Men and women with Down syndrome exhibit different kinematic (but not spatio‐temporal) gait patterns

Abstract

Background Gait phenotypes are well documented in people with Down syndrome (pwDS), but sexrelated differences are still unexplored. This study investigated the existence of possible differences in spatio-temporal and kinematic parameters of gait between men and women with DS using quantitative three-dimensional gait analysis. Methods Gait patterns of 117 pwDS (53 F, 64 M) who underwent a computerised gait analysis from 2002 to 2017 were retrospectively analysed to obtain spatio-temporal gait parameters and kinematics in the sagittal plane at hip, knee and ankle joints, as well as foot progression. Results Overall, when considered as a single group, the gait patterns found for pwDS confirmed the findings of previous studies. However, when analysed by sex, our data revealed that women with DS exhibit a larger hip flexion at late stance (42% to 54% of the gait cycle) and reduced knee flexion at the beginning of the swing phase (61% to 69% of the gait cycle). In contrast, men are characterised by larger foot extrarotation angles through most of the stance phase (from 0% to 55% of the gait cycle) and at the end of the swing phase (92% to 99% of the gait cycle). No differences between men and women with DS were found concerning ankle dorsi-plantar-flexion or in all spatio-temporal parameters normalised by individuals' anthropometry, excluding cadence (higher in women). ConclusionsThe findings of the present study highlight the need to investigate gait dysfunctions in pwDS by taking their sex into consideration. Such an approach may be useful not only in gaining a better understanding of the pathophysiology of gait disturbances associated with DS but also in supporting a better orientation of rehabilitative treatments.M. Pau et al. • Gait in men and women with Down syndrome

Sex differences in the gait kinematics of patients with Down syndrome: A preliminary report

“…Rather, a sex-specific movement pattern emerged from multi-plane joints motion: in females, sagittal-plane joint kinematics was more altered at the pelvis, hip and knee level; pelvis and hip rotation and pelvis tilt were also impaired; an opposite trend was found on foot progression, as the corresponding GVSs was higher in men. These results further confirm recent observations showing that women with DS tend to have larger hip flexion at late stance and reduced knee flexion at early swing, while men showed larger foot extra rotation at late swing (15). Hip and knee flexion deficits are probably associated, as in healthy women, with weaker abdominal (20) and hip flexor (22) muscles.…”

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

“…Analogous differences in the kinematic pattern were found in studies comparing individuals with DS to healthy controls 2,27) , the latter highlighting a significant reduction in ankle range of motion in DS, with a wider plantar-flexion range observed during the entire movement. Recently, two studies 32,33) evaluated the differences in gait kinematic parameters between men and women with Down Syndrome in more than 340 patients aged 7-50 years. Overall, the gait function in females seems to be more impaired than in males, with the exception of foot progression.…”

“…Overall, the gait function in females seems to be more impaired than in males, with the exception of foot progression. Women with DS exhibit a larger hip flexion at late stance (42% to 54% of the gait cycle) and reduced knee flexion at the beginning of the swing phase (61% to 69% of the gait cycle), step length was shorter, and the Gait Profile Score (GPS, a synthetic measure of gait abnormality) was higher than in male patients 32,33) .…”

“…Focusing on gender-related differences, women exhibit a larger hip flexion at late stance and reduced knee flexion at the beginning of the swing phase, shorter step length and higher GPS than in male patients 32,33) . These findings are likely due to the weakness of the hip flexors and of the abdominal muscles typical of women with DS.…”

“…They adopt a pelvic strategy (i.e., greater pelvic leading-side listing and forward rotation) to achieve a higher leading toe clearance with a longer step length. Pau et al, 2019 32) DS: 117 Females: 53 (26.7 years); Males: 64 (27.8 years)…”