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Control of Walking Speed in Children With Cerebral Palsy
Jon R Davids1, Nina Q Cung, Suzy Chen
1Shriners Hospital for Children Northern California, Sacramento, CA.
Insights
Most children with cerebral palsy (CP) can adjust their walking speed, but this ability varies by motor impairment level. Children with higher impairment (GMFCS III) show less control over gait speed.
Area of Science:
- Pediatrics
- Neurology
- Biomechanics
Background:
- Gait speed control is crucial for children's daily activities.
- Children with cerebral palsy (CP) often exhibit impaired gait.
- The ability of children with CP to modulate gait speed is not fully understood.
Purpose of the Study:
- To investigate the prevalence of gait speed control in children with CP.
- To examine the relationship between motor impairment levels and gait characteristics.
- To identify distinct gait adjustment strategies across different impairment levels.
Main Methods:
- Retrospective analysis of time-distance parameters (TDPs) in 212 children with CP and 34 typically developing children.
- Comparison of free (self-selected) and fast walking speeds.
- Statistical analysis using ANOVA across Gross Motor Function Classification System (GMFCS) levels.
Main Results:
- 85% of children with CP could increase gait speed on demand.
- Children with GMFCS levels I and II demonstrated faster free-walking speeds and longer stride lengths than GMFCS level III.
- No significant differences in cadence were observed at fast speeds across GMFCS levels.
Conclusions:
- Children with CP at GMFCS levels I and II largely possess gait speed control.
- A significant portion of children with CP at GMFCS level III lack the ability to control gait speed.
- GMFCS level III children may be classifiable into subgroups based on gait speed control, warranting further investigation.
Background:
Children's ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels.
Methods:
A retrospective review of time-distance parameters (TDPs) for 212 subjects with CP and 34 typically developing subjects walking at free and fast speeds was performed. Only children who could increase their gait speed above the minimal clinically important difference were defined as having a fast walk. Analysis of variance was used to compare TDPs of children with CP, among Gross Motor Function Classification System (GMFCS) levels, and children in typically developing group.
Results:
Eight-five percent of the CP group (GMFCS I, II, III; 96%, 99%, and 34%, respectively) could increase gait speed on demand. At free speed, children at GMFCS I and II were significantly faster than children at GMFCS level III. At free speed, children at GMFCS I and II had significantly greater stride length than those at GMFCS levels III. At free speed, children at GMFCS level III had significantly lower cadence than those at GMFCS I and II. There were no significant differences in cadence among GMFCS levels at fast speeds. There were no significant differences among GMFCS levels for percent change in any TDP between free and fast walking.
Discussion:
Almost all children with CP at GMFCS levels I and II can control the speed of gait, however, only one-third at GMFCS III level have this ability. This study suggests that children at GMFCS III level can be divided into 2 groups based on their ability to control gait speed; however, the prognostic significance of such categorization remains to be determined.
Level Of Evidence:
Diagnostic level II.
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