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[Upper extremity kinetics and energy expenditure during walker-assisted gait in children with cerebral palsy]
Katherine A Konop1, Kelly M B Strifling, Mei Wang
1Marquette Universitesi, Biyomedikal Mühendislik Bölümü, Milwaukee, WI, USA.
Insights
Anterior walker use in children with spastic diplegic cerebral palsy (CP) showed strong correlations between upper extremity joint reaction forces and increased energy expenditure. These findings suggest a link between forward propulsion forces and higher energy use during gait.
Area of Science:
- Biomechanics
- Pediatric Rehabilitation
- Movement Science
Context:
- Spastic diplegic cerebral palsy (CP) affects gait and mobility in children.
- Walker-assisted gait is common for children with CP to improve ambulation.
- Understanding the biomechanical demands of walker use is crucial for optimizing assistive device prescription.
Purpose:
- To investigate the relationship between upper extremity (UE) kinetics and energy expenditure during anterior and posterior walker-assisted gait in children with CP.
- To identify specific kinetic variables that correlate with energy expenditure and gait parameters.
Summary:
- Ten children with spastic diplegic CP underwent gait analysis using instrumented walker handles.
- Anterior walker use was generally associated with a higher energy expenditure index (EEIHR).
- Significant correlations (r>0.80) were found between specific UE joint reaction forces (e.g., wrist, elbow, shoulder) and EEIHR during anterior walker use.
Impact:
- Findings suggest that the forces exerted by the upper extremities during anterior walker propulsion are linked to increased energy expenditure in children with CP.
- This research may inform strategies to optimize walker design and gait training to improve energy efficiency.
- Further investigation into joint kinematics and refined correlation analysis is warranted.
Objectives:
We evaluated the relationships between upper extremity (UE) kinetics and the energy expenditure index during anterior and posterior walker-assisted gait in children with spastic diplegic cerebral palsy (CP).
Methods:
Ten children (3 boys, 7 girls; mean age 12.1 years; range 8 to 18 years) with spastic diplegic CP, who ambulated with a walker underwent gait analyses that included UE kinematics and kinetics. Upper extremity kinetics were obtained using instrumented walker handles. Energy expenditure index was obtained using the heart rate method (EEIHR) by subtracting resting heart rate from walking heart rate, and dividing by the walking speed. Correlations were sought between the kinetic variables and the EEIHR and temporal and stride parameters.
Results:
In general, anterior walker use was associated with a higher EEIHR. Several kinetic variables correlated well with temporal and stride parameters, as well as the EEIHR. All of the significant correlations (r>0.80; p<0.005) occurred during anterior walker use and involved joint reaction forces (JRF) rather than moments. Some variables showed multiple strong correlations during anterior walker use, including the medial JRF in the wrist, the posterior JRF in the elbow, and the inferior and superior JRFs in the shoulder.
Conclusion:
The observed correlations may indicate a relationship between the force used to advance the body forward within the walker frame and an increased EEIHR. More work is needed to refine the correlations, and to explore relationships with other variables, including the joint kinematics.
