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M. Zago et al.
sion GVS observed in males, and it is reinforced by
previously observed sex-related differences in plantar
pressure distribution among children and adolescents
with DS due to a different distribution of fat mass (24).
Synthetic indexes (such as GPS and GVSs) inhe-
rently lack focus on the angular kinematics of joints
throughout the step cycle (25), as high GVS values are
uninformative about the signs of deviation (increased
or diminished joint angle). However, they allowed the
gross kinematic differences between males and females
with DS to be examined. Future longitudinal analyses
would allow specific trends in the gait function over
the entire lifespan to be determined, potentially due to
sex- and age-related comorbidities, such as osteoporo-
sis, early menopause and muscle hypotonia and, most
importantly, the relationship between sex-specific gait
impairments and fall rate.
Conclusion
In summary, spatiotemporal parameters and synthetic
gait indexes showed that males and females with DS
exhibit different joint patterns during gait, as observed
previously in healthy individuals due to a combina-
tion of intrinsic morphological and musculoskeletal
factors (12, 21): pelvic tilt, hip and knee flexion, and
hip rotation were more altered in females; however,
foot progression, which constitutes a specific trait of
this pathology, was more impaired in men.
This study impacts on both diagnostics and rehabi-
litation: in instrumented gait analysis and functional
evaluations, female and male patients with DS are
often pooled. There is evidence that therapists and
clinicians should be aware of specific features when
evaluating the severity of gait impairment and desig-
ning customized rehabilitation strategies.
ACKNOWLEDGEMENTS
This project was partially supported by an unconditioned Re-
search Grant supplied from the “Filippo Serpero Foundation”,
Milan, Italy.
The authors have no conflicts of interest to declare.
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