Fatigue in Children and Young Adults With Physical Disabilities: Relation With Energy Demands of Walking and Physical Fitness

Motor function and gait decline in individuals with cerebral palsy during adulthood: a narrative review of potential physiological determinants

Cerebral palsy (CP) is the most common childhood-onset disability. The evolution of gait according to severity is well known amongst children and thought to peak between 8 and 12 years of age among those walking without assistive devices. However, among adults, clinical experience as well as scientific studies report, through clinical assessments, questionnaires and interviews, increasing walking difficulties leading to an increased dependency of assistive devices in everyday ambulation. For many individuals with CP, this change will occur around 30-40 years, with the risk of losing mobility increasing with age. This narrative review aims to first provide objective evidence of motor function and gait decline in adults with CP when ageing, and then to offer mechanistic hypotheses to explain those alterations. Many studies have compared individuals with CP to the typically developing population, yet the evolution with ageing has largely been understudied. Comorbid diagnoses comprise one of the potential determinants of motor function and gait decline with ageing in people with CP, with the first manifestations happening at an early age and worsening with ageing. Similarly, ageing appears to cause alterations to the neuromuscular and cardiovascular systems at an earlier age than their typically developing (TD) peers. Future studies should, however, try to better understand how the physiological particularities of CP change with ageing that could pave the way for better strategies for maintaining function and quality of life in people with CP.

The Effects of Trunk Impairment on Fatigue and Balance in Children with Cerebral Palsy

Cerebral palsy (CP) involves trunk impairment, leading to decreased postural control that is an important contributor to problems maintaining daily activities without undue fatigue. Our aim in this research was to determine the effects of trunk impairment on fatigue and balance in children with hemiplegic CP. We included 65 ambulatory children with CP in this cross-sectional study, and we grouped them into those with greater trunk impairment (Group 1, n = 33) and lesser trunk impairment (Group 2, n = 32) according to their scores on the Trunk Imparment Scale (TIS). We assessed their fatique level using the Pediatric Quality of Life Inventory™ Version 4.0 Multidimensional Fatigue Scale (PedsQL-MFS), and their balance ability using the Pediatric Balance Scale (PBS). We found that the PedsQL-MFS parameters, except the general and cognitive fatigue scores, were significantly better for participants in Group 2 than in Group 1; however Group 2 showed significantly higher scores for balance ability than did Group 1 (p < .001). All of the TIS parameters were significantly correlated with sleep/rest fatigue, and PBS scores and trunk coordination were also significantly correlated with general fatigue (p = .013) and cognitive fatigue (p = .003) which are subparameters of the PedsQL-MFS and PBS (p < .001). However static balance was highly and negatively correlated with cognitive fatigue (p < .037).Increased trunk impairment contributed to the exacerbation of fatigue and balance problems in children with hemiplegic CP. Inadequate trunk control was associated with poor sleep and poor resting quality rather than perceived general and cognitive fatigue.

Walking and Fatigue in People with Cerebral Palsy: Brief Report

The aim of this study was to examine the relationship between perceived fatigue and perceptions of walking abilities and difficulty in people with cerebral palsy (CP). Twenty individuals with CP (range 10-21y; mean age 14.8y) who usually walk in the community were recruited. Community mobility was assessed using the Functional Mobility Scale. Participants were asked about their walking ability and frequency, perceived effort during walking (using the Children's Effort Rating Table), and perceived fatigue (using the Fatigue Impact and Severity Self-Assessment). Community mobility, frequency, and perceived effort during walking were significantly related to fatigue. No relationship was found between time spent walking (maximum walking time) and fatigue. Here we demonstrate that perceived fatigue is related to walking in people with CP.

Validation of the Gait Outcomes Assessment List questionnaire and caregiver priorities for individuals with cerebral palsy

AIM

To expand upon previous validation of the Gait Outcomes Assessment List (GOAL) questionnaire in individuals with cerebral palsy (CP), to rank items by importance, and to summarize written-in (free text) goals.

METHOD

For this cross-sectional study, the parent-version 5.0 of the GOAL was completed by 310 consecutive caregivers of 310 individuals aged 3 to 25 years with CP (189 males, 121 females; mean [SD] age: 10y [4y 2mo]; Gross Motor Function Classification System [GMFCS] levels I-IV) concurrent with a gait analysis. Distribution properties and validity were quantified using questionnaires, kinematics, and oxygen consumption. Items classified as at least 'difficult' to perform and 'very important' to improve were considered caregiver priorities and rank ordered. Free text goals were categorized. Results were summarized for everyone and by GMFCS level.

RESULTS

Most scores were normally distributed. Validity was acceptable, with concurrent greater than construct validity. Among all 310 caregivers, fatigue was the highest priority, followed by gait pattern and appearance items. The rank of priorities varied by GMFCS level. Common free text goals included toileting independently as well as improved fine motor and ball sport skills.

INTERPRETATION

The GOAL is a valid tool that can help prioritize goals across GMFCS levels I to IV. Identifying the top goals may improve shared decision-making and prioritize research for this sample.

More Than Just Adolescence: Differences in Fatigue Between Youth With Cerebral Palsy and Typically Developing Peers

OBJECTIVE

To quantify differences in fatigue and disordered sleep between adolescents with cerebral palsy (CP) and their typically developing peers. A secondary aim was to investigate the association between fatigue and disordered sleep in adolescents with CP.

METHODS

A convenience sample of 36 youth with CP aged 10-18 years was matched for age and sex with 36 typically developing peers. The Fatigue Impact and Severity Self-Assessment (FISSA), the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue profile, and the Sleep Disturbance Scale for Children (SDSC) were collected.

RESULTS

Higher fatigue was reported in participants with CP than in their typically developing peers based on the FISSA total score (mean paired difference=19.06; 99% confidence interval [CI], 6.06-32.1), the FISSA impact subscale (mean paired difference=11.19; 99% CI, 3.96-18.4), and the FISSA Management and Activity Modification subscale (mean paired difference=7.86; 99% CI, 1.1-14.6). There were no differences between groups in the PROMIS fatigue profile (mean paired difference=1.63; 99% CI, -1.57-4.83) or the SDSC total score (mean paired difference=2.71; 99% CI, -2.93-8.35).

CONCLUSION

Youth with CP experienced significantly more fatigue than their peers as assessed by a comprehensive measure that considered both general and diagnosis-specific concerns. Sleep did not differ between youth with CP and their typically developing peers. These findings underscore the need to consider the clinical management of fatigue across the lifespan of individuals with CP to prevent the associated deterioration of functional abilities.