Department of Health and Sport Science, University of Dayton, Dayton, OH, USA.
Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA.
Hum Mov Sci. 2024 Jun;95:103213. doi: 10.1016/j.humov.2024.103213. Epub 2024 Mar 23.
Individuals with Down syndrome (DS) walk with altered gait patterns compared to their typically developing (TD) peers. While walking at faster speeds and with external ankle load, preadolescents with DS demonstrate spatiotemporal and kinetic improvements. However, evidence of joint kinematic adjustments is unknown, which is imperative for targeted rehabilitation design.
How does increasing walking speed and adding ankle load affect the joint kinematics of children with and without DS during overground walking?
In this cross-sectional observational study, thirteen children with DS aged 7-11 years and thirteen age- and sex-matched TD children completed overground walking trials. There were two speed conditions: normal speed and fast speed (as fast as possible without running). There were two load conditions: no load and ankle load (2% of body mass added bilaterally above the ankle). A motion capture system was used to register the ankle, knee, and hip joint angles in the sagittal plane. Peak flexion/extension angles, range of motion, and timing of peak angles were identified. In addition, statistical parametric mapping (SPM) was conducted to evaluate the trajectory of the ankle, knee, and hip joint angles across the entire gait cycle.
SPM analysis revealed the DS group walked with greater ankle, knee, and hip flexion compared to the TD group for most of the gait cycle, regardless of condition. Further, increasing walking speed led to improved ankle joint kinematics in both groups by shifting peak plantarflexion closer to toe-off. However, knee extension during stance was challenged in the DS group. Adding ankle load improved hip and knee kinematics in both groups but reduced peak plantarflexion around toe-off. The kinematic adjustments in the DS group suggest specific motor strategies to accommodate their neuromuscular deficits, which can provide a foundation to design targeted gait-based interventions for children with DS.
唐氏综合征（DS）患者的步态模式与正常发育（TD）同龄人不同。在以更快的速度和施加外部踝关节负荷行走时，青春期前 DS 患者的时空和动力学表现得到改善。然而，关节运动学调整的证据尚不清楚，这对于有针对性的康复设计至关重要。
在地面行走时，增加行走速度和施加踝关节负荷如何影响 DS 儿童和 TD 儿童的关节运动学？
在这项横断面观察性研究中，13 名 7-11 岁的 DS 儿童和 13 名年龄和性别匹配的 TD 儿童完成了地面行走试验。有两种速度条件：正常速度和快速速度（尽可能快地跑而不跑）。有两种负荷条件：无负荷和踝关节负荷（在脚踝上方双侧添加 2%的体重）。运动捕捉系统用于记录矢状面踝关节、膝关节和髋关节角度。确定了峰值屈曲/伸展角度、运动范围和峰值角度的时间。此外，还进行了统计参数映射（SPM）以评估整个步态周期中踝关节、膝关节和髋关节角度的轨迹。
SPM 分析表明，无论条件如何，DS 组在整个步态周期中比 TD 组的踝关节、膝关节和髋关节都有更大的屈曲。此外，增加行走速度会导致两组踝关节运动学的改善，通过将峰值跖屈更接近足趾离地来实现。然而，DS 组在站立时的膝关节伸展受到挑战。在两组中，施加踝关节负荷都改善了髋关节和膝关节的运动学，但减少了足趾离地时的峰值跖屈。DS 组的运动学调整表明存在特定的运动策略，以适应其神经肌肉缺陷，这可以为设计针对 DS 儿童的基于步态的靶向干预措施提供基础。
