Clinical usefulness and challenges of instrumented motion analysis in patients with intellectual disabilities

Abstract

Background: Clinical laboratory testing of locomotor disorders is challenging in patients with intellectual disability (ID). Nevertheless, also in this population gait analysis has substantial value as motor problems are common. To promote its use, adequate protocols need to be developed and the impact on clinical decision making needs to be documented.Research Question: What is the clinical usefulness of instrumented motion analysis in patients with ID?Method: This narrative review consists of three parts. A literature review was performed to describe the gait pattern of patients with ID. Next, benefits and challenges of standard gait analysis protocols are described. Finally, a case of a girl with ID due to genetic cause showing gait abnormalities is discussed. Results:The literature review resulted in 20 studies on "gait" in patients with an "ID", published since August, 1 st 2013. Gait deviations were observed in all studies investigating the ID population with an underlying genetic syndrome. Observed gait deviations in the ID population might be attributed to physical characteristics, cognitive components or both. The main goal of clinical gait assessment is the identification of gait deviations and the evaluation of their progress over time, in order to optimize the treatment plan. The choice of adequate method and measurement modalities depends on the clinical goal, the available resources and the abilities of the patient. In the case report we presented, we succeeded in performing an instrumented 3D gait analysis in a girl with severe ID at the ages of 4y4m, 6y0m, 7y2m and 8y2m. Progressive gait deviations were found suggesting a crouch gait pattern was developing. Results of the gait analysis led to the prescription of rigid ankle-foot orthoses.Significance: Gait analysis has substantial value for patients with ID. Gait analysis allows clinicians to objectify the relationship between physical characteristics and gait features.

Feasibility and Reliability Assessment of Video-Based Motion Analysis and Surface Electromyography in Children with Fragile X during Gait

“…In agreement with previous findings [ 5 ], our data strengthen the hypothesis that a characteristic pattern of hyperflexed hip and ankle joints with hyperextended knees suggests the presence of an overall immature motor control of gait, and this might be the hallmark of gait in these individuals. The results of this study could be used to tailor specific rehabilitation protocols that aim to restore a more efficient gait pattern.…”

“…As far as spatiotemporal parameters, longer stance period, reduced swing phase duration, cadence and gait speed are characteristic of both Full Mutation and Mosaic FXS individuals, a reduced stride length was specifically observed in the Full Mutation subjects. All these characteristics define a less stable gait; similar kinematics findings were reported in subjects with different neurodevelopmental disorders or neurological conditions associated with ID [5]. In particular, individuals with Down Syndrome showed a reduced range of motion in the sagittal plane at both hip and knee joints accompanied by lower ankle angles both in dorsiflexion and in plantarflexion and a higher hip flexion, compensated for by a reduced knee flexion angle during the swing phase of gait.…”

“…FXS, in fact, is also characterized by locomotor alterations associated with hypotonia, ligamentous laxity and flat foot, which have never been fully investigated. On the other hand, locomotor disorders in several childhood neurological conditions, and now even in children with neurodevelopmental disorders with ID, have been assessed in the context of gait analysis [ 5 , 45 , 46 , 47 , 48 , 49 , 50 ].…”

“…This observation could indeed be explained by the important phenotype modulation that a genetic mosaicism can exert. The same degree of compensation seen in subjects who carry a classical FMR1 full mutation might not be needed in FXS mosaic individuals because of a milder muscle alteration or possibly higher cognitive function, one of the crucial determinants of gait [ 5 ]. One could anticipate that, at a later age, some of these subjects could experience further muscle and balance alterations due to the presence of a concurrent premutation; the limits of current scientific knowledge on the risks of developing FXTAS and the young age of our cohort do not allow us to infer this information [ 23 , 24 , 54 , 56 ].…”

“…These syndromes are characterized by both physical and cognitive impairments, and therefore both aspects are considered responsible for their gait alterations. In subjects with Ehlers–Danlos syndrome, a lower dorsiflexion both in the stance and the swing phases was found to be associated with weakness of the Tibialis Anterior and Gastrocnemius Lateralis, joint stiffness, joint laxity and hypotonia [ 5 , 6 , 7 , 8 ]. All these neurodevelopmental conditions, characterized by flat foot associated with joint laxity and hypotonia, lead to an increase in the activity of the Tibialis Anterior and a decrease in the activity of the Peroneus Longus [ 9 ].…”