SUMMARY
Forty‐six separate gait studies were analysed for 21 ambulatory patients with Duchenne muscular dystrophy. Three groups were defined on the basis of significant gait variables: early, transitional and late. Disease progression can be predicted with 91 per cent accuracy by three gait variables: cadence, dorsiflexion in swing, and anterior pelvic tilt.
The patients in the early group manifested a positive Gower's sign but gait changes were subtle, being principally slightly increased hip flexion in swing, decreased dorsiflexion in swing and reduction in cadence. The force line moved in front of the knee center early in single‐limb support.
In the transitional stage, anterior pelvic tilt was exaggerated, cadence was turther reduced, and foot drop in swing phase was increased. Shoulder sway was noted as a compensation for gluteus medius weakness. The base of support widened. The force line remained behind the hip joint and in front of the knee joint throughout single‐limb support.
In the late stage, work output increased, cadence continued to drop, shoulder sway increased further, and there was a wider base of support. The force line remained very close to the center of the hip and in front of the knee at all times during single‐limb support.
The authors' conclusions are: (1) the earliest postural change in gait is increased lumbar lordosis secondary to gluteus maximus weakness, and at this time the quadriceps are relatively competent; (2) quadriceps insufficiency was the key factor in gait deterioration. It appeared in the transitional stage and was characterized by exaggerated anterior pelvic tilt, restricted hip extension in stance phase, equinus posturing, and maintenance of the force line in front of the knee throughout single‐limb support. Long‐leg bracing is indicated when these signs of quadriceps insufficiency are noted.
RÉSUMÉ
La mécanisme pathologique de la démarche dans la myopathic de Duchenne
46 démarches séparées ont été analysées chez 21 sujets ambulatoires atteints de myopathie de Duchenne. Trois groupes ont été définis sur la base de variables significatives de la démarche: précoce, intermédiaire et tardif. La progression de la maladie a pu être prédite avec 91 pour cent de précision à partir de trois variables de la démarche: la cadence, la dorsi‐flexion durant le temps oscillant et la bascule pelvienne antérieure.
Les malades du premier groupe présentaient un signe de Gower positif mais les modifications de la démarche étaient minimes. Principalement un léger accroissement de la flexion de hanche durant le temps oscillant, une diminution de la dorsiflexion durant le temps oscillant et une diminution de la cadence. La ligne de gravité était déplacée en avant du centre du genou, précocément durant le temps de support sur un seul membre.
Dans le groupe intermédiaire, la bascule pelvienne antérieure était exagérée, la cadence était encore plus réduite et la chute du pied durant le temps oscillant était accrue. Le roulement des épaules était observé comme compensation de la faiblesse des fessie...
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