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Energy efficiency in gait, activity, participation, and health status in children with cerebral palsy
Claire Kerr1, Jackie Parkes, Mike Stevenson
1Gait Analysis Laboratory, Belfast Health and Social Care Trust, Musgrave Park Hospital, Stockman's Lane, Belfast, UK. claire.kerr@belfasttrust.hscni.net
Insights
Energy efficiency during gait in children with cerebral palsy (CP) correlates with activity limitations but not participation or health status. Therapies improving gait efficiency may not enhance overall participation or health outcomes.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Biomechanical Engineering
Background:
- Cerebral palsy (CP) affects children's mobility and participation.
- Energy efficiency of gait is a key factor in ambulatory function for children with CP.
- Understanding the relationship between gait efficiency and functional outcomes is crucial for targeted interventions.
Purpose of the Study:
- To determine the relationship between gait energy efficiency and activity limitation, participation restriction, and health status in children with CP.
- To explore differences in these measures based on CP clinical subtypes and gross motor classification.
- To investigate interrelationships among gait efficiency, activity, participation, and health in this population.
Main Methods:
- A longitudinal study involving 184 ambulatory children with CP (aged 4-17 years).
- Assessment of energy efficiency (oxygen cost) during gait.
- Measurement of activity limitation, participation restriction, and health status using validated tools.
- Analysis of data considering clinical subtypes (spastic, non-spastic) and Gross Motor Function Classification System (GMFCS) levels.
Main Results:
- A significant correlation was found between energy efficiency during gait and activity limitations.
- No significant relationship was observed between gait energy efficiency and participation restriction or overall health status.
- Most measures, except psychosocial health, showed significant differences across clinical subtypes and GMFCS levels.
Conclusions:
- Gait energy efficiency in children with CP is linked to activity limitations but does not reflect their participation or health status.
- Interventions aimed solely at improving gait energy efficiency may not translate to broader improvements in participation or general health.
- Further research is needed to understand the complex interplay between biomechanical factors and functional outcomes in pediatric CP.
Abstract:
The aim of the study was to establish if a relationship exists between the energy efficiency of gait, and measures of activity limitation, participation restriction, and health status in a representative sample of children with cerebral palsy (CP). Secondary aims were to investigate potential differences between clinical subtypes and gross motor classification, and to explore other relationships between the measures under investigation. A longitudinal study of a representative sample of 184 children with ambulant CP was conducted (112 males, 72 females; 94 had unilateral spastic C P, 84 had bilateral spastic C P, and six had non-spastic forms; age range 4-17 y; Gross Motor Function Classification System Level I, n=57; Level II, n=91; Level III, n=22; and Level IV, n=14); energy efficiency (oxygen cost) during gait, activity limitation, participation restriction, and health status were recorded. Energy efficiency during gait was shown to correlate significantly with activity limitations; no relationship between energy efficiency during gait was found with either participation restriction or health status. With the exception of psychosocial health, all other measures showed significant differences by clinical subtype and gross motor classification. The energy efficiency of walking is not reflective of participation restriction or health status. Thus, therapies leading to improved energy efficiency may not necessarily lead to improved participation or general health.
