Muscle activation and energy-requirements for varying postures in children and adolescents with cerebral palsy

Area of Science:

• Pediatric Physical Therapy
• Neuromuscular Disorders
• Rehabilitation Medicine

Background:

• Children and adolescents with cerebral palsy (CP) often experience prolonged sedentary behavior.
• Understanding energy expenditure and muscle activity in different postures is crucial for managing health in individuals with CP.

Purpose of the Study:

• To quantify energy expenditure and muscle activity in children and adolescents with CP.
• To compare these measures across various postures, including sedentary approximations and standing.

Main Methods:

• A cohort study involving 19 participants with spastic CP (ages 4-20, GMFCS-E&R levels I-V).
• Indirect calorimetry measured energy expenditure (METs); surface electromyography assessed muscle activity.
• Measurements were taken in supine, sitting with/without support, and standing postures.

Main Results:

• Standing consistently resulted in energy expenditure exceeding 1.5 METs across all Gross Motor Function Classification System Expanded and Revised (GMFCS-E&R) levels.
• A trend indicated increased muscle activation with less postural support.
• Significantly greater muscle activation during standing compared to rest was observed only in GMFCS-E&R level III.

Conclusions:

• Standing posture significantly elevates energy expenditure in children and adolescents with CP above sedentary thresholds.
• Repositioning to standing may be an effective strategy to increase light activity and decrease sedentary time.
• These findings support incorporating standing interventions to improve physical activity levels in this population.