{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T03:22:32Z","timestamp":1772594552855,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Forschungsgemeinschaft","award":["MU 2970\/4-2"],"award-info":[{"award-number":["MU 2970\/4-2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Symmetry"],"abstract":"<jats:p>Motor dysfunctions in patients with Down Syndrome (DS) result in poor locomotion and an altered gait phenotype, characterized by compromised stability management and frequent bilateral asymmetries. Directing ground reaction forces to a point above the center of mass, referred to as the virtual pivot point (VPP), is one means of maintaining stability during walking. This cross-sectional observational study compared the dynamic gait function of 33 individuals with DS (mean age: 17.7 \u00b1 6.4 years, 13 females) to a group of 36 healthy controls (mean age: 15.5 \u00b1 6.1 years, 15 females), using the concept of the VPP. Results showed that the VPP was located more anteriorly in individuals with DS compared to healthy controls, with no differences in the variability (R2) or symmetry of VPP coordinates. This anterior VPP position is likely due to the larger hip moments observed in patients with DS during the propulsive phase of stance. High R2 values in DS suggest that the VPP is strongly related to dynamic stability during walking.<\/jats:p>","DOI":"10.3390\/sym15020544","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T04:58:23Z","timestamp":1676869103000},"page":"544","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Study on the Intersection of Ground Reaction Forces during Overground Walking in Down Syndrome: Effects of the Pathology and Left\u2013Right Asymmetry"],"prefix":"10.3390","volume":"15","author":[{"given":"Johanna","family":"Vielemeyer","sequence":"first","affiliation":[{"name":"Institute of Sport Sciences, Friedrich Schiller University Jena, 07749 Jena, Germany"},{"name":"Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Sole","sequence":"additional","affiliation":[{"name":"Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2772-4837","authenticated-orcid":false,"given":"Manuela","family":"Galli","sequence":"additional","affiliation":[{"name":"Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0649-3665","authenticated-orcid":false,"given":"Matteo","family":"Zago","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4688-1515","authenticated-orcid":false,"given":"Roy","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany"},{"name":"Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Condoluci","sequence":"additional","affiliation":[{"name":"IRCCS San Raffaele Pisana Hospital, Tosinvest Sanit\u00e0, 00163 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1589\/jpts.32.303","article-title":"Gait and Postural Control Patterns and Rehabilitation in Down Syndrome: A Systematic Review","volume":"32","author":"Zago","year":"2020","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/hmg\/ddp010","article-title":"Down Syndrome\u2013Recent Progress and Future Prospects","volume":"18","author":"Wiseman","year":"2009","journal-title":"Hum. Mol. Genet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.bandc.2016.02.007","article-title":"Gait Dyspraxia as a Clinical Marker of Cognitive Decline in Down Syndrome: A Review of Theory and Proposed Mechanisms","volume":"104","author":"Schmitt","year":"2016","journal-title":"Brain Cogn."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1016\/j.ridd.2014.07.017","article-title":"Gait Characteristics in Individuals with Intellectual Disabilities: A Literature Review","volume":"35","author":"Almuhtaseb","year":"2014","journal-title":"Res. Dev. Disabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1080\/09638280701610353","article-title":"Postural Control in Patients with Down Syndrome","volume":"30","author":"Galli","year":"2008","journal-title":"Disabil. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.ridd.2010.09.009","article-title":"Gait Development during Lifespan in Subjects with Down Syndrome","volume":"32","author":"Rigoldi","year":"2011","journal-title":"Res. Dev. Disabil."},{"key":"ref_7","first-page":"7","article-title":"Gait Patterns in Prader-Willi and Down Syndrome Patients","volume":"21","author":"Cimolin","year":"2010","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.gaitpost.2008.03.001","article-title":"Joint Stiffness and Gait Pattern Evaluation in Children with Down Syndrome","volume":"28","author":"Galli","year":"2008","journal-title":"Gait Posture"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/MRR.0000000000000092","article-title":"Effects of Obesity on Gait Pattern in Young Individuals with Down Syndrome","volume":"38","author":"Galli","year":"2015","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1080\/20473869.2021.1893923","article-title":"Variability and Coordination Patterns of Walking with Different Speeds in Active and Non-Active Children with Down Syndrome: A Cross-Sectional Case-Control Study","volume":"68","author":"Sohrabi","year":"2022","journal-title":"Int. J. Dev. Disabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.gaitpost.2009.06.003","article-title":"Effects of Down Syndrome on Three-Dimensional Motion during Walking at Different Speeds","volume":"30","author":"Agiovlasitis","year":"2009","journal-title":"Gait Posture"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1016\/j.ridd.2014.04.012","article-title":"Mechanical Energy Assessment of Adult with Down Syndrome during Walking with Obstacle Avoidance","volume":"35","author":"Salami","year":"2014","journal-title":"Res. Dev. Disabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.gaitpost.2017.08.003","article-title":"SIAMOC Position Paper on Gait Analysis in Clinical Practice: General Requirements, Methods and Appropriateness. Results of an Italian Consensus Conference","volume":"58","author":"Benedetti","year":"2017","journal-title":"Gait Posture"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102892","DOI":"10.1016\/j.humov.2021.102892","article-title":"Kinematic Patterns during Walking in Children: Application of Principal Component Analysis","volume":"80","author":"Malloggi","year":"2021","journal-title":"Hum. Mov. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1038\/ncomms1073","article-title":"Upright Human Gait Did Not Provide a Major Mechanical Challenge for Our Ancestors","volume":"1","author":"Maus","year":"2010","journal-title":"Nat. Commun."},{"key":"ref_16","first-page":"20170404","article-title":"Force Direction Patterns Promote Whole Body Stability Even in Hip-Flexed Walking, but Not Upper Body Stability in Human Upright Walking","volume":"473","author":"Rode","year":"2017","journal-title":"Proc. R. Soc. A Math. Phys. Eng. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"jeb.204305","DOI":"10.1242\/jeb.204305","article-title":"Ground Reaction Forces Intersect above the Center of Mass Even When Walking down Visible and Camouflaged Curbs","volume":"222","author":"Vielemeyer","year":"2019","journal-title":"J. Exp. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"110387","DOI":"10.1016\/j.jbiomech.2021.110387","article-title":"Ground Reaction Forces Intersect above the Center of Mass in Single Support, but Not in Double Support of Human Walking","volume":"120","author":"Vielemeyer","year":"2021","journal-title":"J. Biomech."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.humov.2011.07.006","article-title":"Force Direction Pattern Stabilizes Sagittal Plane Mechanics of Human Walking","volume":"31","author":"Gruben","year":"2012","journal-title":"Hum. Mov. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3389\/fnbot.2018.00039","article-title":"Leg Force Control Through Biarticular Muscles for Human Walking Assistance","volume":"12","author":"Sharbafi","year":"2018","journal-title":"Front. Neurorobot."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jtbi.2015.06.036","article-title":"Positioning the Hip with Respect to the COM: Consequences for Leg Operation","volume":"382","author":"Blickhan","year":"2015","journal-title":"J. Theor. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"20141405","DOI":"10.1098\/rspb.2014.1405","article-title":"Trunk Orientation Causes Asymmetries in Leg Function in Small Bird Terrestrial Locomotion","volume":"281","author":"Andrada","year":"2014","journal-title":"Proc. R. Soc. B Biol. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1109\/TNSRE.2019.2926119","article-title":"Down Syndrome: Gait Pattern Alterations in Posture Space Kinematics","volume":"27","author":"Zago","year":"2019","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1016\/j.ridd.2012.03.016","article-title":"Gait Strategy in Patients with Ehlers-Danlos Syndrome Hypermobility Type and Down Syndrome","volume":"33","author":"Rigoldi","year":"2012","journal-title":"Res. Dev. Disabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.humov.2018.11.010","article-title":"Dynamic Balance Assessment during Gait in Children with Down and Prader-Willi Syndromes Using Inertial Sensors","volume":"63","author":"Belluscio","year":"2019","journal-title":"Hum. Mov. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"247","DOI":"10.36311\/jhgd.v31.11279","article-title":"Foot Rotation Asymmetry in Down Syndrome and the Relationship with Crawling and Walking Onset: A Crosssectional Study","volume":"31","author":"Valero","year":"2021","journal-title":"J. Hum. Growth Dev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/00003086-198305000-00021","article-title":"Energy Generation and Absorption at the Ankle and Knee during Fast, Natural, and Slow Cadences","volume":"175","author":"Winter","year":"1983","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1016\/j.jbiomech.2008.07.031","article-title":"Muscle Contributions to Support and Progression over a Range of Walking Speeds","volume":"41","author":"Liu","year":"2008","journal-title":"J. Biomech."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.gaitpost.2013.07.113","article-title":"Kinetic Patterns of Treadmill Walking in Preadolescents with and without Down Syndrome","volume":"39","author":"Wu","year":"2014","journal-title":"Gait Posture"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.ridd.2014.03.019","article-title":"Frequency Domain Analysis of Ground Reaction Force in Preadolescents with and without Down Syndrome","volume":"35","author":"Wu","year":"2014","journal-title":"Res. Dev. Disabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/0167-9457(91)90046-Z","article-title":"A Gait Analysis Data Collection and Reduction Technique","volume":"10","author":"Davis","year":"1991","journal-title":"Hum. Mov. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0966-6362(03)00038-9","article-title":"Anthropometric Parameters in Children: A Comparison of Values Obtained from Dual Energy x-Ray Absorptiometry and Cadaver-Based Estimates","volume":"19","author":"Ganley","year":"2004","journal-title":"Gait Posture"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1016\/j.jbiomech.2008.03.002","article-title":"Changes in Segmental Inertial Properties with Age","volume":"41","author":"Muri","year":"2008","journal-title":"J. Biomech."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.gaitpost.2007.08.006","article-title":"The Symmetry Angle: A Novel, Robust Method of Quantifying Asymmetry","volume":"27","author":"Avrin","year":"2008","journal-title":"Gait Posture"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.edurev.2010.12.001","article-title":"Eta Squared and Partial Eta Squared as Measures of Effect Size in Educational Research","volume":"6","author":"Richardson","year":"2011","journal-title":"Educ. Res. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1016\/j.jbiomech.2008.05.013","article-title":"Walking with Increased Ankle Pushoff Decreases Hip Muscle Moments","volume":"41","author":"Lewis","year":"2008","journal-title":"J. Biomech."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1152\/jappl.2000.88.5.1804","article-title":"Age Causes a Redistribution of Joint Torques and Powers during Gait","volume":"88","author":"DeVita","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"M303","DOI":"10.1093\/gerona\/51A.6.M303","article-title":"Step Length Reductions in Advanced Age: The Role of Ankle and Hip Kinetics","volume":"51","author":"Judge","year":"1996","journal-title":"J. Gerontol.\u2013Ser. A Biol. Sci. Med. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1093\/ptj\/74.4.299","article-title":"Differences in the Gait Characteristics of Patients with Diabetes and Peripheral Neuropathy Compared with Age-Matched Controls","volume":"74","author":"Mueller","year":"1994","journal-title":"Phys. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"200570","DOI":"10.1098\/rsos.200570","article-title":"Postural Stability in Human Running with Step-down Perturbations: An Experimental and Numerical Study: Postural Stability in Human Running","volume":"7","author":"Drama","year":"2020","journal-title":"R. Soc. Open Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.gaitpost.2014.10.004","article-title":"Gait Characteristics of Adults with Down Syndrome Explain Their Greater Metabolic Rate during Walking","volume":"41","author":"Agiovlasitis","year":"2015","journal-title":"Gait Posture"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1152\/japplphysiol.00969.2000","article-title":"Variability of Ground Reaction Forces during Treadmill Walking","volume":"92","author":"Masani","year":"2002","journal-title":"J. Appl. Physiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Zago, M., di Giuli, R., Beltramini, G., Bolzoni, A., Baj, A., Galli, M., Giann\u00ec, A.B., and Sforza, C. (2022). Donor-Site Morbidity after Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Stair Climbing Asymmetry and Functional Outcome. Symmetry, 14.","DOI":"10.3390\/sym14091888"}],"container-title":["Symmetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-8994\/15\/2\/544\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:39:28Z","timestamp":1760121568000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-8994\/15\/2\/544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,17]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["sym15020544"],"URL":"https:\/\/doi.org\/10.3390\/sym15020544","relation":{},"ISSN":["2073-8994"],"issn-type":[{"value":"2073-8994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,17]]}}}