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O34: Case- control study to identify deviations in gait and physical examination in children and adolescents with Dravet syndrome
Gait & Posture xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
O34 Case- control study to identify deviations in gait and physical examination in children and adolescents with Dravet syndrome ⁎
Lore Wyersa, , Patricia Van de Wallea,c, Karen Verheyena,b, Berten Ceulemansb, Kaat Deslooverec, Ann Hallemansa a b c
University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium Antwerp University Hospital, Antwerp, Belgium University of Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
1. Introduction Dravet Syndrome (DS) is a severe infantile onset epilepsy syndrome with a prevalence of 1/30.000. Developmental delay, also in gross motor function, becomes a serious concern during the second year of life [1]. Scarce literature based on mere clinical or observational data, suggests that more than half of the patients aged > 13 years have developed a crouch gait [2–4]. Furthermore, Rodda et al. identified structural deformities of the lower limbs in DS and hypothesized that they contribute to the development of the observed pathological gait pattern [2]. 2. Research Question Which deviations can be identified using instrumented 3D gait analysis, including comprehensive physical examination (PE) in children with DS?
group (in red) were compared to those of age- and gender-matched typically developing children (TD, in black) by paired samples t-test using statistical parametric mapping (SPM) (* = p < 0.05). 4. Results SPM revealed significant differences for hip (p=0.006), knee (p=0.003) and ankle (p < 0.001) in the sagittal plane at the end of stance as well as for the ankle in the transverse plane (p=0.003) over the entire gait cycle. PE revealed mild hamstrings shortening (popliteal angle between –50° and –70°) in 6/15, excessive dorsal flexion (≥ 25°, knee 90°) in 9/16, slightly increased femoral anteversion (30°) in 8/15 and pes planovalgus in 13/16 patients.
5. Discussion 3. Methods 3D gait analyses (Vicon T10, 100 Hz, Nexus 1.8.5 software, VCM) including PE for range of motion, alignment and foot deviations was performed on 16 patients with DS, aged 3-23 years (mean age 12.36 ± 5.74 years). Lower body joint angular time profiles in the DS
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.gaitpost.2017.06.288
0966-6362/ © 2017 Elsevier B.V. All rights reserved.
The gait deviations in the sagittal plane and structural deformities reported by Rodda et al. were also observed in this study. Based on 3D gait analysis and SPM, a gait pattern with increased hip and knee flexion as well as ankle dorsal flexion was observed. However, this was not the typical crouch pattern as observed in CP, as the sagittal plane
Gait & Posture xxx (xxxx) xxx–xxx
L. Wyers et al.
children with DS. However, to fully understand the cause and clinical impact, in depth analysis of all gait parameters, including kinetics and muscle activation patterns in a larger cohort are needed.
deviations are not present in early stance but are concentrated at the end of stance phase. An explanation for this increased flexion in the sagittal plane can be found in the PE that reveals hypermobility in dorsal flexion which might compromise second rocker. On the other hand, hamstrings shortening seems not to be of this kind that it introduces increased knee flexion at in initial contact and early stance. Although femoral anteversion was slightly increased, no rotational deviations were found proximally. However, increased ankle external rotation over the gait cycle as well as high presence of planovalgus warrant further investigation of their impact on gait. From this preliminary study, we can conclude that clear gait deviations are seen in
References [1] [2] [3] [4]
2
Ceulemans, Dev. Med. Child Neurol. 53 (2011) 19–23. Rodda, et al. Arch. Neurol. 69 (2012) 873–878. Rilstone, et al. Epilepsia 53 (2012) 1421–1428. Fasano, et al. Neurology 82 (2014) 2250–2251.
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
O34 Case- control study to identify deviations in gait and physical examination in children and adolescents with Dravet syndrome ⁎
Lore Wyersa, , Patricia Van de Wallea,c, Karen Verheyena,b, Berten Ceulemansb, Kaat Deslooverec, Ann Hallemansa a b c
University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium Antwerp University Hospital, Antwerp, Belgium University of Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
1. Introduction Dravet Syndrome (DS) is a severe infantile onset epilepsy syndrome with a prevalence of 1/30.000. Developmental delay, also in gross motor function, becomes a serious concern during the second year of life [1]. Scarce literature based on mere clinical or observational data, suggests that more than half of the patients aged > 13 years have developed a crouch gait [2–4]. Furthermore, Rodda et al. identified structural deformities of the lower limbs in DS and hypothesized that they contribute to the development of the observed pathological gait pattern [2]. 2. Research Question Which deviations can be identified using instrumented 3D gait analysis, including comprehensive physical examination (PE) in children with DS?
group (in red) were compared to those of age- and gender-matched typically developing children (TD, in black) by paired samples t-test using statistical parametric mapping (SPM) (* = p < 0.05). 4. Results SPM revealed significant differences for hip (p=0.006), knee (p=0.003) and ankle (p < 0.001) in the sagittal plane at the end of stance as well as for the ankle in the transverse plane (p=0.003) over the entire gait cycle. PE revealed mild hamstrings shortening (popliteal angle between –50° and –70°) in 6/15, excessive dorsal flexion (≥ 25°, knee 90°) in 9/16, slightly increased femoral anteversion (30°) in 8/15 and pes planovalgus in 13/16 patients.
5. Discussion 3. Methods 3D gait analyses (Vicon T10, 100 Hz, Nexus 1.8.5 software, VCM) including PE for range of motion, alignment and foot deviations was performed on 16 patients with DS, aged 3-23 years (mean age 12.36 ± 5.74 years). Lower body joint angular time profiles in the DS
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.gaitpost.2017.06.288
0966-6362/ © 2017 Elsevier B.V. All rights reserved.
The gait deviations in the sagittal plane and structural deformities reported by Rodda et al. were also observed in this study. Based on 3D gait analysis and SPM, a gait pattern with increased hip and knee flexion as well as ankle dorsal flexion was observed. However, this was not the typical crouch pattern as observed in CP, as the sagittal plane
Gait & Posture xxx (xxxx) xxx–xxx
L. Wyers et al.
children with DS. However, to fully understand the cause and clinical impact, in depth analysis of all gait parameters, including kinetics and muscle activation patterns in a larger cohort are needed.
deviations are not present in early stance but are concentrated at the end of stance phase. An explanation for this increased flexion in the sagittal plane can be found in the PE that reveals hypermobility in dorsal flexion which might compromise second rocker. On the other hand, hamstrings shortening seems not to be of this kind that it introduces increased knee flexion at in initial contact and early stance. Although femoral anteversion was slightly increased, no rotational deviations were found proximally. However, increased ankle external rotation over the gait cycle as well as high presence of planovalgus warrant further investigation of their impact on gait. From this preliminary study, we can conclude that clear gait deviations are seen in
References [1] [2] [3] [4]
2
Ceulemans, Dev. Med. Child Neurol. 53 (2011) 19–23. Rodda, et al. Arch. Neurol. 69 (2012) 873–878. Rilstone, et al. Epilepsia 53 (2012) 1421–1428. Fasano, et al. Neurology 82 (2014) 2250–2251.