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Updated: Dec 9, 2025
Lower Limb Biomechanical Analysis of Healthy Participants
Published on: April 15, 2020
Relationship between lower limb strength and walking capacities in children with spastic bilateral cerebral palsy
Annie Pouliot-Laforte1,2, Audrey Parent1,2, Reggie Hamdy3
1Sainte-Justine UHC Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada.
Insights
Muscle strength is linked to walking ability in children with bilateral cerebral palsy (BCP). Strength training is beneficial for weaker children, but not necessarily for stronger ones.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Children with bilateral cerebral palsy (BCP) often experience impaired motor function, affecting their walking capacity.
- Understanding the relationship between muscle strength and walking is crucial for effective rehabilitation strategies.
Purpose of the Study:
- To evaluate the relationship between various walking capacities and muscle strength in children with BCP.
- To determine if this relationship differs between stronger and weaker children within the BCP cohort.
Main Methods:
- Thirty-two children with spastic BCP participated.
- Measurements included comfortable, fast, and endurance walking speeds, Energy Expenditure Index (EEI), and lower limb muscle strength (Global Strength Index - GSI).
- Statistical analyses involved Pearson's correlation and regression models.
Main Results:
- A logarithmic relationship was found between GSI and walking capacities (explaining 24-34% of variance).
- Muscle strength (GSI) correlated with walking speeds in weaker children.
- No significant correlation between GSI and walking capacities was observed in stronger children.
Conclusions:
- Muscle strength is logarithmically related to walking capacities in children with BCP.
- Interventions targeting muscle strength are most beneficial for weaker children with BCP.
- For stronger children with BCP, rehabilitation should focus on factors beyond muscle strength.
Purpose:
Evaluate the relationship between different walking capacities and muscle strength in children with bilateral cerebral palsy (BCP) and assess these relationships in stronger and weaker children.
Materials And Methods:
Thirty-two children with spastic BCP were included. All participants walked under three speed conditions: comfortable, fast, and for a longer period (6 min). Walking speeds, Energy Expenditure Index (EEI), and lower limb muscle strength were measured. A global strength index (GSI) was computed as the sum of each muscle group strength. Pearson's coefficient and regression models were computed between walking capacities and the GSI.
Results:
GSI was correlated with the EEI and all walking speeds. Logarithmic regressions models explained between 24 and 34% of the variance of walking capacities. Then, the group was divided in two subgroups (weaker and stronger children). GSI was correlated with comfortable and endurance waking speed in weaker children, but not in stronger children.
Conclusion:
This study reports logarithmic relationship between muscle strength and walking capacities in children with BCP. The subgroup analysis implies that muscle strength has an impact on walking capacities solely in weaker children, suggesting that muscle strength must be preserved and reinforced in interventions targeting motor function in weaker children with BCP.Implications for rehabilitationIn a sample of children with spastic bilateral cerebral palsy, this study shows that global muscle strength is associated with walking capacities and the relationship seems more complex than linear.Based on the results, interventions should focus on maintaining or improving muscle strength in weaker children as no association was observed between muscle strength and walking capacities in stronger children.In stronger children, intervention should focus on factors other than muscle strength as it does not influence walking capacities.Based on this study, a more accurate screening of children who could benefit from strength training could be completed by initial global muscle strength.
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