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Habitual Physical Activity and Walking Endurance Following Inpatient Rehabilitation in Children With Cerebral Palsy
Pawel Chmara1, Amadeusz Brzykcy1,2, Sabina Brazevic1
1Department of Pediatric Orthopedics and Traumatology, Wiktor Dega Orthopedic and Rehabilitation Clinical Hospital of Poznan University of Medical Sciences, Poznań, POL.
Insights
In cerebral palsy (CP) GMFCS level II, inpatient rehabilitation improved walking endurance, especially in active children. However, physical activity levels did not correlate with endurance gains, and inefficient gait mechanics were observed in active participants.
Area of Science:
- Pediatric rehabilitation
- Movement science
- Clinical biomechanics
Background:
- Cerebral palsy (CP) GMFCS level II presents significant functional heterogeneity in ambulatory abilities.
- The relationship between physical activity (PA) measured by accelerometry and walking endurance (6-minute walk test, 6MWT) post-rehabilitation in CP is not well understood.
Purpose of the Study:
- To examine correlations between habitual PA and changes in walking endurance after inpatient rehabilitation.
- To investigate if spatiotemporal gait parameters explain the inverse relationship between PA classification and baseline 6MWT performance in children with CP GMFCS II.
Main Methods:
- Twenty-five children with CP GMFCS II underwent a two-week inpatient rehabilitation program.
- Walking endurance was assessed using the 6MWT before and after rehabilitation.
- Habitual PA was monitored for 72 hours using wearable devices, excluding sleep and therapy sessions.
Main Results:
- Significant improvements in 6MWT distance were noted for the overall group and the active subgroup, but not the inactive subgroup.
- No significant correlations were found between normalized PA measures and 6MWT improvement.
- The active subgroup exhibited lower baseline 6MWT performance despite higher daily step counts and demonstrated inefficient gait biomechanics.
Conclusions:
- Two weeks of inpatient rehabilitation led to clinically meaningful improvements in walking endurance in children with CP GMFCS II, particularly those classified as active.
- Habitual physical activity intensity and gains in walking endurance were not correlated.
- Inefficient gait biomechanics in the active subgroup may underlie the observed inverse relationship between PA classification and baseline 6MWT performance.
Background:
Cerebral palsy (CP) at GMFCS level II is the most functionally heterogeneous ambulatory group, with high intra-group variability in walking endurance and daily physical activity. The relationship between six-minute walk test (6MWT) outcomes and accelerometer-based monitoring following inpatient rehabilitation remains unclear.
Aim:
The aim of this study was to assess correlations between wear-time-normalised habitual physical activity (PA) parameters and rehabilitation-induced change in walking endurance, and to determine whether objectively measured spatiotemporal gait parameters explain the inverse relationship between metabolic equivalent of task (MET)-based PA classification and baseline 6MWT performance in this population.
Methods:
Twenty-five children with CP at GMFCS II (female: 10, male: 15; age: 13.40 ± 1.12 years) completed a two-week inpatient rehabilitation programme. The 6MWT was performed on the first and final day. PA was monitored over 72 hours using a wearable device, which was removed during sleep, bathing, and activities that might cause damage to the device; data were not recorded during structured therapy sessions. Participants were classified as active (n = 13) or inactive (n = 12). Analysis included paired t-test, Pearson and Spearman correlations, Mann-Whitney U test, and Cohen's dz. Spatiotemporal gait parameters were obtained from instrumented gait analysis.
Results:
Significant improvement in 6MWT distance was observed in the entire group (moderate effect), and the active subgroup (medium-to-large effect); no improvement was found in the inactive subgroup. No significant correlations between normalised PA measures and 6MWT improvement were identified. At baseline, the active subgroup showed lower 6MWT distance despite higher step accumulation. Between-group PA differences were significant. Spatiotemporal analysis revealed inefficient gait biomechanics in the active subgroup (lower walking speed, shorter step and stride length, longer stance phase). An exploratory analysis found a negative correlation between baseline 6MWT and rehabilitation-induced change in the inactive subgroup.
Conclusions:
Two weeks of inpatient rehabilitation produced clinically meaningful improvements in walking endurance, particularly in the active subgroup. Habitual PA intensity and endurance gains were not correlated. Inefficient gait biomechanics in the active subgroup may help explain the paradoxical inverse relationship between MET classification and baseline 6MWT performance.
