Résumé :
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Objective: The aim of this study was to map balance and gait deficits in relation to muscle strength, stumbles and falls. Methods: All adult walking individuals with classical or late-onset genetically proven DM1 between 20-60 years of age were invited to participate in an assessment by the physiotherapist at the Neuromuscular Centre. Self assessments of walking difficulties and balance confidence were performed together with physical examination of Time to walk 10m (max gait speed), Timed Up& Go (TUG), One Leg Stance (OLS), Tandem Stance (TS) and isometric muscle strength in the legs measured with handheld myometry.Results: Fifty-one individuals with DM1 participated (m/f =20/31, 41.3 ± 9.7 yrs). Muscular Impairment Rating Scale (MIRS) showed median 4 (1-5). Thirty-seven percent had fallen 4 (0-60) times last year. Patients with MIRS 4 (n=36, m/f=17/19), reported decreased balance and walking ability, 75% had outdoor walking difficulty compared to 33% in MIRS 3 (n=15, m/f=3/12). Fifty-eight percent of MIRS 4 avoided activities due to fear of falling. Time to walk 10m was mean 8.3sec (9.3 / 6.1sec resp, p<0.01);TUG mean was 10.4sec (11.2 / 8.4sec resp, p<0.01);53% had OLS < 10 sec, and 35% had TS<10sec. Foot dorsiflexor strength was mean 131.6 N, (88.5 / 235.2 N resp, p<0.001); Knee flexors was mean 100 N (88.9 / 125.8 N resp, p<0.001); Knee extensor strength was mean 277.4 N (252.1 and 338.2 N resp, p<0.001). The differences in hip abductors & flexors were smaller but still statistically significant. There were, as expected, significant differences between genders in the stronger muscles. However, no significant differences in strength between men and women could be detected in the weakest muscle groups (foot dorsiflexors and knee flexors).Conclusions: A high percentage of the DM1 individuals at the clinic suffer from gait and balance difficulties, partly due to weak distal muscles. Thirty-seven percent of the whole study group had fallen four times or more during the last year. Many DM1 individuals with a MIRS 4 have difficulties with participation in outdoor activities and sports, which they avoid due to the risk of falling. Is it possible to diminish the risks of falling and increase the quality of life? This study was the basis of a recently conducted intervention study, aiming to evaluate the effects of functional balance exercise.
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