Intensive gait
training at an early age appears to produce long-term improvements in this population.
Future research should focus on the interaction between the motor and cognitive function,
and on the functional effects due to the exposure to an enriched environment.
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Affiliation(s)
- Matteo Zago
- Department of Electronics, Information and Bioengineering, Politecnico di Milano: Via Golgi 39, 20133, Milano, Italy
| | - Natalia Almeida Carvalho Duarte
- Department of Electronics, Information and Bioengineering, Politecnico di Milano: Via Golgi 39, 20133, Milano, Italy.,Santa Casa de Misericordia de Presidente Prudente, Brazil
| | | | | | | | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano: Via Golgi 39, 20133, Milano, Italy
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Zago M, Federolf PA, Levy SR, Condoluci C, Galli M. Down Syndrome: Gait Pattern Alterations in Posture Space Kinematics. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1589-1596. [PMID: 31265404 DOI: 10.1109/tnsre.2019.2926119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gait characteristics in Down syndrome (DS) are documented in terms of discrete kinematic variables. However, such features are strictly interrelated and reflect neurological and developmental delays. A phenotypical, quantitative assessment of how multi-joint walking patterns are activated and controlled during gait would enhance the understanding of locomotor mechanisms in such patients. We adopted an analysis framework based on principal component analysis: the gait kinematics of 221 patients aged 6-45 were expressed in terms of a reduced set of one-dimensional movement components. Their time course during the gait cycle was described by score vectors, here called principal positions; its second time derivative, called principal acceleration, characterized the activity of the neuromuscular controller on each component. Outcomes were compared to an age-matched group of 49 healthy individuals. After controlling for the effect of walking speed, we observed that the main alterations in gait patterns emerged in the fourth component which is mostly devoted to stability management (group differences, p < 0.001). Rather, the main sagittal-plane locomotor patterns showed only subtle differences from the control group. Using statistical parametrical mapping, we found when (step-to-step transitions) and how (interrelated joints motion) the fourth movement deviated from normal: in particular, an excessive hip adduction and trunk inclination during the transition between single and double support phases. These findings match the neurological and sensorimotor trait of DS and suggest the promotion of targeted rehabilitative interventions. Furthermore, this paper opens to the adoption of principal positions and principal accelerations to investigate the neuromuscular control of movement patterns during locomotion.
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15
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Hallemans A, Van de Walle P, Wyers L, Verheyen K, Schoonjans AS, Desloovere K, Ceulemans B. Clinical usefulness and challenges of instrumented motion analysis in patients with intellectual disabilities. Gait Posture 2019; 71:105-115. [PMID: 31039461 DOI: 10.1016/j.gaitpost.2019.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/04/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinical laboratory testing of locomotor disorders is challenging in patients with intellectual disability (ID). Nevertheless, also in this population gait analysis has substantial value as motor problems are common. To promote its use, adequate protocols need to be developed and the impact on clinical decision making needs to be documented. RESEARCH QUESTION What is the clinical usefulness of instrumented motion analysis in patients with ID? METHOD This narrative review consists of three parts. A literature review was performed to describe the gait pattern of patients with ID. Next, benefits and challenges of standard gait analysis protocols are described. Finally, a case of a girl with ID due to genetic cause showing gait abnormalities is discussed. RESULTS The literature review resulted in 20 studies on "gait" in patients with an "ID", published since August, 1st 2013. Gait deviations were observed in all studies investigating the ID population with an underlying genetic syndrome. Observed gait deviations in the ID population might be attributed to physical characteristics, cognitive components or both. The main goal of clinical gait assessment is the identification of gait deviations and the evaluation of their progress over time, in order to optimize the treatment plan. The choice of adequate method and measurement modalities depends on the clinical goal, the available resources and the abilities of the patient. In the case report we presented, we succeeded in performing an instrumented 3D gait analysis in a girl with severe ID at the ages of 4y4m, 6y0m, 7y2m and 8y2m. Progressive gait deviations were found suggesting a crouch gait pattern was developing. Results of the gait analysis led to the prescription of rigid ankle-foot orthoses. SIGNIFICANCE Gait analysis has substantial value for patients with ID. Gait analysis allows clinicians to objectify the relationship between physical characteristics and gait features.
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Affiliation(s)
- A Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Belgium - M²OCEAN, University of Antwerp, Belgium.
| | - P Van de Walle
- Department of Rehabilitation Sciences andPhysiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Belgium
| | - L Wyers
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Belgium
| | - K Verheyen
- Division of Child Neurology, Pediatrics department, Antwerp University Hospital, Belgium - Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Belgium
| | - A-S Schoonjans
- MD, Division of Child Neurology, Pediatrics department, Antwerp University Hospital, Belgium
| | - K Desloovere
- Neuromotor Rehabilitation group, Department of Rehabilitation Sciences, Leuven Catholic University, Belgium
| | - B Ceulemans
- Division of Child Neurology, Pediatrics department, Antwerp University Hospital, Belgium
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Corsi C, Cimolin V, Capodaglio P, Condoluci C, Galli M. A biomechanical study of gait initiation in Down syndrome. BMC Neurol 2019; 19:66. [PMID: 30987596 PMCID: PMC6466789 DOI: 10.1186/s12883-019-1288-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/31/2019] [Indexed: 12/17/2022] Open
Abstract
Background 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.
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Affiliation(s)
- Carolina Corsi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Via Cadorna 90, I-28824, Piancavallo, VB, Italy
| | | | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
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Beerse M, Henderson G, Liang H, Ajisafe T, Wu J. Variability of spatiotemporal gait parameters in children with and without Down syndrome during treadmill walking. Gait Posture 2019; 68:207-212. [PMID: 30504087 DOI: 10.1016/j.gaitpost.2018.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increasing walking speed and including bilateral external ankle load have been shown to improve aspects of the gait pattern of children with Down syndrome (DS). However, it is unknown if speed and ankle load improves the cycle-to-cycle variability in a similar way. RESEARCH QUESTION How do changes of walking speed and external ankle load impact spatiotemporal variability during treadmill walking in children with and without DS? METHODS Thirteen children with DS (aged 7-10 years) and thirteen age- and sex-matched typically developing (TD) children participated in this study. Subjects completed two bouts of 60-second treadmill walking at two different speeds (slow and fast) and two load conditions (no load and ankle load equaling to 2% bodyweight at each side). Kinematic data was captured using a Vicon motion capture system. Mean and coefficient of variance of spatiotemporal gait variables were calculated and compared between children with and without DS. RESULTS AND SIGNIFICANCE Across all conditions, the DS group took shorter and wider steps than the TD group, but walked with a similar swing percentage, double support percentage, and foot rotation angle. Further, the DS group demonstrated greater variability of all spatiotemporal parameters, except for step width and foot rotation angle. Our results indicated that children with DS can modulate their spatiotemporal gait pattern accordingly like their TD peers when walking faster on a treadmill and/or with an external ankle load. Smaller step width variability in the DS group suggests that mediolateral stability may be prioritized during treadmill walking to safely navigate the treadmill and complete walking tasks. Similar temporal parameters but distinct spatial parameters in the DS group suggest that they may have developed similar rhythmic control but are confined by their spatial movement limitations.
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Affiliation(s)
- Matthew Beerse
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA; Department of Health and Sport Science, University of Dayton, Dayton, OH, USA
| | - Gena Henderson
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Huaqing Liang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Toyin Ajisafe
- Department of Kinesiology, Texas A&M University Corpus Christi, Corpus Christi, TX, USA
| | - Jianhua Wu
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA; Center for Movement & Rehabilitation Research, Georgia State University, Atlanta, GA, USA.
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18
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Pau M, Condoluci C, Zago M, Galli M. Men and women with Down syndrome exhibit different kinematic (but not spatio-temporal) gait patterns. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:64-71. [PMID: 30375089 DOI: 10.1111/jir.12560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/26/2018] [Accepted: 10/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND 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.
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Affiliation(s)
- M Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - C Condoluci
- Department of Rehabilitation of Pediatrics and Developmental Disabilities, IRCCS San Raffaele Pisana, Rome, Italy
| | - M Zago
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - M Galli
- Department of Rehabilitation of Pediatrics and Developmental Disabilities, IRCCS San Raffaele Pisana, Rome, Italy
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Kanai Y, Mutsuzaki H, Nakayama T, Yozu A, Iwasaki N. Relationship between the use of lower extremity orthoses and the developmental quotient of The Kyoto Scale of Psychological Development in children with Down syndrome. J Phys Ther Sci 2018; 30:1019-1023. [PMID: 30154593 PMCID: PMC6110224 DOI: 10.1589/jpts.30.1019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/07/2018] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The Kyoto Scale of Psychological Development is an evaluation scale developed in the field of psychology. The initial aim of this study was to determine whether the quotient of the Postural-Motor area in the scale was correlated with the use of orthosis in patients with Down syndrome. The second aim was to examine a correlation among Postural-Motor, Cognitive-Adaptive, and Language-Social areas in the participants. [Participants and Methods] Patients with Down syndrome who had received a developmental examination, the Kyoto Scale of Psychological Development, were retrospectively investigated. The sample included 78 participants. Data on the participants' calendar ages ranged from 4.1 to 6.0 years, and the mean age was 4.9 at the examination. The investigated parameters were the number of participants who used an orthosis or insole and the mean developmental quotient for the Postural-Motor, Cognitive-Adaptive, and Language-Social areas. [Results] Twenty participants who completed the exam used an orthosis, and 18 of these had an insole as a first orthosis. The mean Postural-Motor quotient was significantly lower in participants who used an orthosis than in those who did not (52.3 ± 14.7). [Conclusion] The mean quotient of the Postural-Motor area was significantly lower in patients with Down syndrome who were prescribed some kind of orthosis than in those who were not. There was a significant correlation among the quotients of the three areas. The use of orthosis was expected to positively influence the Cognitive-Adaptive and Language-Social areas through the future in people with Down syndrome who have some difficulty with posture and movement.
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Affiliation(s)
- Yoshihide Kanai
- Department of Physical Therapy, Ibaraki Prefectural
University of Health Sciences: 4669-2 Ami-machi Ami, Inashiki-gun, Ibaraki 300-0394
Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural
University of Health Sciences, Japan
| | - Tomohiro Nakayama
- Department of Paediatrics, Ibaraki Prefectural University
of Health Sciences Hospital, Japan
| | - Arito Yozu
- Department of Rehabilitation Medicine, Ibaraki Prefectural
University of Health Sciences, Japan
| | - Nobuaki Iwasaki
- Department of Paediatrics, Ibaraki Prefectural University
of Health Sciences Hospital, Japan
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Baban A, Castori M. Pharmacological resources, diagnostic approach and coordination of care in joint hypermobility-related disorders. Expert Rev Clin Pharmacol 2018; 11:689-703. [PMID: 29979900 DOI: 10.1080/17512433.2018.1497973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Joint hypermobility (JH) is the hallmark of many hereditary soft connective tissue disorders, including Ehlers-Danlos syndromes and related disorders, disorders of the TGFβ-pathway, lateral meningocele syndrome, arterial tortuosity syndrome, and cutis laxa syndromes. Contemporary practice separates individuals with isolated, non-syndromic JH from patients with Mendelian syndromes and those with hypermobility spectrum disorders. The latter is a new nosologic entity grouping together individuals with JH and related musculoskeletal manifestations, but lacking inclusion criteria for well-defined and/or single-gene disorders. Area covered: Nomenclature of JH and JH-related disorders are summarized on a practically oriented perspective. Critical areas of clinical management comprise pain; cardiovascular and respiratory issues; fatigue and dysautonomia; bone fragility; and capillary, skin and soft tissue fragility. Medical management stands on low-evidence data. Ongoing preclinical and clinical studies are aimed to reach a more personalized pharmacological approach to the management of the cardiovascular risk, musculoskeletal pain, and reduced bone mass. Expert commentary: Correct classification of patients with JH-related disorders needs a systematic approach, in which a wide array of molecular tests should be intermingled with strong clinical competences in highly specialized settings. A multispecialty, hierarchical approach should be encouraged for optimal coordination of care in systemic phenotypes.
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Affiliation(s)
- Anwar Baban
- a Department of Pediatric Cardiology and Cardiac Surgery , IRCCS-Ospedale Pediatrico Bambino Gesù , Rome , Italy
| | - Marco Castori
- b Division of Medical Genetics , IRCCS-Casa Sollievo della Sofferenza , San Giovanni Rotondo , FG , Italy
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Banwell HA, Paris ME, Mackintosh S, Williams CM. Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review. J Foot Ankle Res 2018; 11:21. [PMID: 29854006 PMCID: PMC5975578 DOI: 10.1186/s13047-018-0264-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/11/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Flexible flat foot is a normal observation in typically developing children, however, some children with flat feet present with pain and impaired lower limb function. The challenge for health professionals is to identify when foot posture is outside of expected findings and may warrant intervention. Diagnoses of flexible flat foot is often based on radiographic or clinical measures, yet the validity and reliability of these measures for a paediatric population is not clearly understood. The aim of this systematic review was to investigate how paediatric foot posture is defined and measured within the literature, and if the psychometric properties of these measures support any given diagnoses. METHODS Electronic databases (MEDLINE, CINAHL, EMBASE, Cochrane, AMED, SportDiscus, PsycINFO, and Web of Science) were systematically searched in January 2017 for empirical studies where participants had diagnosed flexible flat foot and were aged 18 years or younger. Outcomes of interest were the foot posture measures and definitions used. Further articles were sought where cited in relation to the psychometric properties of the measures used. RESULTS Of the 1101 unique records identified by the searches, 27 studies met the inclusion criteria involving 20 foot posture measures and 40 definitions of paediatric flexible flat foot. A further 18 citations were sought in relation to the psychometric properties of these measures. Three measures were deemed valid and reliable, the FPI-6 > + 6 for children aged three to 15 years, a Staheli arch index of > 1.07 for children aged three to six and ≥ 1.28 for children six to nine, and a Chippaux-Smirak index of > 62.7% in three to seven year olds, > 59% in six to nine year olds and ≥ 40% for children aged nine to 16 years. No further measures were found to be valid for the paediatric population. CONCLUSION No universally accepted criteria for diagnosing paediatric flat foot was found within existing literature, and psychometric data for foot posture measures and definitions used was limited. The outcomes of this review indicate that the FPI - 6, Staheli arch index or Chippaux-Smirak index should be the preferred method of paediatric foot posture measurement in future research.
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Affiliation(s)
- Helen A. Banwell
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia 5001 Australia
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Maisie E. Paris
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Shylie Mackintosh
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
| | - Cylie M. Williams
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001 Australia
- Allied Health, Peninsula Health, Frankston, VIC 3199 Australia
- School of Primary and Allied Health, Monash University, Frankston, VIC 3199 Australia
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Abstract
Down syndrome is a common disorder with many oral conditions and systemic manifestations. Dentists need to take a holistic approach including behavioral, oral, and systemic issues. This review of the literature focuses on oral anomalies, systemic interaction, management, and recommendations.
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Affiliation(s)
- Azizah Bin Mubayrik
- Department Oral Medicine & Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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23
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Kanai Y, Mutsuzaki H, Nakayama T, Yozu A, Iwasaki N. The prevalence of the flat foot condition and insole prescription in people with Down's syndrome: a retrospective population-based study. J Phys Ther Sci 2018; 30:520-524. [PMID: 29706698 PMCID: PMC5908994 DOI: 10.1589/jpts.30.520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/09/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The general approach for flat foot (FF) treatment in people with Down's syndrome (DS) is the use of insoles. However, the appropriate timing of the first insole prescription remains unclear. An aim of this present research was to investigate the status of prevalence of FF and orthosis prescription in the DS population. [Subjects and Methods] Two hundred fifteen subjects with DS who were seen at our hospital were retrospectively investigated. Investigated parameters were: prevalence of FF and other foot diseases, ratio and timing of orthopaedic consultation, ratio and timing of orthoses prescription, and mean age at the time of orthosis prescription. [Results] The prevalence of FF was 27.0% (58 subjects), and 50 subjects (23.3%) consulted an orthopaedic surgeon. An orthosis was prescribed for 54 subjects; 88.9% of these orthoses were insoles. Foot and leg orthoses other than insoles were prescribed significantly more frequently for females than males. The mean ages at the time of the first prescription of all types of orthoses and an insole were 7.3 years and 6.4 years, respectively. [Conclusion] The prevalence of FF was low, and the age at which subjects with DS were prescribed an orthosis was relatively high at our institution compared to previous reports. Since physical therapists see patients who could potentially have FF, those with suspected FF should then be referred to an orthopaedic doctor, which would enable the earlier orthosis prescription.
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Affiliation(s)
- Yoshihide Kanai
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami-machi Ami, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Japan
| | - Tomohiro Nakayama
- Department of Paediatrics, Ibaraki Prefectural University of Health Sciences, Japan
| | - Arito Yozu
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences, Japan
| | - Nobuaki Iwasaki
- Department of Paediatrics, Ibaraki Prefectural University of Health Sciences, Japan
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de Mello Monteiro CB, da Silva TD, de Abreu LC, Fregni F, de Araujo LV, Ferreira FHIB, Leone C. Short-term motor learning through non-immersive virtual reality task in individuals with down syndrome. BMC Neurol 2017; 17:71. [PMID: 28410583 PMCID: PMC5391542 DOI: 10.1186/s12883-017-0852-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 03/30/2017] [Indexed: 01/08/2023] Open
Abstract
Background Down syndrome (DS) has unique physical, motor and cognitive characteristics. Despite cognitive and motor difficulties, there is a possibility of intervention based on the knowledge of motor learning. However, it is important to study the motor learning process in individuals with DS during a virtual reality task to justify the use of virtual reality to organize intervention programs. The aim of this study was to analyze the motor learning process in individuals with DS during a virtual reality task. Methods A total of 40 individuals participated in this study, 20 of whom had DS (24 males and 8 females, mean age of 19 years, ranging between 14 and 30 yrs.) and 20 typically developing individuals (TD) who were matched by age and gender to the individuals with DS. To examine this issue, we used software that uses 3D images and reproduced a coincidence-timing task. Results The results showed that all individuals improved performance in the virtual task, but the individuals with DS that started the task with worse performance showed higher difference from the beginning. Besides that, they were able to retain and transfer the performance with increase of speed of the task. Conclusion Individuals with DS are able to learn movements from virtual tasks, even though the movement time was higher compared to the TD individuals. The results showed that individuals with DS who started with low performance improved coincidence- timing task with virtual objects, but were less accurate than typically developing individuals. Trial registration ClinicalTrials.gov Identifier: NCT02719600.
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Affiliation(s)
- Carlos Bandeira de Mello Monteiro
- School of Arts, Sciences and Humanities, University of São Paulo, Av. Arlindo Béttio, 1000, Ermelino Matarazzo, São Paulo, 03828-000, Brazil.,School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Talita Dias da Silva
- School of Arts, Sciences and Humanities, University of São Paulo, Av. Arlindo Béttio, 1000, Ermelino Matarazzo, São Paulo, 03828-000, Brazil. .,Harvard School of Public Health, Harvard University, Boston, MA, USA.
| | | | - Felipe Fregni
- Center for Neurosciences (NEC), University of São Paulo, São Paulo, Brazil.,Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Luciano Vieira de Araujo
- School of Arts, Sciences and Humanities, University of São Paulo, Av. Arlindo Béttio, 1000, Ermelino Matarazzo, São Paulo, 03828-000, Brazil
| | | | - Claudio Leone
- School of Public Health, University of São Paulo, São Paulo, Brazil
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Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:148-157. [PMID: 28145606 DOI: 10.1002/ajmg.c.31539] [Citation(s) in RCA: 296] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the last decade, growing attention has been placed on joint hypermobility and related disorders. The new nosology for Ehlers-Danlos syndrome (EDS), the best-known and probably the most common of the disorders featuring joint hypermobility, identifies more than 20 different types of EDS, and highlights the need for a single set of criteria to substitute the previous ones for the overlapping EDS hypermobility type and joint hypermobility syndrome. Joint hypermobility is a feature commonly encountered in many other disorders, both genetic and acquired, and this finding is attracting the attention of an increasing number of medical and non-medical disciplines. In this paper, the terminology of joint hypermobility and related disorders is summarized. Different types of joint hypermobility, its secondary musculoskeletal manifestations and a simplified categorization of genetic syndromes featuring joint hypermobility are presented. The concept of a spectrum of pathogenetically related manifestations of joint hypermobility intersecting the categories of pleiotropic syndromes with joint hypermobility is introduced. A group of hypermobility spectrum disorders is proposed as diagnostic labels for patients with symptomatic joint hypermobility but not corresponding to any other syndromes with joint hypermobility. © 2017 Wiley Periodicals, Inc.
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Anderson-Mooney AJ, Schmitt FA, Head E, Lott IT, Heilman KM. Gait dyspraxia as a clinical marker of cognitive decline in Down syndrome: A review of theory and proposed mechanisms. Brain Cogn 2016; 104:48-57. [PMID: 26930369 PMCID: PMC4801771 DOI: 10.1016/j.bandc.2016.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/13/2016] [Accepted: 02/21/2016] [Indexed: 12/15/2022]
Abstract
Down syndrome (DS) is the most common genetic cause of intellectual disability in children. With aging, DS is associated with an increased risk for Alzheimer's disease (AD). The development of AD neuropathology in individuals with DS can result in further disturbances in cognition and behavior and may significantly exacerbate caregiver burden. Early detection may allow for appropriate preparation by caregivers. Recent literature suggests that declines in gait may serve as an early marker of AD-related cognitive disorders; however, this relationship has not been examined in individuals with DS. The theory regarding gait dyspraxia and cognitive decline in the general population is reviewed, and potential applications to the population with individuals with DS are highlighted. Challenges and benefits in the line of inquiry are discussed. In particular, it appears that gait declines in aging individuals with DS may be associated with known declines in frontoparietal gray matter, development of AD-related pathology, and white matter losses in tracts critical to motor control. These changes are also potentially related to the cognitive and functional changes often observed during the same chronological period as gait declines in adults with DS. Gait declines may be an early marker of cognitive change, related to the development of underlying AD-related pathology, in individuals with DS. Future investigations in this area may provide insight into the clinical changes associated with development of AD pathology in both the population with DS and the general population, enhancing efforts for optimal patient and caregiver support and propelling investigations regarding safety/quality of life interventions and disease-modifying interventions.
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Affiliation(s)
- Amelia J Anderson-Mooney
- University of Kentucky College of Medicine, Department of Neurology, 740 S. Limestone, Suite B-101, Lexington, KY 40536, United States.
| | - Frederick A Schmitt
- University of Kentucky College of Medicine, Department of Neurology and Sanders-Brown Center on Aging, 800 S. Limestone, Room 312, Lexington, KY 40536, United States.
| | - Elizabeth Head
- University of Kentucky, Department of Molecular & Biomedical Pharmacology and Sanders-Brown Center on Aging, 800 S. Limestone, Room 203, Lexington, KY 40536, United States.
| | - Ira T Lott
- University of California - Irvine School of Medicine, Department of Pediatrics, Bldg 2 3rd Floor Rt 81, 101 The City Drive, Mail Code: 4482, Orange, CA 92668, United States.
| | - Kenneth M Heilman
- University of Florida College of Medicine, Department of Neurology, Room L3-100, McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL 32611, United States.
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Lim PQ, Shields N, Nikolopoulos N, Barrett JT, Evans AM, Taylor NF, Munteanu SE. The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome. J Foot Ankle Res 2015; 8:4. [PMID: 25722747 PMCID: PMC4342196 DOI: 10.1186/s13047-015-0062-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/31/2015] [Indexed: 01/21/2023] Open
Abstract
Background Foot deformity, flat feet, and the use of ill-fitting footwear are common in children and adolescents with Down syndrome (DS). The aim of this study was to determine whether these observations are associated with foot-specific disability in this group. Methods A cross-sectional study design. Foot structure (foot posture determined using the Arch Index, presence of hallux valgus and lesser toe deformities) and footwear fit (determined by length and width percentage differences between the participant’s foot and footwear) were assessed in 50 participants with DS (22 females, 28 males) aged five to 18 with a mean (SD) age of 10.6 (3.9) years. Foot-specific disability was determined using the parent-reported Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Associations between foot structure and footwear fit with the four domains (Physical, School and play, Emotional and Footwear) of the OxAFQ-C were determined using multivariate regression modelling. Results The mean (SD) Arch Index was 0.29 (0.08), and the prevalence of flat feet, hallux valgus and lesser toe deformities was 76%, 10% and 12% respectively. Few participants wore footwear that was too short (10%), but the use of footwear that was too narrow was common (58%). The presence of hallux valgus was significantly associated with increased disability for the OxAFQ-C School and play domain scores. The use of narrow-fitting footwear was significantly associated with increased levels of disability for the OxAFQ-C Physical, School and play, and Emotional domains. However, these variables only explained between 10% to 14% of the variance in the OxAFQ-C domain scores. There were no significant associations between foot structure and footwear fit with the OxAFQ-C Footwear domain scores. Conclusions Flatter feet and lesser toe deformities are not associated with foot-specific disability in children and adolescents with DS. Hallux valgus is associated with foot-specific disability during school and play activities. Ill-fitting footwear (too narrow) is common and is associated with foot-specific disability. Further research is required to identify if the relationship between narrow-fitting footwear and foot-specific disability is causal, and to identify other factors associated with foot-specific disability in children and adolescents with DS.
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Affiliation(s)
- Polly Qx Lim
- Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Nora Shields
- Discipline of Physiotherapy, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Nikolaos Nikolopoulos
- Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Joanna T Barrett
- Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Angela M Evans
- Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia ; Lower Extremity and Gait Studies Program, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Nicholas F Taylor
- Discipline of Physiotherapy, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria 3086 Australia ; Lower Extremity and Gait Studies Program, La Trobe University, Bundoora, Victoria 3086 Australia
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