Characteristic behaviors associated with gait of individuals with Rett syndrome

Abstract

Background

Individuals with Rett syndrome (RTT) exhibit impaired motor performance and gait performance, leading to decreased quality of life. Currently, there is no robust observational instrument to identify gait characteristics in RTT. Current scales are limited as individuals with intellectual disorders may be unable to understand instructions. Our primary purpose was to utilize video analysis to characterize the behaviors associated with walking in individuals with RTT and explore the relationship between behaviors during overground and during treadmill walking.

Methods

Fourteen independently ambulatory females with RTT were video-taped and observed during overground and treadmill walking. Their gait was codified into an observational checklist to reveal prominent features associated with gait in this population.

Results

Participants exhibited similar rates of freezing, veering, and hand stereotypies between overground and treadmill walking; however, freeze duration was shortened during treadmill walking. Toe walking was prominently exhibited during overground, but not treadmill walking. During both walking modes, participants required extensive external motivation to maintain their walking patterns.

Conclusions

Results identify several gait characteristics observable during overground and treadmill walking. In general, participants behaved similarly during overground and treadmill walking. We conclude that both overground and treadmill walking are appropriate tools to evaluate gait in this population.

Implications for rehabilitation

• Locomotor rehabilitation may increase the quantity of walking performed by the patients, which can alleviate negative effects of the sedentary lifestyle commonly observed in patients with Rett syndrome (RTT).

• Video analysis of natural walking can be an effective tool to characterize gait in patients with RTT which does not require particular instructions which may not be fully understood.

• Both overground and treadmill walking are appropriate means of evaluating gait in individuals with RTT.

Keywords:

• Ataxia of gait
• clinical decision-making
• neurodevelopmental disorder
• rehabilitation
• Rett syndrome

Acknowledgements

The authors would like to thank all of the participants, their families, and the health care professionals working with them for the efforts in support of this research. Additionally, we thank Ms. Peijun Zhang for her assistance with data tabulation.

Disclosure statement

The authors report no declaration of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author, CSL, upon reasonable request.

Additional information

Funding

Funding for this research was provided by the Blue Bird Circle (Houston, TX) through a grant awarded to Bernhard Suter with additional funding provided by the Kayla Schwartz Fund.