Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review

Zago, Matteo; Duarte, Natália de Almeida Carvalho; Grecco, Luanda André Collange; Claes, Claudia; Oliveira, Cláudia Santos; Galli, Manuela

doi:10.1589/jpts.32.303

Cited by 25 publications

(21 citation statements)

References 56 publications

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“…As already widely discussed, this pathology presents typical characteristics, including joint stiffness, muscular hypotonia, ligamentous laxity, poor balance and motor coordination, low push-off ability, greater CoM oscillations in the medio-lateral direction ( Rigoldi et al., 2011 ; Zago et al., 2020 ).…”

Section: Discussionmentioning

confidence: 96%

“…Typical characteristics of these patients are muscular hypotonia, joint stiffness and ligamentous laxity that lead to an incorrect postural control, a reduction in walking speed and step length, an inadequate static balance with antero-posterior and medio-lateral oscillations and a greater step width ( Agiovlasitis et al., 2011 ; Horvat et al., 2012 ). All this inevitably leads to a greater energy expenditure due to an altered pattern of kinetic and potential energy of these subjects and the adoption of compensatory strategies, which often result in an abnormal gait ( Salami et al., 2014 ; Webber et al., 2004 ; Zago et al., 2020 ). Improvement in gait and postural control after several training sessions, in terms of kinematics and kinetics, has been observed in several studies, demonstrating how physical activity programs can encourage a better lifestyle and slow down the development of age-related and sedentary diseases ( Carmeli et al., 2002 ; Maki et al., 1994 ; Rigoldi et al., 2011 ; Winter et al., 2003 ), particularly if training and rehabilitation are carried out in childhood, before children acquire walking patterns ( Zago et al., 2020 ).…”

Section: Introductionmentioning

confidence: 99%

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Energy analysis of gait in patients with down syndrome

Ferrario

Claes²,

Tarabini³

et al. 2022

Heliyon

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Energy analysis of gait in patients with down syndrome

Ferrario

Claes²,

Tarabini³

et al. 2022

Heliyon

Self Cite

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“…The ligaments around joints could strengthen the structure stability [38] Based on our results, the foot structure is another factor, except the ankle stiffness, that induces an inefficient balance strategy. It may require other compensatory strategy involving the hip adopted, resulting in a greater displacement of the centre of pressure in both anteroposterior and mediolateral direction [42]. The potential cause of this abnormal loading pattern is the poor alignment of the transverse tarsal joint and the ligament laxity [18].…”

Section: Discussionmentioning

confidence: 99%

Abnormal Biomechanical Conditions of the Foot in Child with Down Syndrome During Standing: A Finite Element Study

Huang

Zhang

et al. 2021

Preprint

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Background: Down syndrome children have a high incidence of pes planus. Pain follows and does harm to their daily life. To well manage their foot pain, it’s necessary to know the mechanism of the pain from the aspect of biomechanics. The purpose of this study was to characterize the abnormal biomechanical conditions of foot in Down syndrome children during standing, comparing to the normal control children by finite element method. Methods: Two participants aged 5 were recruited in this study that are a Down syndrome child with pes planus and a normal control child. Two three-dimension finite element foot models were constructed from CT of the two participants, each of which include bones, ligaments, plantar fascia, cartilages, epiphyseal plates and an encapsulated soft tissue. The plantar pressure during standing and anthropometric data were collected from the same participants for model validation and simulation. Results: The abnormal alignment of the transverse tarsal joint showed in Down syndrome child. The contact pressure in Down syndrome child was higher in tibiotalar joint, compared with the normal control child. The tensile force of spring, plantar calcaneocuboid ligaments in Down syndrome child was approximately 9 folds and 58 folds greater than normal control child, respectively. In Down syndrome child contact force of the talonavicular joint was 0.05 times the body weight and calcaneocuboid joint was near zero, whereas the value in normal control child was 0.11 and 0.01 respectively. Conclusion: The Down syndrome child showed abnormal biomechanical conditions in foot in terms of joints contact pressure, tensile force of ligament around transverse tarsal joint and contact force transmission through transverse tarsal joint. These abnormal biomechanical conditions resulted from pes planus are the potential factors that may cause their foot pain. Conservative interventions should be considered at their early age to eliminate negative effect of these potential factors.

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“…The increased ventilatory response could be of central origin and adaptive to the effort secondary to altered gait patterns (Agiovlasitis et al, 2015), neuromuscular abnormalities, and neurological impairments affecting stability and motor control (Zago et al, 2020). The physiological response of DS individuals may be disproportionate to the exercise performed.…”

Section: Submaximal Cardiorespiratory and Hemodynamic Responsesmentioning

confidence: 99%

Hemodynamic and cardiorespiratory responses to submaximal and maximal exercise in adults with Down syndrome

et al. 2022

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Introduction: The genetic disorder causing Down syndrome (DS) affects the cardiorespiratory and hemodynamic parameters. When exercising, sufficient blood flow is necessary for active muscles. Cardiac output (Q) must be proportional to the peripheral requirements. In case the stroke volume (SV) is lower, the heart rate (HR) will increase further in order to maintain an adequate blood flow in the active territories (HR compensatory response). People with DS have a lower HR response to maximal exercise. Nevertheless, the response of the hemodynamic and cardiorespiratory parameters during the submaximal phases of maximal exercise was not well studied.Objective: to evaluate cardiorespiratory and hemodynamic parameters 1) during submaximal and 2) maximal metabolic treadmill test in individuals with and without DS.Methods: fifteen adults with DS (age = 27.33 ± 4.98 years old; n = 12 males/3 females) and 15 adults without disabilities, matched by age and sex, participated in this cross-sectional study. Peak and submaximal cardiorespiratory and hemodynamic parameters were measured during a treadmill test. Linear mixed-effects models were used to analyse interactions between the variables. Post-hoc analyses were employed to assess within and between-group differences.Results: The DS group showed lower peak values for ventilation (VE), respiratory exchange ratio (RER), tidal volume (VT), ventilatory equivalent for O2 (VEqO2), end-tidal partial pressure for O2 (PETO2), O2 uptake (VO2) and CO2 production (all p < 0 .050), Q, SV, systolic and diastolic blood pressure (SBP, DBP), and HR (all p < 0 .050). There were group-by-time interactions (all p < 0 .050) for all ventilatory submaximal values. Significant group and time differences were observed for VE; RER; respiratory rate (RR); VEqO2; PETO2; VO2, and VT (all p < 0 .050). There were also group-by-time interactions (all p < 0 .050) and group and time differences for SBP, mean arterial blood pressure (MAP) and HR (all p < 0.010).Conclusion: During submaximal exercise, we verified a compensatory response of HR, and greater VE and VO2 in the individuals with DS. In addition, we were able to observe that the DS group had a reduced SBP and MAP response to submaximal exercise. On the other hand, we found that adults with DS have lower peak hemodynamic and cardiorespiratory values, and a lower cardiac reserve. Further research is warranted to investigate the effects of these results on the general health of adults with DS and the impact of long-term exercise programs on these parameters.

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Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review

Cited by 25 publications

References 56 publications

Energy analysis of gait in patients with down syndrome

Energy analysis of gait in patients with down syndrome

Abnormal Biomechanical Conditions of the Foot in Child with Down Syndrome During Standing: A Finite Element Study

Hemodynamic and cardiorespiratory responses to submaximal and maximal exercise in adults with Down syndrome

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