Muscle Activation during Gait in Children with Duchenne Muscular Dystrophy

Abstract

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.

Muscle weakness has a limited effect on motor control of gait in Duchenne muscular dystrophy

“…Since the REF is not one of the prime movers of synergy one, the increased REF weights suggest an increase in level of co-contraction during loading response and at the end of swing phase. This is in line with the findings of Ropars et al (2016), who reported increased coactivation of the REF and MEH during gait in children with DMD of a similar age. The quadriceps is one of the first muscle groups that starts to deteriorate and is characterized by muscle atrophy [3,44].…”

Non-neural Muscle Weakness Has Limited Influence on Complexity of Motor Control during Gait

“…There are only a small number of studies describing DMD gait (Sutherland et al, 1981 ; D'Angelo et al, 2009 ; Gaudreault et al, 2010 ; Doglio et al, 2011 ; Ganea et al, 2012 ; Ropars et al, 2016 ). Furthermore, none of these studies have verified to what extent these gait deviations were associated with muscle weakness (Sutherland et al, 1981 ; D'Angelo et al, 2009 ; Gaudreault et al, 2010 ; Doglio et al, 2011 ; Ganea et al, 2012 ; Ropars et al, 2016 ).…”

“…There are only a small number of studies describing DMD gait (Sutherland et al, 1981 ; D'Angelo et al, 2009 ; Gaudreault et al, 2010 ; Doglio et al, 2011 ; Ganea et al, 2012 ; Ropars et al, 2016 ). Furthermore, none of these studies have verified to what extent these gait deviations were associated with muscle weakness (Sutherland et al, 1981 ; D'Angelo et al, 2009 ; Gaudreault et al, 2010 ; Doglio et al, 2011 ; Ganea et al, 2012 ; Ropars et al, 2016 ). In CP, several researchers have analyzed the relationship between muscle weakness and gait impairments, but their results are inconsistent (Damiano et al, 1995 , 2010 ; Wiley and Damiano, 1998 ; Desloovere et al, 2006 ; Lee et al, 2008 ; Dallmeijer et al, 2011 ; Eek et al, 2011 ; Sagawa et al, 2013 ; Meyns et al, 2016 ; Shin et al, 2016 ).…”

Functional, neuroplastic and biomechanical changes induced by early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (e-HABIT-ILE) in pre-school children with unilateral cerebral palsy: study protocol of a randomized control trial

“…Children will sit in a standardized seat at a table and will be asked to perform two reach-to-grasp tasks. Spatio-temporal and kinematic parameters will be calculated along with muscle activation indices such as the Arm Profile Score [55] and the EMG-Profile Score for UE motion [56].…”