Early onset of stabilizing strategies for gait and obstacles: Older adults with Down syndrome

Abstract

Our goal was to examine the gait patterns of older adults with Down syndrome (DS) for precocious stabilizing adaptations during comfortable over-ground walking and in more challenging conditions. Twelve participants with DS and 12 with typical development (TD) were matched for height, weight and age (range 35 to 62 years). We used a 6-camera motion capture system to assess foot trajectories over obstacles. Participants first walked at their preferred speed over a 5.3 m instrumented gait mat (unperturbed condition). Subsequent walking trials included perturbations mid-walkway: a) minimal obstacle to step over (12 cm high), b) moderate obstacle to step onto with both feet and then off (standard step), c) maximum obstacle to step onto with only one foot and over with the other (standard step).Adults with DS walked slower with shorter, wider strides while spending more time in both stance and double support. These adaptations increased during the moderate and maximal perturbations. They stepped with the minimal perturbation obstacle further forward in their crossing step and produced a lower, flatter trajectory of the lead foot, with less dorsiflexion at crossing. This strategy decreased trailing toe clearance but did not alter leading heel clearance.The combined effects of ligamentous laxity, low tone, obesity, inactivity and physiological decrements associated with aging lead to these stability-enhancing adaptations at a younger chronological age in adults with DS. We believe intervention to increase overall stability will be beneficial in helping adults with DS maintain optimal functional mobility and health.

Gait and Balance

“…More specifically, the reduced stability shown in adults with Down syndrome is documented by the increased variability in the base of stance width and step length (Agiovlasitis et al 2009a;Smith and Ulrich 2008), by the increased mediolateral variability of the center of mass, and by the higher mediolateral range of motion of the center of mass (Agiovlasitis et al 2009a;Buzzi et al 2002;Kubo and Ulrich 2006a;Kubo and Ulrich 2006b), especially at higher walking speeds (Agiovlasitis et al 2009a). Similar findings and conclusions have also been shown in studies investigating children with ID during walking Kubo and Ulrich 2006a;Kubo and Ulrich 2006b).…”

“…However, the significantly higher increase in mediolateral variability of the center of mass as a function of walking speed that is observed in individuals with ID compared to asymptomatic peers, is not always compensated by an increase in base of stance width (Smith and Ulrich 2008). Especially in younger people, an increase in walking speed is accompanied by a reduction in step duration as well (Agiovlasitis et al 2009a).…”

“…It has been shown that they walk slower, with higher cadence, shorter step length, wider base of stance width and longer double support phase (Cioni et al 2001;Galli et al 2008a;Kubo and Ulrich 2006a;Kubo and Ulrich 2006b;Parker and Bronks 1980;Parker et al 1986;Smith et al 2007;Smith and Ulrich 2008;Ulrich et al 2004;Virji-Babul and Brown 2004). The reduced walking speed is also reflected in the decreased ground reaction forces during the push off phase (Cioni et al 2001;Galli et al 2008a;Kubo and Ulrich 2006a;Smith et al 2007;Smith and Ulrich 2008). Furthermore, persons with Down syndrome show increased head movement and increased variability in step length, base of stance width and kinematic patterns (Parker and Bronks 1980).…”

“…In addition, children and adults with Down syndrome demonstrate a general picture of walking characterized by reduced stability, as reflected by displacements of their center of mass (Agiovlasitis et al 2009a;Black et al 2007;Buzzi and Ulrich 2004;Kubo and Ulrich 2006a;Kubo and Ulrich 2006b;Parker and Bronks 1980;Smith and Ulrich 2008). More specifically, the reduced stability shown in adults with Down syndrome is documented by the increased variability in the base of stance width and step length (Agiovlasitis et al 2009a;Smith and Ulrich 2008), by the increased mediolateral variability of the center of mass, and by the higher mediolateral range of motion of the center of mass (Agiovlasitis et al 2009a;Buzzi et al 2002;Kubo and Ulrich 2006a;Kubo and Ulrich 2006b), especially at higher walking speeds (Agiovlasitis et al 2009a).…”

Use of Video Modeling to Teach Weight Lifting Techniques to Adults with Down Syndrome: A Pilot Study

“…Together, delays in motor development and decreased levels of strength can delay an individual's acquisition of functional movement skills across the lifespan (Carmeli, Ariav, Bar-Yossef, Levy & Imam, 2012;Carmeli, Kessel, Coleman & Ayalon, 2002;Cioni, Cocilovo & DiPasquale, 1994;Mendonca, Pereira & Fernhall, 2011). The failure to develop adequate functional movement skills may result in decreased mobility, an increased risk of falls, and the inability to complete activities of daily living (Carmeli, Bar-Chad, Lenger & Coleman, 2002;Horvat & Croce, 1995;Lifshitz, Merrick & Morad, 2008;Maaskant et al, 1996;Smith & Ulrich, 2008).…”