Gait Assessment in Children With Duchenne Muscular Dystrophy During Long-Distance Walking

The aim of this study was to investigate the alteration of the gait pattern in 25 children with Duchenne muscular dystrophy, using body-worn inertial sensors during a long walking distance. Normalized spatiotemporal gait parameters and their variability were extracted from the angular velocity of the shanks; the smoothness of the trunk movement was assessed based on the spectral entropy of the acceleration norm. As compared to healthy children, patients with Duchenne muscular dystrophy showed significantly lower stride velocity and a less smooth trunk movement. When the group of patients was divided into mild and moderate based on the Motor Function Measure, the authors noticed significantly higher values both for cadence and stride velocity, as well as improved trunk smoothness in the mild versus moderate group. The potential of such parameters to distinguish between different disease states opens new perspectives for the objective assessment of efficacy of the new therapies associated with Duchenne muscular dystrophy.

[1]  Kamiar Aminian,et al.  What is the relationship between fear of falling and gait in well-functioning older persons aged 65 to 70 years? , 2010, Archives of physical medicine and rehabilitation.

[2]  Kamiar Aminian,et al.  A New Approach for Quantitative Analysis of Inter-Joint Coordination During Gait , 2008, IEEE Transactions on Biomedical Engineering.

[3]  Jacques Fermanian,et al.  A motor function measure for neuromuscular diseases. Construction and validation study. , 2005, Neuromuscular disorders : NMD.

[4]  N. Cox.  Statistical Models in Engineering , 1970 .

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

[6]  J. Friedman.  Regularized Discriminant Analysis , 1989 .

[7]  J. Schröter,et al.  The 'Entlastungsgang'. A hip unloading gait as a new conservative therapy for hip pain in the adult. , 1999, Gait & posture.

[8]  T. Inouye,et al.  Quantification of EEG irregularity by use of the entropy of the power spectrum. , 1991, Electroencephalography and clinical neurophysiology.

[9]  Kamiar Aminian,et al.  Gait alterations of diabetic patients while walking on different surfaces. , 2009, Gait & posture.

[10]  M. Stokes,et al.  Gait Analysis in Duchenne Muscular Dystrophy , 1985 .

[11]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[12]  J. Hsu,et al.  Gait and Posture Changes in the Duchenne Muscular Dystrophy Child , 1993, Clinical orthopaedics and related research.

[13]  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.

[14]  F. Leturcq,et al.  Clinical Heterogeneity of Duchenne Muscular Dystrophy (DMD): Definition of Sub-Phenotypes and Predictive Criteria by Long-Term Follow-Up , 2009, PloS one.

[15]  Kamiar Aminian,et al.  Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes. , 2002, Journal of biomechanics.

[16]  Wiebren Zijlstra,et al.  Accelerometry based assessment of gait parameters in children. , 2006, Gait & posture.

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

[18]  S. Iannaccone.  Outcome measures for pediatric spinal muscular atrophy. , 2002, Archives of neurology.

[19]  Jeffrey M. Hausdorff,et al.  Maturation of gait dynamics: stride-to-stride variability and its temporal organization in children. , 1999, Journal of applied physiology.

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

[21]  A. Hof.  Scaling gait data to body size , 1996 .

[22]  Catherine Dehollain,et al.  Gait assessment in Parkinson's disease: toward an ambulatory system for long-term monitoring , 2004, IEEE Transactions on Biomedical Engineering.

[23]  Jeffrey M. Hausdorff,et al.  Gait variability and basal ganglia disorders: Stride‐to‐stride variations of gait cycle timing in parkinson's disease and Huntington's disease , 1998, Movement disorders : official journal of the Movement Disorder Society.

[24]  Jay J. Han,et al.  The 6‐minute walk test as a new outcome measure in Duchenne muscular dystrophy , 2010, Muscle & nerve.

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

[26]  B. E. Maki,et al.  Gait Changes in Older Adults: Predictors of Falls or Indicators of Fear? , 1997, Journal of the American Geriatrics Society.

[27]  W. Thalheimer,et al.  How to calculate effect sizes from published research: A simplified methodology , 2002 .

[28]  Daniel Vélez Día,et al.  Biomechanics and Motor Control of Human Movement , 2013 .

[29]  L. Hedges,et al.  Statistical Methods for Meta-Analysis , 1987 .

[30]  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.

[31]  V. Dubowitz,et al.  Quantitation of muscle function in children: A prospective study in duchenne muscular dystrophy , 1982, Muscle & nerve.

[32]  N. Kampanis,et al.  Gait variability measurements in lumbar spinal stenosis patients: part A. Comparison with healthy subjects , 2009, Physiological measurement.

[33]  Tom Fawcett,et al.  An introduction to ROC analysis , 2006, Pattern Recognit. Lett..

[34]  Eric Watelain,et al.  A comparison of gait in spinal muscular atrophy, type II and Duchenne muscular dystrophy. , 2004, Gait & posture.

[35]  Kamiar Aminian,et al.  Ambulatory Monitoring of Physical Activities in Patients With Parkinson's Disease , 2007, IEEE Transactions on Biomedical Engineering.

[36]  Jeffrey M. Hausdorff,et al.  Gait variability and fall risk in community-living older adults: a 1-year prospective study. , 2001, Archives of physical medicine and rehabilitation.

[37]  Joarder Kamruzzaman,et al.  Support Vector Machines and Other Pattern Recognition Approaches to the Diagnosis of Cerebral Palsy Gait , 2006, IEEE Transactions on Biomedical Engineering.

[38]  Jacques Fermanian,et al.  A motor function measure scale for neuromuscular diseases. Construction and validation study , 2005, Neuromuscular Disorders.

[39]  E. Bertini,et al.  Current methodological issues in the study of children with inherited neuromuscular disorders , 2008, Developmental medicine and child neurology.

[40]  Ingram Olkin,et al.  Estimation of a Single Effect Size: Parametric and Nonparametric Methods , 1985 .

[41]  Arash Salarian,et al.  Ambulatory monitoring of motor functions in patients with Parkinson"s disease using kinematic sensors , 2006 .

[42]  Shuichi Obuchi,et al.  Power spectrum entropy of acceleration time-series during movement as an indicator of smoothness of movement. , 2008, Journal of physiological anthropology.

[43]  Kamiar Aminian,et al.  Continuous monitoring and quantification of multiple parameters of daily physical activity in ambulatory Duchenne muscular dystrophy patients. , 2011, European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society.

[44]  S. Meyer,et al.  Relationship between balance abilities and gait characteristics in children with post-traumatic brain injury , 2008, Brain injury.

[45]  D A Steyn-Ross,et al.  Cortical entropy changes with general anaesthesia: theory and experiment. , 2004, Physiological measurement.