Ribeirão Preto Medical School, University of São Paulo, Brazil.
Ribeirão Preto Medical School, University of São Paulo, Brazil.
J Biomech. 2020 Jan 2;98:109485. doi: 10.1016/j.jbiomech.2019.109485. Epub 2019 Nov 6.
Therapeutic gait interventions for individuals with Duchenne Muscular Dystrophy (DMD) should be based on understanding how movement of the individual is affected and whether different clusters of individuals, determined by clinical severity, differ. Gait indexes have been developed to synthesize the data provided by the three-dimensional (3D) gait analysis such as the Gait Deviation Index (GDI) and the Gait Profile Score (GPS) where the gait variable score (GVS) can be calculated. The objective this study was to evaluate the potential use of the GDI and GPS and MAP using data from 3D gait analysis of DMD patients. The dimension 1 score of the Motor Function Measurement defined the groups that composed the cluster analysis. Twenty patients with DMD composed 2 groups according to the cluster analysis (Cluster 1, n = 10; Cluster 2, n = 10). Three-dimensional gait analysis was conducted where GDI, GPS and GVS (pelvic tilt/obliquity; hip flexion-extension/adduction-abduction/rotation; knee flexion-extension; ankle dorsiflexion-plantarflexion, foot progression angle) were calculated. Cluster 1 group presented lower hip flexion-extension and lower pelvic obliquity when compared with Cluster 2 group (p < 0.05). There was no difference between groups for GDI, GPS total and maximum isometric muscle strength of the lower limbs (p > 0.05). This study showed that GVS could detect alterations on the parameters obtained using three-dimensional gait analysis for those DMD patients separated according to motor function regarding pelvic and hip kinematic patterns. The rehabilitation of patients with DMD is recommended from the early stages of the disease (as Cluster 1, with >MFM) with the hip joint being the therapeutic target.
针对杜氏肌营养不良症(DMD)患者的治疗性步态干预措施应基于了解个体运动的受影响情况,以及是否存在不同的临床严重程度的个体聚类存在差异。步态指数已被开发出来,以综合三维(3D)步态分析提供的数据,例如步态偏差指数(GDI)和步态概况评分(GPS),其中可以计算步态变量评分(GVS)。本研究旨在评估 GDI 和 GPS 以及 MAP 在 DMD 患者 3D 步态分析数据中的潜在用途。运动功能测量的维度 1 评分定义了构成聚类分析的组。根据聚类分析,20 名 DMD 患者分为 2 组(第 1 组,n=10;第 2 组,n=10)。进行了 3D 步态分析,计算了 GDI、GPS 和 GVS(骨盆倾斜/倾斜;髋关节屈伸/内收/外展/旋转;膝关节屈伸;踝关节背屈/跖屈,足行进角度)。与第 2 组相比,第 1 组的髋关节屈伸和骨盆倾斜较小(p<0.05)。两组之间 GDI、GPS 总和下肢最大等长肌肉力量无差异(p>0.05)。本研究表明,GVS 可以检测到根据运动功能将 DMD 患者分组后,通过三维步态分析获得的参数变化,涉及骨盆和髋关节运动学模式。建议从疾病早期(如 MFM 分级>1 级)开始对 DMD 患者进行康复治疗,髋关节是治疗的目标。