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Updated: Apr 27, 2026
Lower Limb Biomechanical Analysis of Healthy Participants
Published on: April 15, 2020
Variability explained by strength, body composition and gait impairment in activity and participation measures for
Donna Oeffinger1, George Gorton2, Sahar Hassani3
1Shriners Hospital for Children, Lexington, KY, USA doeffinger@shrinenet.org.
Insights
Gait impairment significantly impacts activity and participation in cerebral palsy, but strength and body composition play minor roles. Understanding these factors is key for effective treatment strategies in this diverse population.
Area of Science:
- Paediatric Orthopaedics
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Cerebral palsy (CP) affects motor function, impacting daily activities and participation.
- Ambulatory individuals with CP exhibit significant variability in functional outcomes.
- Identifying factors influencing this variability is crucial for targeted interventions.
Purpose of the Study:
- To quantify the variability in activity and participation measures for ambulatory individuals with CP.
- To determine the contribution of strength, body composition, gait impairment, and participant characteristics to this variability.
Main Methods:
- A multicentre prospective cross-sectional study involving 377 ambulatory individuals with CP (GMFCS levels I-III).
- Assessments included muscle strength, body composition, gait analysis, and functional outcome measures (GMFM-66, PODCI).
- Multiple linear regression and bootstrap analyses were used, stratified by Gross Motor Function Classification System (GMFCS) level.
Main Results:
- Variability explained by the studied factors ranged from 11% to 50%.
- Gait impairment was the most consistent predictor, with increased impairment correlating to lower outcome scores.
- Strength and body composition explained minimal variability; participant characteristics were significant in some models.
Conclusions:
- Variability in outcome measures for individuals with CP is complex and only partially explained by strength and gait impairment.
- The heterogeneity of CP presents challenges in explaining outcome variations.
- Clinicians should consider these multifaceted factors when developing treatment plans.
Objective:
To determine the amount of variability in scores on activity and participation measures used to assess ambulatory individuals with cerebral palsy explained by strength, body composition, gait impairment and participant characteristics.
Design:
Multicentre prospective cross-sectional study.
Setting:
Seven paediatric-orthopaedic specialty hospitals.
Participants:
Three hundred and seventy-seven ambulatory individuals (241 males, 136 females) with cerebral palsy, Gross Motor Function Classification System (GMFCS) levels I-III (I = 148, II = 153, III = 76), ages 8-18 years (mean 12 years 9 months, SD 2 years 8 months).
Methods:
Participants completed assessments of GMFCS level, patient history, lower extremity muscle strength, Gross Motor Function Measure (GMFM-66), Pediatric Outcomes Data Collection Instrument (PODCI), instrumented gait analysis, 1 minute walk test, Timed Up-and-Go and body composition. Multiple linear regression and bootstrap analyses were performed for each outcome measure, stratified by GMFCS level.
Results:
The amount of variability in outcome measures explained by participant characteristics, strength, and gait impairment ranged from 11% to 50%. Gait impairment was the most common predictor variable and frequently explained the greatest variance across all outcome measures and GMFCS levels. As gait impairment increased, scores on outcome measures decreased. Strength findings were inconsistent and not a primary factor. Body composition contributed minimally (<4%) in explaining variability. Participant characteristics (cerebral palsy type, gestational age and age at walking onset), were significant predictor variables in several models.
Conclusions:
Variability in outcome measure scores is multifaceted and only partially explained by strength and gait impairment illustrating the challenges of attempting to explain variation within this heterogeneous population. Clinicians treating individuals with cerebral palsy should consider this when developing treatment paradigms.
