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Published on: June 5, 2019
Age-related changes in energy efficiency of gait, activity, and participation in children with cerebral palsy
Claire Kerr1, Brona C McDowell, Jackie Parkes
1School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland. c.kerr@qub.ac.uk
Insights
Energy efficiency during gait declines in ambulatory children with cerebral palsy (CP) around age 12, despite continued improvements in motor function. This highlights the need for tailored support to maintain capabilities.
Area of Science:
- Pediatric rehabilitation
- Movement science
- Biomechanical analysis
Background:
- Cerebral palsy (CP) affects motor function and participation in children.
- Understanding age-related changes in energy efficiency is crucial for optimizing interventions.
Purpose of the Study:
- To describe age-related trends in energy efficiency during gait, activity, and participation in ambulatory children with CP.
- To analyze changes in motor function and functional skills over time.
Main Methods:
- Prospective longitudinal study of 184 ambulatory children with CP (ages 4-16).
- Assessed Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), Lifestyle Assessment Questionnaire-Cerebral Palsy (LAQ-CP), and oxygen cost during gait.
- Follow-up assessments conducted after approximately 2 years and 7 months.
Main Results:
- Significant improvements observed in GMFM, PEDI, and LAQ-CP scores over time.
- Mean oxygen cost (energy efficiency) deteriorated with age.
- Gait was most inefficient around age 12; motor function improved until age 13-14 before declining.
- Baseline scores were the strongest predictor of future scores.
Conclusions:
- Energy efficiency declines in ambulatory children with CP as they age, particularly around adolescence.
- Findings emphasize the need for timely and appropriate services to support physical capabilities and functional skills into adulthood.
Aim:
The aim of this study was to use a prospective longitudinal study to describe age-related trends in energy efficiency during gait, activity, and participation in ambulatory children with cerebral palsy (CP).
Method:
Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), and Lifestyle Assessment Questionnaire-Cerebral Palsy (LAQ-CP) scores, and energy efficiency (oxygen cost) during gait were assessed in representative sample of 184 children (112 male; 72 female; mean age 10y 9mo; range 4-16y) with CP. Ninety-four children had unilateral spastic CP, 84 bilateral spastic CP, and six had other forms of CP. Fifty-seven were classified as Gross Motor Function Classification System (GMFCS) level I, 91 as level II, 22 as level III, and 14 as level IV). Assessments were carried out on two occasions (visit 1 and visit 2) separated by an interval of 2 years and 7 months. A total of 157 participants returned for reassessment.
Results:
Significant improvements in mean raw scores for GMFM, PEDI, and LAQ-CP were recorded; however, mean raw oxygen cost deteriorated over time. Age-related trends revealed gait to be most inefficient at the age of 12 years, but GMFM scores continued to improve until the age of 13 years, and two PEDI subscales to age 14 years, before deteriorating (p<0.05). Baseline score was consistently the single greatest predictor of visit 2 score. Substantial agreement in GMFCS ratings over time was achieved (κ(lw) =0.74-0.76).
Interpretation:
These findings have implications in terms of optimal provision and delivery of services for young people with CP to maximize physical capabilities and maintain functional skills into adulthood.
