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Energy cost of walking in children with cerebral palsy: relation to the Gross Motor Function Classification System
Therese E Johnston1, Stephanie E Moore, Lance T Quinn
1Shriners Hospitals for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA. tjohnston@shrinenet.org
Insights
Children with cerebral palsy (CP) have a higher energy cost of walking than typically developing children. This cost increases with the severity of motor impairment, as measured by the Gross Motor Function Classification System (GMFCS).
Area of Science:
- Pediatric Rehabilitation
- Movement Science
- Biomechanical Engineering
Background:
- Cerebral palsy (CP) significantly impacts motor function, affecting daily activities like walking.
- The Gross Motor Function Classification System (GMFCS) categorizes functional motor skills in children with CP.
- Understanding the metabolic demands of walking in children with CP is crucial for effective treatment.
Purpose of the Study:
- To compare the energy cost of walking in children with cerebral palsy (CP) across different GMFCS levels.
- To evaluate the relationship between GMFCS level and the energy expenditure during walking.
- To determine if energy cost can serve as a distinguishing factor between GMFCS levels.
Main Methods:
- Participants included children with CP (GMFCS levels I-IV) and typically developing children.
- Energy cost of walking was measured using the gas dilution method.
- Children walked on an oval track while wearing a dilution mask to assess metabolic demand.
Main Results:
- Children with CP exhibited a significantly higher energy cost of walking compared to typically developing peers.
- A strong positive correlation was found between the energy cost of walking and GMFCS level (r=0.87).
- Significant differences in energy cost were observed across GMFCS levels and between adjacent levels.
Conclusions:
- The energy cost of walking increases progressively with higher GMFCS levels, reflecting greater functional impairment.
- Energy expenditure during walking serves as a valid indicator differentiating between GMFCS levels in children with CP.
- Metabolic demand should be a key consideration when developing treatment strategies for children with cerebral palsy.
Abstract:
This study compared the energy cost of walking in children with cerebral palsy (CP) classified at different levels of the Gross Motor Function Classification System (GMFCS) with that in children with typical development. Sixteen female and 14 male children with CP (mean age 9 years 6 months, SD 2 years 4 months, range 6 years 4 months to 13 years 4 months) and 14 male and 13 female typically developing children (mean age 10 years, SD 1 year 6 months, range 7 years 1 month to 12 years 11 months) participated. Children with CP were classified at GMFCS level I, n=5; level II, n=10; level II, n=9; and level IV, n=6. Energy cost was assessed by the gas dilution method as each child walked around an oval track wearing a dilution mask. Significant differences were found across GMFCS levels (p<0.0001) and between adjacent levels (p<0.013). Children with CP displayed a higher energy cost of walking than the typically developing children (p<0.0001). A strong correlation (0.87) was found between the energy cost of walking and GMFCS level (p<0.01) when children with typical development were assigned a GMFCS level of zero to allow statistical analysis. This indicates increasing energy cost of walking with increasing severity of functional involvement. These differences in energy cost across GMFCS levels provide another distinguishing factor between GMFCS levels and further emphasize the importance of considering metabolic demand in determining treatment options.
