Foot rotation asymmetry in Down syndrome and the relationship with crawling and walking onset: a cross sectional study

Camila Valero,Alzira Alves De Siqueira Carvalho,Patricia Merly Martinelli,Patricia Melo Bezerra,David Feder,Francisco Winter Dos Santos Figueiredo,Zan Mustacchi

doi:10.36311/jhgd.v31.11279

Camila Valero, Alzira Alves De Siqueira Carvalho + Show 5 more

Open Access

https://doi.org/10.36311/jhgd.v31.11279

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Abstract

Introduction: Down syndrome individuals have different gait patterns, which include specific characteristics such as foot rotation asymmetry. Objective: The aim of this study was to analyze the relationship between this asymmetry and the previous acquisition of hands-and-knees crawling in Down syndrome children, as well as the probable association of this gait to gender, ethnicity, comorbidities, physiotherapy, and occupational therapy interventions. Methods: In this cross-sectional study, 361 children with or without foot rotation asymmetry were selected. An online questionnaire was administered to the parents or guardians of those children. Results: Hands-and-knees crawling decreased the prevalence of foot rotation asymmetry in Down syndrome children. The longer it took for walking onset, the higher the prevalence of this asymmetry. Indeed, for each month of delay there was a 7% increase in prevalence. There was a significant relationship between orthopedic alterations in knees or flat feet and foot rotation asymmetry. There was no significance related to gender, ethnicity, other comorbidities, physiotherapy or occupational therapy interventions. Conclusion: The findings in this study revealed that foot rotation asymmetry may be related to the acquisition of the motor skills described above, especially with regards to hands-and-knees crawling and walking onset.

Highlights

Down syndrome individuals have different gait patterns, which include specific characteristics such as foot rotation asymmetry
This study investigated the possible relationship between hands-and-knees crawling and this gait pattern, as well as the association of foot rotation asymmetry and others comorbidities and specific intervention
The presence of an extra copy of chromosome 21 is associated with identifiable physical and anatomical characteristics, which are accompanied by cardiac, orthopedic, visual, hearing, and neurological alterations that trigger a delay in motor development2-4

Summary

Introduction

Down syndrome individuals have different gait patterns, which include specific characteristics such as foot rotation asymmetry. The presence of an extra copy of chromosome 21 is associated with identifiable physical and anatomical characteristics, which are accompanied by cardiac, orthopedic, visual, hearing, and neurological alterations that trigger a delay in motor development. Many researchers aim to find motor development parameters that manifest later in DS compared with ordinary children. These alterations occur due to dendritic growth deficiencies and abnormal myelination of cortical and subcortical structures of the brain, changes that lead to overall generalized synaptic dysfunction. Motor development differences occur by the fourth month of age. These differences amplify as motor demands become more complex, especially when muscle coactivation against gravity is required; this action is hampered by muscular hypotonia and ligament laxity

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