Marije Goudriaan1, Marleen Van den Hauwe2, Cristina Simon-Martinez3, Catherine Huenaerts4, Guy Molenaers5, Nathalie Goemans6, Kaat Desloovere4. 1. KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium. Electronic address: marije.goudriaan@kuleuven.be. 2. KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Department of Child Neurology, Leuven, Belgium. 3. KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium. 4. KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium. 5. University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium; KU Leuven - Department of Development and Regeneration, University of Leuven, Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Pellenberg, Belgium. 6. University Hospitals Leuven, Department of Child Neurology, Leuven, Belgium; KU Leuven - Department of Development and Regeneration, University of Leuven, Leuven, Belgium.
Abstract
BACKGROUND: Prolonged ambulation is considered important in children with Duchenne muscular dystrophy (DMD). However, previous studies analyzing DMD gait were sensitive to false positive outcomes, caused by uncorrected multiple comparisons, regional focus bias, and inter-component covariance bias. Also, while muscle weakness is often suggested to be the main cause for the altered gait pattern in DMD, this was never verified. RESEARCH QUESTION: Our research question was twofold: 1) are we able to confirm the sagittal kinematic and kinetic gait alterations described in a previous review with statistical non-parametric mapping (SnPM)? And 2) are these gait deviations related to lower limb weakness? METHODS: We compared gait kinematics and kinetics of 15 children with DMD and 15 typical developing (TD) children (5-17 years), with a two sample Hotelling's T2 test and post-hoc two-tailed, two-sample t-test. We used canonical correlation analyses to study the relationship between weakness and altered gait parameters. For all analyses, α-level was corrected for multiple comparisons, resulting in α = 0.005. RESULTS: We only found one of the previously reported kinematic deviations: the children with DMD had an increased knee flexion angle during swing (p = 0.0006). Observed gait deviations that were not reported in the review were an increased hip flexion angle during stance (p = 0.0009) and swing (p = 0.0001), altered combined knee and ankle torques (p = 0.0002), and decreased power absorption during stance (p = 0.0001). No relationships between weakness and these gait deviations were found. SIGNIFICANCE: We were not able to replicate the gait deviations in DMD previously reported in literature, thus DMD gait remains undefined. Further, weakness does not seem to be linearly related to altered gait features. The progressive nature of the disease requires larger study populations and longitudinal analyses to gain more insight into DMD gait and its underlying causes.
BACKGROUND: Prolonged ambulation is considered important in children with Duchenne muscular dystrophy (DMD). However, previous studies analyzing DMD gait were sensitive to false positive outcomes, caused by uncorrected multiple comparisons, regional focus bias, and inter-component covariance bias. Also, while muscle weakness is often suggested to be the main cause for the altered gait pattern in DMD, this was never verified. RESEARCH QUESTION: Our research question was twofold: 1) are we able to confirm the sagittal kinematic and kinetic gait alterations described in a previous review with statistical non-parametric mapping (SnPM)? And 2) are these gait deviations related to lower limb weakness? METHODS: We compared gait kinematics and kinetics of 15 children with DMD and 15 typical developing (TD) children (5-17 years), with a two sample Hotelling's T2 test and post-hoc two-tailed, two-sample t-test. We used canonical correlation analyses to study the relationship between weakness and altered gait parameters. For all analyses, α-level was corrected for multiple comparisons, resulting in α = 0.005. RESULTS: We only found one of the previously reported kinematic deviations: the children with DMD had an increased knee flexion angle during swing (p = 0.0006). Observed gait deviations that were not reported in the review were an increased hip flexion angle during stance (p = 0.0009) and swing (p = 0.0001), altered combined knee and ankle torques (p = 0.0002), and decreased power absorption during stance (p = 0.0001). No relationships between weakness and these gait deviations were found. SIGNIFICANCE: We were not able to replicate the gait deviations in DMD previously reported in literature, thus DMD gait remains undefined. Further, weakness does not seem to be linearly related to altered gait features. The progressive nature of the disease requires larger study populations and longitudinal analyses to gain more insight into DMD gait and its underlying causes.
Authors: Katherine E Bukovec; Xiao Hu; Matthew Borkowski; Duane Jeffery; Silvia S Blemker; Robert W Grange Journal: J Appl Physiol (1985) Date: 2020-09-03
Authors: Ines Vandekerckhove; Marleen Van den Hauwe; Nathalie De Beukelaer; Elze Stoop; Marije Goudriaan; Margaux Delporte; Geert Molenberghs; Anja Van Campenhout; Liesbeth De Waele; Nathalie Goemans; Friedl De Groote; Kaat Desloovere Journal: Front Hum Neurosci Date: 2022-06-02 Impact factor: 3.473