Journal of Rehabilitation Medicine 51-2 | Page 69

J Rehabil Med 2019; 51: 144–146 SHORT COMMUNICATION SEX DIFFERENCES IN THE GAIT KINEMATICS OF PATIENTS WITH DOWN SYNDROME: A PRELIMINARY REPORT Matteo ZAGO, PhD 1,2 , Claudia CONDOLUCI, MD 3 , Massimiliano PAU, MD 4 and Manuela GALLI, PhD 1 Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 2 Fondazione Istituto Farmacologico Filippo Serpero, Milano, 3 IRCCS San Raffaele Pisana, Tosinvest Sanità, Roma, and 4 Department of Mechanical, Chemical and Materials Engineering, Università di Cagliari, Cagliari, Italy 1 Objective: Sex-specific medicine requires understan- ding of the specific therapeutic needs and patho­ physiology of men and women. In these terms, we investigated sex-related differences in the gait kine- matics of patients with Down syndrome. Design: Retrospective observational cohort study. Subjects: A sample of 230 patients (103 females) aged 7–50 years underwent a standard gait-analysis test from 2000 to 2015. Methods: Spatiotemporal gait parameters and synt- hetic indexes were computed as Gait Profile Score (GPS) and pelvis/lower limbs as Gait Variable Scores. Results: Although speed, normalized step width, %stance and %swing were similar, in female pa- tients step length was shorter and GPS was higher than in male patients, with no significant effect of age, speed and body mass index. Sex-specific fea- tures were found at the pelvis, hip and knee level (sagittal plane), and at the ankle level (transverse plane). Conclusion: Overall, in people with Down syndrome, the gait function of females tends to be more impai- red than in males, with the exception of foot pro- gression. Therapists should consider these differen- ces when evaluating the severity of gait impairment and designing rehabilitation strategies. Key words: Down syndrome; sex; gait analysis; kinematics. Accepted Oct 23, 2018; Epub ahead of print Dec 19, 2018 J Rehabil Med 2019: 51: 144–146 Correspondence address: Matteo Zago, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza Leonardo da Vinci 32, IT-20133 Milano, Italy. E-mail: [email protected] S ex-specific medicine, a global trend in modern healthcare, requires detailed understanding of the different signs, pathophysiology and therapeutic needs of males and females (1). Little is known about sex differences in the gait function of patients with Down syndrome (DS). DS is a chromosomal aneuploidy that produces disruptions in various body systems, inclu- ding musculoskeletal function, and delayed neuropsy- chomotor development (2). In particular, ligament laxity, osteoporosis, and muscle hypotonia in the lower limbs critically affect postural control and mobility (3–5): gait function is characterized by reduced speed, reduced step length and increased step width, balance LAY ABSTRACT In Down syndrome, gait function tends to be more im- paired in females than in males, even when taking into account the confounding effects of age, gait speed and anthropometrics. Therapists should be aware of these differences when evaluating the severity of gait impair- ment and in designing rehabilitation strategies. deficit, joint instability (increased mediolateral centre of mass displacement) and energetic inefficiency (6–8). Alterations in joints kinematics include excessive pelvic tilt, external hip and tibial rotation, increased hip flexion and knee flexion during the stance phase, with associated limited range of motion, abnormal foot rotation and reduced propulsive action of the ankle plantarflexors (4, 9, 10). With respect to healthy women, age-matched healthy men generally walk at higher speed, take longer steps with consequent reduced cadence (11), and show joint kinematics peculiarities, driven by both morphological and social factors (12). In the event of musculoskeletal (13) or neurological diseases (14, 15), sex-specific gait patterns may be enhanced or modified. We hypothesize that sex-related differences could also be present in people with DS. This paper characterized the gait kinematic phenotype of males and females with DS. As the gait function is, to some extent, trainable in people with intellectual disabilities (5), distinct features may suggest rede- signing or customizing rehabilitation and physical treatment procedures. METHODS Participants and procedures A sample of 230 patients diagnosed with DS (103 females, 127 males) were recruited for this retrospective cohort study from 2000 to 2015. A total of 44 patients (22 females, 22 males) aged 6–12 years, 39 (16 females, 23 males) aged 13–18 years, 134 (60 females, 74 males) aged 19–40 years and 13 (5 females, 8 males) aged > 40 years were analysed. Inclusion criteria were: diagnosed pure trisomy 21 chromosome abnormality, no clinical sign of dementia, and no previous surgery. All individuals could understand and complete the gait test and walk independently. Patients or legal guardians signed a written informed consent prior to participation. This study was approved by the ethics committee of the IRCCS San Raffaele hospital (protocol #17/17) and conducted according to the Declaration of Helsinki. This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2507 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977