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Body-weight support is the primary driver of elevated walking cost in cerebral palsy

Andrew J Ries1, Katherine M Steele2, J Maxwell Donelan3

  • 1Gillette Children's Specialty Healthcare.

Research Square
|February 27, 2026
PubMed

Insights

Children with cerebral palsy (CP) have higher walking energy costs mainly due to body-weight support needs. Reducing this support significantly lowers energy expenditure, offering new rehabilitation targets.

Area of Science:

  • Biomechanics
  • Human Movement Science
  • Rehabilitation Engineering

Background:

  • Children with cerebral palsy (CP) demonstrate significantly increased energy expenditure during walking.
  • The precise biomechanical factors driving this elevated energetic cost in CP remain incompletely understood.
  • This knowledge gap hinders the development of effective interventions for improving walking in children with CP.

Purpose of the Study:

  • To investigate whether increased demands for body-weight support and lateral stabilization contribute to the elevated energetic cost of walking in children with CP.
  • To quantify the independent effects of body-weight support and mediolateral stabilization on walking energy expenditure in children with CP and typically developing (TD) peers.

Main Methods:

  • Utilized a custom mechatronic system to apply controlled vertical body-weight support (1-60%) and mediolateral stabilization stiffness (50-1500 N/m).
  • Assessed steady-state energetic cost of walking using indirect calorimetry in children with CP (n=23) and TD peers (n=10).
  • Employed linear regression models to analyze the energetic responses to each intervention.

Main Results:

  • Body-weight support significantly decreased net energetic cost in both groups, with a 3.5 times greater effect observed in children with CP.
  • A 41% reduction in energetic cost was achieved in the CP group across the support range, normalizing their energy expenditure to TD levels.
  • Mediolateral stabilization had minimal impact on energetic cost in both CP and TD groups, with no identified predictors of response.

Conclusions:

  • Body-weight support is the primary factor contributing to the elevated energetic cost of walking in children with CP.
  • Lateral stabilization plays a minor role in the energetic demands of walking for this population under tested conditions.
  • Gravitational support emerges as a critical biomechanical target for developing energy-focused rehabilitation strategies and assistive technologies for children with CP.
Abstract

Keywords:
Cerebral palsyassistive technologybody-weight supportgait biomechanicslateral stabilizationmetabolic costrehabilitation engineeringwalking energetics

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