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Physical Strain: A New Perspective on Walking in Cerebral Palsy.

Abstract：

OBJECTIVES:To describe (1) physical strain of walking, (2) the proportion of participants walking above the anaerobic threshold, and (3) 4 phenotypes of physical strain of walking on the basis of deviations in aerobic capacity and walking energy cost (EC) in children and adolescents with cerebral palsy (CP). DESIGN:Cohort study. SETTING:Academic medical center. PARTICIPANTS:A sample (N=57) of participants (n=37; mean age, 13.5±4.0y) with CP (Gross Motor Function Classification System [GMFCS] levels I [n=13], II [n=17], and III [n=7]) and typically developing (TD) participants (n=20; mean age, 11.8±3.5y). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Oxygen consumption (Vo2walk), speed, and EC were determined during walking at a comfortable speed. Peak oxygen consumption (Vo2peak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was reduced if lower than the 10th percentile, and EC was increased if higher than 3SD. Physical strain was defined as follows: (Vo2walk/Vo2peak)×100. RESULTS:Participants with CP had a higher physical strain (GMFCS level I, 55%±12% GMFCS level II, 62%±17%; GMFCS level III, 78%±14%) than did TD participants (40%±11%) (P<.001). Forty-three percent of participants with CP showed a Vo2walk at or above their anaerobic threshold as compared with 10% of TD participants (P=.007). Phenotypes showed that a reduced Vo2peak (n=9) or an increased EC (n=9) lead to an 18% to 20% higher physical strain, whereas a combination (n=12) leads to a 40% increase. CONCLUSIONS:Children and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable proportion walks close to or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and a reduced Vo2peak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in individuals with CP require different intervention strategies.

journal_name

Arch Phys Med Rehabil

journal_title

Archives of physical medicine and rehabilitation

authors

Balemans AC,Bolster EA,Brehm MA,Dallmeijer AJ

doi

10.1016/j.apmr.2017.05.004

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

2507-2513

issue

eissn

0003-9993

issn

1532-821X

pii

S0003-9993(17)30380-5

journal_volume

pub_type

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Physical Strain: A New Perspective on Walking in Cerebral Palsy.