Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Belgium; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Belgium.
Gait Posture. 2021 Feb;84:321-328. doi: 10.1016/j.gaitpost.2020.12.029. Epub 2020 Dec 31.
Dravet Syndrome (DS) is a developmental and epileptic encephalopathy starting in infancy and characterised by treatment resistant epilepsy with cognitive impairment and progressive motor dysfunction. Walking becomes markedly impaired with age, but the mechanical nature of gait problems remains unclear.
What are the kinetic strategies characterised in gait of patients with DS?
This case-control study compared 41 patients with DS aged 5.2-26.1 years (19 female, 22 male) to 41 typically developing (TD) peers. Three dimensional gait analysis (VICON) was performed to obtain spatiotemporal parameters, kinematics and kinetics during barefoot, level walking at self-selected walking velocity. The sagittal plane support moment was analysed using Statistical Parametric Mapping (SPM). Three DS subgroups were identified based on differences in kinetic strategies characterised by the net internal knee joint moments and trunk lean. Kinematic and kinetic time profiles of the subgroups were compared to the TD group (SPM t-test). Clinical characteristics from physical examination and parental anamnesis were compared between DS (sub)groups using non-parametric tests (Kruskal-Wallis, Wilcoxon rank-sum, Fisher's exact).
Support moments in stance were significantly increased in the DS group compared to TD and strongly related to minimum knee flexion in midstance. Persistent internal knee extension moments during stance were detected in a subgroup of 27 % of the patients. A second subgroup of 34 % showed forward trunk lean and attained internal knee flexion moments. The remaining 39 % had neutral or backward trunk lean with internal knee flexion moments. Subgroups differed significantly in age and functional mobility.
Inefficient kinetic patterns suggested that increased muscle effort was needed to control lower limb stability. Three distinct kinetic strategies that underly kinematic deviations were identified. Clinical evaluation of gait should pay attention to knee angles, trunk lean and support moments.
Dravet 综合征（DS）是一种始于婴儿期的发育性和癫痫性脑病，其特征为耐药性癫痫，伴有认知障碍和进行性运动功能障碍。随着年龄的增长，行走能力明显受损，但步态问题的力学性质尚不清楚。
DS 患者步态的动力学策略有哪些特点？
本病例对照研究比较了 41 名年龄 5.2-26.1 岁（19 名女性，22 名男性）的 DS 患者和 41 名典型发育（TD）同龄人。使用三维步态分析（VICON）在赤脚、以自身选择的步行速度在水平表面行走时，获得时空参数、运动学和动力学。使用统计参数映射（SPM）分析矢状面支撑力矩。根据净膝关节内力矩和躯干倾斜度的动力学策略差异，将 DS 分为三个亚组。将亚组的运动学和动力学时间曲线与 TD 组进行比较（SPM t 检验）。使用非参数检验（Kruskal-Wallis、Wilcoxon 秩和、Fisher 精确检验）比较 DS（亚）组的体格检查和父母病史的临床特征。
与 TD 相比，DS 组在站立时的支撑力矩明显增加，并且与中足时最小膝关节屈曲密切相关。在 27%的患者中发现了持续的膝关节伸展力矩。34%的患者存在前躯干倾斜，并产生膝关节内屈力矩。其余 39%的患者具有中立或后躯干倾斜，伴有膝关节内屈力矩。亚组在年龄和功能移动性方面存在显著差异。
低效的动力学模式表明，需要增加肌肉努力来控制下肢稳定性。确定了三种不同的动力学策略，这些策略构成了运动学偏差的基础。步态的临床评估应注意膝关节角度、躯干倾斜和支撑力矩。
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