title: Early signs of gait deviation in Duchenne muscular dystrophy.
abstract: BACKGROUND
  Most analytical studies found in literature only focus on specific aspects of Duchenne muscular dystrophy (DMD) gait and posture (joint range of motion, standing balance, variations of gait spatial-temporal parameters). Some of them analyze single cases and do not provide a comprehensive evaluation of locomotion. There are few studies about DMD gait patterns, most of them concerning small groups of patients, sometimes not homogeneous, in which the clinical manifestations of the next stages of DMD were present.
  
  
  OBJECTIVE
  The goal of our study was to analyze the characteristics of gait patterns in early stage patients, when clinical and functional evaluation do not allow to quantify initial walking worsening or to identify the changes adopted to compensate for muscle weakness.
  
  
  METHODS
  Gait Analysis Laboratory by using a six-camera motion capture system (Vicon, Oxford Metrics, UK), set at a sampling rate of 60 Hz. Subjects were asked to walk barefoot at their usual cadence, along a 10-m walkway, where one force platform (Kistler, Switzerland), embedded in the middle portion of the pathway, measured the foot-ground reaction forces. Retroreflective markers were placed on the subjects according to the protocol described in Davis et al.
  
  
  METHODS
  A group of 15 patients aging from 5 to 6.8 years was compared with a similar age control group composed of 9 healthy children.
  
  
  RESULTS
  Spatial and temporal parameters showed significant differences between the two groups: cadence was increased and step length was decreased significantly in the DMD group. We found a significant increase in the range of anterior-posterior pelvic tilt and in pelvic rotation. In the frontal plane there was a tendency for an increased pelvic obliquity. Dynamic range of motion in sagittal plane showed a significant difference at the ankle, with an increased plantarflexion in swing in the dystrophic patients. Maximum dorsiflexion was reduced in the DMD group. Kinetic analysis showed significant differences in power generation and absorption at the hip joint and at the ankle joint. At knee there was a reduced flexor moment in mid-stance. Ankle showed a reduced dorsiflexor moment in terminal stance and pre-swing with a consequent reduction in the peak-to-peak excursion.
  
  
  CONCLUSIONS
  It was shown that instrumented gait analysis, being more sensitive than other clinical and functional assessment methods, allowed to quantify the very early modifications characterizing locomotion worsening in the first stage of the DMD.
authors.affiliation: Department of Neuroscience and Rehabilitation, G. Gaslini Institute and University of Genoa, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Doglio
authors.forename: E
authors.initials: E
authors.lastname: Pavan
authors.forename: I
authors.initials: I
authors.lastname: Pernigotti
authors.forename: P
authors.initials: P
authors.lastname: Petralia
authors.forename: C
authors.initials: C
authors.lastname: Frigo
authors.forename: C
authors.initials: C
authors.lastname: Minetti
mesh_terms: D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008124:Locomotion / Q000502:physiology; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D020388:Muscular Dystrophy, Duchenne / Q000175:diagnosis / Q000503:physiopathology*; D004856:Postural Balance / Q000502:physiology*