Using Anthropometric Measurements to Predict Orthotic Influence on Gait Parameters in Children With Down Syndrome

The purpose of this study is to demonstrate the differences in functional outcomes provided by supramalleolar orthoses and foot orthoses, as well as develop specific criterion for matching individuals with Down syndrome (DS) of differing orthopedic impairments with the most beneficial orthotic device.

Participants must be able to walk independently or with an assistive device, such as a walker, for 50 feet at one time, and have at least six months of walking experience. Participants must also be able to follow simple verbal instructions. Both males and females will be included in this study, and children of any race may participate as long as they meet the inclusion criteria and are between three and ten years of age at the time of data collection. Exclusion criteria include a history of uncorrected visual and inner ear impairments, and lower extremity orthopedic surgical corrections.

There are no costs associated with participation in this study, and subjects will not be paid for their participation.

Participants in this study will be fitted for the appropriate size orthoses either by physical therapists in the participants' school district, or by one of the researchers prior to data collection. The correct fitting orthotic will be sized using the sizing guides provided by Cascade. These are footplates of various sizes that provide the length of the child's foot in inches and the orthosis width that will fit the child. Measurements of height, weight, leg length, medial longitudinal arch height, tibial torsion, and calcaneal eversion will be taken for each subject. Weight will be measured in kilograms using a scale, while height, leg length, and medial longitudinal arch height will be measured using a metric tape measure. Tibial torsion will be measured with the participant lying in prone (on their stomach) on the plinth with one knee flexed to 90 degrees. The angle of tibial torsion is formed by a line perpendicular to the line between the medial and lateral malleoli of the ankle, and a line parallel to the femur. This angle will be measured using a goniometer, which is an instrument used to measure joint angles and range of motion, and this angle will be measured once on each side. Finally, while standing, calcaneal eversion will be measured by determining the angle between neutral calcaneal alignment and resting stance. Neutral calcaneal alignment is found by palpating the position of the talus, so that the talus bone is felt equally on both sides of the foot. Once neutral alignment has been determined a line will be drawn with washable marker between the posterior talus and midline of the calf. The participant will then be asked to stand in their normal position and a goniometer will be used to measure the angle between the neutral alignment and the resting alignment of the ankle.

In addition to these measurements, a hypermobility screen will be performed in which mobility of fingers, wrists, elbows, knees, and the spine will be scored. The screen is scored using a point system in which one point is given for the ability to perform each of the tasks in the screen. These tasks include the ability to actively extend the little fingers 90 degrees at the metacarpophalangeal joints, passively touch the thumbs to the volar surface of the forearms, extend the wrists more than 90 degrees, extend elbows and knees more than 10 degrees, and the ability to bend the spine to reach the floor with palms flat on the ground. Gait of each participant will be assessed in conditions of shoes only, with foot orthoses, and with supramalleolar orthoses. This order will be determined by selecting a condition at random from a hat, such that the first condition chosen will be performed and assessed first.