Footsteps, falls and functional ambulation in children with neuromuscular disease
Carroll KM[1,2], de Valle KL[1,2], Ryan MM[1,2,3], Kennedy RA[1,2]
1. Department of Neurology, The Royal Children’s Hospital, Parkville, Australia
2. Murdoch Children’s Research Institute, Parkville, Australia
3. The University of Melbourne, Parkville, Australia
One hundred and seven independently ambulant children attending the outpatient Neuromuscular Clinic at The Royal Children’s Hospital were enrolled in this study. The children were aged 4-18 years (mean 9.4, SD 3.2); their diagnoses included Duchenne muscular dystrophy (n=37), Becker muscular dystrophy (n=7), Charcot-Marie-Tooth disease (n=16), congenital myopathies (n=16), collagen VI myopathies (n=11), spinal muscular atrophy (n=7), facioscapulohumeral muscular dystrophy (n=5) and `other’ diagnoses (myotonic dystrophy, chronic inflammatory demyelinating polyneuropathy, congenital fibre-type disproportion, undiagnosed; n=8). Gait was assessed using an electronic walkway to measure spatio-temporal gait parameters. Mean self-selected gait speed across the group was slower than reported normative values at 111.2 cm/sec (SD 22.8). Seventy-one children reported falling at least once in the previous month, with 16 children falling every day. Tripping was the most common fall mechanism (reported by 55 children), followed by legs giving way (29), overbalancing (14), slipping (6) and rolling ankles (2). Forty-two children reported injuries from falling – mainly bruises and grazes but also instances of sprains, concussion and fractures. The number of monthly falls was moderately correlated with the 10 metre run time (r = 0.48, p < 0.001) and step time step-to-step gait variability (r = 0.44, p < 0.001). From the Functional Mobility Scale, 17 children were part-time wheelchair users and 77 children reported some limitation in their typical walking over any distance from 5 to 500 metres. Children with neuromuscular diseases face significant challenges to maintain efficient and safe ambulation sufficient to meet their everyday mobility needs.