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Bailly R, Pons C, Haes AC, Nguyen L, Thepaut M, Houx L, Lempereur M, Brochard S. Bone Deformities through the Prism of the International Classification of Functioning, Disability and Health in Ambulant Children with Cerebral Palsy: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:257. [PMID: 38397369 PMCID: PMC10888000 DOI: 10.3390/children11020257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
(1) Aim: The aim of this study was to determine the relationship between lower limb bone deformities and body functions, activity, and participation in ambulant children with CP and whether changing bone morphology affects outcomes in these domains. (2) Methods: A systematic literature search (PROSPERO CRD42020208416) of studies reporting correlations between measures of lower limb bone deformities and measures of body function, activity or participation, or post-surgical outcomes in these domains was conducted from 1990 to 2023 in Medline, Scopus, and Cochrane Library. We assessed study quality with the Checklist for Case Series (CCS) and a quality assessment developed by Quebec University Hospital. Meta-analysis was not possible; therefore, descriptive synthesis was performed. (3) Results: A total of 12 of 3373 screened articles were included. No studies evaluated the relationships between bone deformities and activity or participation, or the effect of isolated bone surgery on these domains. Correlations between bone deformities and body functions were poor-to-moderate. Internal hip rotation during gait improved after femoral derotation osteotomy. (4) Conclusions: A shift in paradigm is urgently required for the research and management of bone deformities in children with CP to include the activity and participation domains of the ICF, as well as consider more psychological aspects such as self-image.
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Affiliation(s)
- Rodolphe Bailly
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
| | - Christelle Pons
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
- Faculty of Medicine, Western Britany University, 29238 Brest, France
| | - Anne-Charlotte Haes
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- School of Physiotherapy (IFMK), CHRU Morvan, 29200 Brest, France
| | - Lisa Nguyen
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- School of Physiotherapy (IFMK), CHRU Morvan, 29200 Brest, France
| | - Matthias Thepaut
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Faculty of Medicine, Western Britany University, 29238 Brest, France
- Pediatric Surgery Department, University Hospital of Brest, 29200 Brest, France
| | - Laëtitia Houx
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
| | - Mathieu Lempereur
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
| | - Sylvain Brochard
- Pediatric Rehabilitation Department, Fondation Ildys, Rue Alain Colas, 29200 Brest, France; (L.H.); (S.B.)
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; (C.P.); (A.-C.H.); (L.N.); (M.T.)
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
- Faculty of Medicine, Western Britany University, 29238 Brest, France
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Comparison of Gross Motor Outcomes Between Children With Cerebral Palsy From Appalachian and Non-Appalachian Counties. Pediatr Phys Ther 2023; 35:66-73. [PMID: 36638031 DOI: 10.1097/pep.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE This study evaluated gross motor outcomes between children with cerebral palsy from non-Appalachian and Appalachian counties in the United States. METHODS For this retrospective, matched-case controlled study, data were sourced from electronic medical record and compared between groups. Groups were matched by age and Gross Motor Function Classification System (GMFCS) level. RESULTS Children from Appalachian counties had significantly higher Gross Motor Function Measure, 66 (GMFM-66) scores and had a cerebral palsy diagnosis reported in the electronic medical record significantly later compared with children from non-Appalachian counties, controlling for age and GMFCS level. CONCLUSION Although it has been documented that families and children from Appalachian counties have poorer overall health outcomes, motor development may not be affected. Our study found that children with cerebral palsy from Appalachian counties scored significantly higher on the GMFM-66 across GMFCS levels.
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Lennon N, Church C, Shields T, Shrader MW, Henley J, Niiler T, Sees JP, Miller F. Factors associated with walking activity in adults with cerebral palsy. Gait Posture 2021; 90:43-47. [PMID: 34390921 DOI: 10.1016/j.gaitpost.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This prospective study used instrumented gait analysis, patient-reported outcomes, and portable accelerometers to examine walking activity in adults with cerebral palsy (CP). RESEARCH QUESTION This study aimed to provide objective data and evaluate factors associated with walking activity in adults with CP. METHODS Participants with CP (ages 25-45 years) completed instrumented gait analysis and patient-reported outcomes, including the Patient Reported Outcome Measurement Information System (PROMIS) and Satisfaction with Life Score (SWLS), and wore a StepWatch for 8 days. Average strides per day, stratified by Gross Motor Function Classification System (GMFCS), were compared with nondisabled adults ages 30-39 years utilizing Welch's t-tests with Bonferroni corrections. Correlation coefficients and stepwise multiple linear regression analyses examined relationships between walking activity and GMFCS, gait deviation index (GDI), gait velocity, PROMIS physical function, SWLS, body mass index (BMI), and employment. RESULTS Participants included 109 adults with CP, ages 29 ± 4 years, classified at GMFCS levels I/II (73 %) and III/IV (27 %). Compared with nondisabled adults, daily stride count was significantly lower in both groups of adults with CP (p < 0.00025), with a progressive decline according to GMFCS level. Walking activity correlated with PROMIS physical function (r = .42), GDI (r = .48), and gait velocity (r = .58). Association for employment was lower (r = 0.27) but significant, while age, SWLS, and BMI were not individually correlated with walking activity. Stepwise, multiple linear regression modeled with Akaike information criterion explained 40.9 % of the observed variability in walking activity in this cohort of adults with CP. SIGNIFICANCE Physical function, as classified by GMFCS or measured by PROMIS and self-selected walking velocity, has the strongest association with and is the most significant predictor of walking activity in adults with CP. After accounting for physical function, a small amount of the variation in walking activity can be explained by GDI, employment, and age.
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Affiliation(s)
- Nancy Lennon
- Nemours/Alfred I. duPont Hospital for Children, Department of Orthopaedics, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| | - Chris Church
- Nemours/Alfred I. duPont Hospital for Children, Gait Analysis Laboratory, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| | - Thomas Shields
- Nemours/Alfred I. duPont Hospital for Children, Gait Analysis Laboratory, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| | - M Wade Shrader
- Nemours/Alfred I. duPont Hospital for Children, Department of Orthopaedics, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| | - John Henley
- Nemours/Alfred I. duPont Hospital for Children, Gait Analysis Laboratory, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| | - Tim Niiler
- Nemours/Alfred I. duPont Hospital for Children, Gait Analysis Laboratory, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| | - Julieanne P Sees
- Nemours/Alfred I. duPont Hospital for Children, Department of Orthopaedics, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
| | - Freeman Miller
- Nemours/Alfred I. duPont Hospital for Children, Department of Orthopaedics, 1600 Rockland Rd., Wilmington, DE, 19803, USA
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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Youn PS, Cho KH, Park SJ. Changes in Ankle Range of Motion, Gait Function and Standing Balance in Children with Bilateral Spastic Cerebral Palsy after Ankle Mobilization by Manual Therapy. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E142. [PMID: 32961844 PMCID: PMC7552781 DOI: 10.3390/children7090142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the effect of ankle joint mobilization in children with cerebral palsy (CP) to ankle range of motion (ROM), gait, and standing balance. We recruited 32 children (spastic diplegia) diagnosed with CP and categorized them in two groups: the ankle joint mobilization (n = 16) group and sham joint mobilization (n = 16) group. Thus, following a six-week ankle joint mobilization, we examined measures such as passive ROM in ankle dorsiflexion in the sitting and supine position, center of pressure (COP) displacements (sway length, area) with eyes open (EO) and closed (EC), and a gait function test (timed up and go test (TUG) and 10-m walk test). The dorsiflexion ROM, TUG, and 10-m walk test significantly increased in the mobilization group compared to the control group. Ankle joint mobilization can be regarded as a promising method to increase dorsiflexion and improve gait in CP-suffering children.
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Affiliation(s)
- Pong Sub Youn
- Department of Physical Therapy, Kyungbok University, Namyangju-si 425, Korea;
| | - Kyun Hee Cho
- AVENS Hospital, Dongan-gu, Anyang-si 307, Korea;
| | - Shin Jun Park
- Department of Physical Therapy, Gangdong University, Daehak-gil 278, Korea
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Oliveira EARD, Moraes LD, Santos JFD, Ozu MHU, Misao MH, Narumia LC. Upper limb weight-bearing effect on the body alignment of individuals with cerebral palsy who have spastic hemiparesis: a randomized clinical trial. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Cerebral Palsy (CP) patients who have spastic hemiparesis usually present asymmetrical weight shift between the affected and non-affected side. Objective: To assess the effects of upper limb (UL) weight-bearing exercises on trunk symmetry, weight shift to the affected side and possible secondary effects on gait (speed and quality). Method: eleven participants with CP were randomized into two groups: Intervention Group (IG) and Control Group (CG); IG (n = 6) performed stretching exercises of the major muscle groups of UL and lower limbs (LL) and UL weight-bearing exercises in prone and seated position for 12 weeks. The CG (n = 5) did not undergo any kind of motor therapy during the study period but received the same exercises that IG after the study. The variables analyzed were: Gross Motor Function Measure (GMFM-88); Pediatric Berg Scale; Trunk Impairment Scale (TIS); Six-minute walking test (6MWT); Ten meters walking test (10MWT); Timed Up & Go (TUG); Edinburgh Visual Gait Scale (EVGS); and ground reaction force. Results: The IG showed improvement on 6MWT, TUG, TIS and Pediatric Berg Scale (p < 0.01), and CG showed improvement on GMFM-88 (p < 0.04) only for the intragroup analysis. Conclusion: The exercises were effective to improve static and dynamic balance, increasing gait speed and identifying a trend of improvement on body alignment and weight shift to the affected side.
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Abstract
BACKGROUND Gait indices were developed to represent the magnitude of impairment extracted from a gait analysis with a single value. The Gillette Gait Index (GGI), and the Gait Deviation Index (GDI) are 2 widely used indices that represent gait impairment differently based on their statistical properties. Our purpose was to (1) report on the results of gait analysis for a broad spectrum of pediatric conditions using the GGI and GDI, and (2) identify the parameters that dominate impairment. METHODS A total of 1439 children with 13 different diagnoses with a complete, baseline gait analysis were identified. The GGI and its 16 parameters were calculated in all cases, and the GDI was calculated from a smaller subset. T tests, and z-scores were used to compare each of these values to typically developing children for each diagnosis. A separate linear regression controlling for age, sex, and use of an orthosis, or assistive device was performed for the GGI. RESULTS In our series, there were 71 typically developing children with a GGI of 31. We qualify relative gait impairment as severe, mild, or moderate as based on the GGI, and propose that values <100 represent mild, 100 to 200 represent moderate, and >200 represents severe impairment. On the basis of strong correlation between the GGI and GDI, we suggest that GDI values >80 represent mild, and values <70 represent severe impairment. T tests and z-scores demonstrated that both the number and magnitude of abnormal parameters increase the GGI. These tests also identified the most clinically relevant parameters contributing to functional impairment for each diagnosis. Multivariate linear regression showed that all diagnoses except flatfoot and scoliosis demonstrated statistically significant differences in GGI scores. CONCLUSIONS This is the first study to apply these gait indices to a large population of diverse pediatric conditions. We propose GGI and GDI values to qualify gait impairment among these conditions as severe, moderate, or mild. Furthermore, impairment in gait reflects both the number and magnitude of abnormal parameters within each condition. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Büğüşan S, Kahraman A, Elbasan B, Mutlu A. Do adolescents with cerebral palsy agree with their caregivers on their participation and quality of life? Disabil Health J 2018; 11:287-292. [DOI: 10.1016/j.dhjo.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/28/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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Mulcahey MJ, Haley SM, Slavin MD, Kisala PA, Ni P, Tulsky DS, Jette AM. Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery. J Pediatr Orthop 2016; 36:749-56. [PMID: 26057065 PMCID: PMC4670604 DOI: 10.1097/bpo.0000000000000533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Patient Reported Outcomes Measurement Information System (PROMIS) was developed to provide patient-reported outcome measures that are designed as being universally relevant across health conditions, low burden, and precise. A major problem for research and clinical practice in cerebral palsy (CP) is the void of outcomes instruments that are capable of evaluating the wide range of abilities and broad age spectrum inherent in this clinical population. Given the tremendous potential of PROMIS, the research questions for this study were "How do PROMIS pediatric computer adaptive tests and short forms detect change in children with CP following elective musculoskeletal surgery?" and "How do PROMIS instruments compare to the Pediatric Quality of Life Inventory Cerebral Palsy Module Version 3.0 (PedsQL CP), Pediatric Outcomes Data Collection Instrument (PODCI), the Timed Up and Go (TUG), and the Gross Motor Functional Measure (GMFM)." METHODS PROMIS Pediatric computer adaptive tests and short forms and the PedsQL, PODCI, TUG, and GMFM were administered before and after surgery. Effect size (ES) and standardized response mean (SRM) were calculated. Floor and ceiling effects were evaluated and, exposure rates for the PROMIS item banks were examined. RESULTS ES and SRM for all PROMIS Pediatric Measures were nonsignificant. PedsQL CP detected significant, positive change in mobility at 6 (ES=0.26; SRM=0.31) and 12 (ES=0.36; SRM=0.36) months; pain at 12 months (ES=0.29; SRM=0.34); and fatigue at 6 (ES=0.24; SRM=0.22) and 12 (ES=0.36; SRM=0.41) months. Significant negative changes were detected by the PODCI (ES=-0.20; SRM=-0.26), GMFM (ES=-0.13; SRM=-0.24), and TUG (ES=-0.29; SRM=-0.25). Ceiling effects were high. Exposure to an appropriate range of the PROMIS Mobility item bank was limited. CONCLUSIONS PROMIS measures were less able to detect change than other measures. PROMIS measures may be improved by tailoring start/stop rules or by adding items to include content appropriate for children with mobility impairments. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- MJ Mulcahey
- Department of Occupational Therapy, School of Health Professions, Thomas Jefferson University, Philadelphia, PA
| | - Stephen M. Haley
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
- Deceased
| | - Mary D. Slavin
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Pengsheng Ni
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - David S. Tulsky
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
- Kessler Foundation Research Center, West Orange, NJ
| | - Alan M. Jette
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
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Sison-Williamson M, Bagley A, Gorton G, Johnson BA, Oeffinger D. Analysis of the relationships that body composition and muscular strength have with oxygen cost of walking in children with cerebral palsy. Gait Posture 2014; 40:628-32. [PMID: 25108644 DOI: 10.1016/j.gaitpost.2014.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 07/01/2014] [Accepted: 07/14/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether body composition and lower extremity strength relate to oxygen cost of walking in children with cerebral palsy (CP), and to evaluate the relative contributions of these measures to explain variation in oxygen cost seen in this population. METHODS A total of 116 children with spastic diplegic CP, Gross Motor Function Classification System levels I-III, aged 8-18 participated. Strength, body composition (body mass index (BMI) and percent body fat) and oxygen cost were recorded. Pearson correlations assessed relationships between variables of body composition and strength to oxygen cost. Forward stepwise linear regression analyzed variance explained by strength and body composition measures. Oxygen data were analyzed by weight status classifications using one-way analysis of variance with significance set at p<0.05. RESULTS Total strength (r=-0.27) and total extensor strength (r=-0.27) had fair inverse relationships with oxygen cost. Total extensor strength explained 7.5% (r(2)=0.075, beta=-0.274, p<0.01) of the variance in oxygen cost. Body composition did not explain significant variance in oxygen cost, however significant differences were found in oxygen consumption (p=0.003) and walking velocity (p=0.042) based on BMI weight classifications. CONCLUSIONS For ambulatory children with CP, oxygen cost during walking can be partially explained by total extensor strength and not body composition. However, those categorized as obese may adjust to a slower walking speed to keep their oxygen cost sustainable, which may further affect their ability to keep up with typically developing peers and possibly lead to greater fatigue.
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Affiliation(s)
| | - Anita Bagley
- Shriners Hospitals for Children, Northern California, United States
| | - George Gorton
- Shriners Hospitals for Children, Springfield, United States
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