Muscle Activation during Gait in Children with Duchenne Muscular Dystrophy

The aim of this prospective study was to investigate changes in muscle activity during gait in children with Duchenne muscular Dystrophy (DMD). Dynamic surface electromyography recordings (EMGs) of 16 children with DMD and pathological gait were compared with those of 15 control children. The activity of the rectus femoris (RF), vastus lateralis (VL), medial hamstrings (HS), tibialis anterior (TA) and gastrocnemius soleus (GAS) muscles was recorded and analysed quantitatively and qualitatively. The overall muscle activity in the children with DMD was significantly different from that of the control group. Percentage activation amplitudes of RF, HS and TA were greater throughout the gait cycle in the children with DMD and the timing of GAS activity differed from the control children. Significantly greater muscle coactivation was found in the children with DMD. There were no significant differences between sides. Since the motor command is normal in DMD, the hyper-activity and co-contractions likely compensate for gait instability and muscle weakness, however may have negative consequences on the muscles and may increase the energy cost of gait. Simple rehabilitative strategies such as targeted physical therapies may improve stability and thus the pattern of muscle activity.

[1]  A. Pedotti,et al.  Electromyographic signals during gait: Criteria for envelope filtering and number of strides , 1998, Medical and Biological Engineering and Computing.

[2]  B. Petrof.  The molecular basis of activity-induced muscle injury in Duchenne muscular dystrophy , 1998, Molecular and Cellular Biochemistry.

[3]  Anna Carla Turconi,et al.  Gait pattern in Duchenne muscular dystrophy. , 2009, Gait & posture.

[4]  A. Manzur,et al.  Glucocorticoid corticosteroids for Duchenne muscular dystrophy. , 2008, The Cochrane database of systematic reviews.

[5]  S Khodadadeh,et al.  Variations of Gait Parameters in Duchenne Muscular Dystrophy , 1990, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[6]  R. Olshen,et al.  The Pathomechanics of Gait in Duchenne Muscular Dystrophy , 1981, Developmental medicine and child neurology.

[7]  S. Rutkove.  Electrical impedance myography: Background, current state, and future directions , 2009, Muscle & nerve.

[8]  S. Nadeau,et al.  Gait patterns comparison of children with Duchenne muscular dystrophy to those of control subjects considering the effect of gait velocity. , 2010, Gait & posture.

[9]  L. Moja,et al.  Efficacy of Muscle Exercise in Patients with Muscular Dystrophy: A Systematic Review Showing a Missed Opportunity to Improve Outcomes , 2013, PloS one.

[10]  G. Comi,et al.  24 Month Longitudinal Data in Ambulant Boys with Duchenne Muscular Dystrophy , 2013, PloS one.

[11]  Armel Crétual,et al.  KeR-EGI, a new index of gait quantification based on electromyography. , 2013, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[12]  Michael H Schwartz,et al.  The effect of walking speed on the gait of typically developing children. , 2008, Journal of biomechanics.

[13]  O. Bar-or,et al.  Cocontraction and phasic activity during GAIT in children with cerebral palsy. , 1996, Electromyography and clinical neurophysiology.

[14]  A. Hof,et al.  Speed dependence of averaged EMG profiles in walking. , 2002, Gait & posture.

[15]  I. Weinbren.  SPONTANEOUS PERIODIC ŒDEMA: A New Syndrome , 1963 .

[16]  B. Freriks,et al.  Development of recommendations for SEMG sensors and sensor placement procedures. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[17]  Michael H Schwartz,et al.  The Gait Deviation Index: a new comprehensive index of gait pathology. , 2008, Gait & posture.

[18]  R. Abresch,et al.  Profiles of neuromuscular diseases. Becker's muscular dystrophy. , 1995, American journal of physical medicine & rehabilitation.

[19]  R. B. Davis,et al.  A gait analysis data collection and reduction technique , 1991 .

[20]  April.  AIDS TO THE INVESTIGATION OF PERIPHERAL NERVE INJURIES , 1943 .

[21]  E. Pavan,et al.  Early signs of gait deviation in Duchenne muscular dystrophy. , 2011, European journal of physical and rehabilitation medicine.

[22]  P. Vignos,et al.  Management of progressive muscular dystrophy in childhood. , 1963, JAMA.

[23]  A. Emery.  Population frequencies of inherited neuromuscular diseases—A world survey , 1991, Neuromuscular Disorders.

[24]  Adam Rozumalski,et al.  The gait profile score and movement analysis profile. , 2009, Gait & posture.

[25]  J. Pélissier,et al.  Analyse de la marche au cours de la dystrophie musculaire de Duchenne , 1999 .

[26]  K P Granata,et al.  Muscle force production and functional performance in spastic cerebral palsy: relationship of cocontraction. , 2000, Archives of physical medicine and rehabilitation.

[27]  Sylvain Brochard,et al.  The influence of gait speed on co-activation in unilateral spastic cerebral palsy children. , 2013, Clinical biomechanics.

[28]  Freeman Miller,et al.  Kinesiological surface electromyography in normal children: range of normal activity and pattern analysis. , 2007, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[29]  R. Finkel,et al.  Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management , 2010, The Lancet Neurology.

[30]  C. D. De Luca,et al.  Surface myoelectric signal cross-talk among muscles of the leg. , 1988, Electroencephalography and clinical neurophysiology.

[31]  J. Patrick,et al.  KNEE MOMENTS IN DUCHENNE MUSCULAR DYSTROPHY , 1986, The Lancet.

[32]  Kamiar Aminian,et al.  Gait Assessment in Children With Duchenne Muscular Dystrophy During Long-Distance Walking , 2012, Journal of child neurology.

[33]  A. Nicorici,et al.  Classification of the Gait Patterns of Boys With Duchenne Muscular Dystrophy and Their Relationship to Function , 2010, Journal of child neurology.

[34]  M. Schwartz,et al.  The minimal clinically important difference for the Gait Profile Score. , 2012, Gait & posture.