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Longitudinal interaction between muscle impairments and gait pathology in growing children with Duchenne muscular
Ines Vandekerckhove1, Geert Molenberghs2,3, Marleen Van den Hauwe1,4
1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Insights
This study quantifies how muscle impairments in Duchenne muscular dystrophy (DMD) affect gait progression in boys. Specific muscle weaknesses correlate with distinct gait abnormalities, informing targeted treatments for improved mobility.
Area of Science:
- Biomedical Engineering
- Clinical Biomechanics
- Pediatric Neuromuscular Disorders
Background:
- Duchenne muscular dystrophy (DMD) causes progressive gait pathology due to muscle weakness and contractures.
- The precise links between specific muscle deficits and gait alterations in DMD remain unquantified.
- Understanding these interactions is crucial for managing mobility in affected children.
Purpose of the Study:
- To longitudinally investigate the relationship between progressive muscle impairments and gait pathology in growing boys with DMD.
- To quantify the associations between specific muscle weaknesses and specific gait features over time.
- To provide a foundation for optimizing interventions for DMD patients.
Main Methods:
- A longitudinal observational cohort study involving 31 boys with DMD (aged 4.6-16.4 years).
- Repeated measurements of lower limb muscle strength (dynamometry), range of motion (goniometry), and 3D gait analysis.
- Joint random-effect models were used to analyze the longitudinal interaction between muscle and gait outcomes.
Main Results:
- Significant correlations were found between muscle impairments and gait features, both initially and in their progression rates.
- Decreased hip extension strength was linked to increased trunk angle and pelvic tilt.
- Reduced knee extension strength correlated with decreased knee extension moment and power absorption.
- Limited dorsiflexion range of motion was associated with reduced dorsiflexion during gait.
Conclusions:
- This study provides the first objective quantification of the longitudinal interaction between muscle impairments and gait features in DMD.
- The identified associations are vital for understanding DMD's pathological gait mechanisms.
- Findings support the development of targeted rehabilitation, orthotic, and orthopedic interventions to improve mobility outcomes.
Background:
Children with Duchenne muscular dystrophy (DMD) present with progressive gait pathology due to progressive muscle weakness and contractures. However, the associations between specific muscle impairments and specific gait features have never been quantified. Therefore, the aim of this longitudinal observational cohort study was to investigate the longitudinal interaction between progressive muscle impairments and progressive gait pathology in growing boys with DMD.
Methods:
Thirty-one boys with DMD (aged 4.6-16.4 years) were repeatedly measured between 2015 and 2022, resulting in a total dataset of 152 observations. Fixed dynamometry, goniometry and 3D gait analysis were used to assess lower limb muscle weakness, passive range of motion and gait. Joint random-effect models between gait and muscle outcomes were fitted. The correlation between the random intercepts (ra) and random slopes (rb) indicated the relationship between the initial values and progression rates over time of two outcomes, respectively.
Results:
Specific muscle impairments were related to specific gait features, both in terms of initial values (ra=0.470-0.757; p < 0.029) and progression rates (rb=0.547-0.812; p < 0.024). Decreased hip extension strength was associated with increased maximal posterior trunk angle (rb=-0.588; p = 0.0004), increased maximal anterior pelvic tilt angle (ra=-0.543; p = 0.0040 and rb=-0.812; p < 0.0001), and reduced maximal hip extension moment (ra=0.536; p = 0.0289). Decreased hip abduction strength was associated with increased step width (ra=-0.549; p = 0.0021) and increased maximal internal foot progression angle (rb=-0.547; p = 0.0117). Decreased knee extension strength was associated with reduced maximal knee extension moment (ra=0.702; p < 0.0001), reduced maximal knee power absorption (ra=0.757; p < 0.0001), and reduced dorsiflexion angle at initial contact (rb=0.684; p = 0.0237). Decreased dorsiflexion range of motion was associated with reduced dorsiflexion angle at initial contact (ra=0.732; p < 0.0001 and rb=0.627; p = 0.0202) and reduced maximal dorsiflexion angle in swing (ra=0.663; p < 0.0001).
Conclusion:
This is the first study that objectively quantified the longitudinal interaction between muscle impairments and gait features, providing valuable insights into the underlying mechanisms of pathological gait in DMD. The observed associations highlight the importance of targeted clinical assessments. These findings offer a foundation for optimizing rehabilitation strategies, orthotic management, and orthopedic interventions, ultimately improving clinical decision-making and enhancing mobility outcomes in children with DMD.
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