Smith Beth A, Ulrich Beverly D
University of Michigan, Division of Kinesiology, 401 Washtenaw Avenue, Ann Arbor, MI 48109-2214, United States.
Gait Posture. 2008 Oct;28(3):448-55. doi: 10.1016/j.gaitpost.2008.02.002. Epub 2008 Mar 21.
Our goal was to examine the gait patterns of older adults with Down syndrome (DS) for precocious stabilizing adaptations during comfortable over-ground walking and in more challenging conditions. Twelve participants with DS and 12 with typical development (TD) were matched for height, weight and age (range 35-62 years). We used a six-camera motion capture system to assess foot trajectories over obstacles. Participants first walked at their preferred speed over a 5.3 m instrumented gait mat (unperturbed condition). Subsequent walking trials included perturbations mid-walkway: (a) minimal obstacle to step over (12 cm high), (b) moderate obstacle to step onto with both feet and then off (standard step), and (c) maximum obstacle to step onto with only one foot and over with the other (standard step). Adults with DS walked slower with shorter, wider strides while spending more time in both stance and double support. These adaptations increased during the moderate and maximal perturbations. They stepped with the minimal perturbation obstacle further forward in their crossing step and produced a lower, flatter trajectory of the lead foot, with less dorsiflexion at crossing. This strategy decreased trailing toe clearance but did not alter leading heel clearance. The combined effects of ligamentous laxity, low tone, obesity, inactivity and physiological decrements associated with aging lead to these stability-enhancing adaptations at a younger chronological age in adults with DS. We believe intervention to increase overall stability will be beneficial in helping adults with DS maintain optimal functional mobility and health.
我们的目标是研究唐氏综合征（DS）老年患者在舒适的地面行走以及更具挑战性的条件下，其步态模式中早熟的稳定适应情况。12名唐氏综合征患者和12名发育正常（TD）的参与者在身高、体重和年龄（35 - 62岁）方面进行了匹配。我们使用六摄像头运动捕捉系统来评估越过障碍物时的足部轨迹。参与者首先以他们偏好的速度在5.3米的仪器化步态垫上行走（无干扰条件）。随后的行走试验包括在人行道中间进行干扰：（a）跨越的最小障碍物（12厘米高），（b）双脚踏上然后离开的中等障碍物（标准步），以及（c）单脚踏上并用另一只脚跨越的最大障碍物（标准步）。唐氏综合征成年患者行走速度较慢，步幅更短、更宽，同时在站立期和双支撑期花费更多时间。在中等和最大干扰期间，这些适应情况有所增加。他们在跨越最小干扰障碍物时，交叉步向前迈得更远，前脚轨迹更低、更平，交叉时背屈更小。这种策略减少了后足趾间隙，但没有改变前足跟间隙。韧带松弛、肌张力低、肥胖、缺乏运动以及与衰老相关的生理衰退等综合影响，导致唐氏综合征成年患者在较年轻的实际年龄就出现了这些增强稳定性的适应情况。我们认为，增加整体稳定性的干预措施将有助于唐氏综合征成年患者保持最佳的功能活动能力和健康状况。
