Energy cost during walking in association with age and body height in children and young adults with cerebral palsy

Bolster, Eline A. M.; Balemans, Astrid C. J.; Brehm, Merel-Anne; Buizer, Annemieke I.; Dallmeijer, Annet J.

doi:10.1016/j.gaitpost.2017.02.026

Cited by 30 publications

(18 citation statements)

References 20 publications

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“… 21 However, these results need to be considered in light of evidence that EE spontaneously decreases with increasing age. 58 In our more recent long-term study with a matched cohort, the improvement in EE for the SDR group approached statistical significance (p = 0.06), while the non-SDR control group did not. 22 The findings are far from conclusive, as variations between patients were large and sample size was small.…”

Section: Outcomes Of Sdrmentioning

confidence: 75%

Selective dorsal rhizotomy in ambulant children with cerebral palsy

Wang

Munger

Chen

et al. 2018

Journal of Children's Orthopaedics

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Abstract:BackgroundSelective dorsal rhizotomy (SDR) is a surgical procedure for treating spasticity in ambulant children with cerebral palsy (CP). However, controversies remain regarding indications, techniques and outcomes.Current evidence summaryBecause SDR is an irreversible procedure, careful patient selection, a multi-disciplinary approach in assessment and management and division of the appropriate proportion of dorsal rootlets are felt to be paramount for maximizing safety. Reliable evidence exists that SDR consistently reduces spasticity, in a predictable manner and to a substantial degree. However, functional improvements are small in the short-term with long-term benefits difficult to assess.Future outlookThere is a need for high-quality studies utilizing long-term functional outcomes and well-matched control groups. Collaborative, multicentre efforts are required to further define the role of SDR as part of the management paradigm in maximizing physical function in spastic CP.

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Section: Outcomes Of Sdrmentioning

confidence: 75%

Selective dorsal rhizotomy in ambulant children with cerebral palsy

Wang

Munger

Chen

et al. 2018

Journal of Children's Orthopaedics

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“…Clinically, energy consumption is most often estimated from the volume of oxygen consumed per unit time and is an indicator of exertion (Schwartz et al, 2006). The energy consumed during walking for children with CP has been estimated to be two to three times that of typically developing (TD) peers (Bolster et al, 2017;Waters and Mulroy, 1999;Duffy et al, 1996;Norman et al, 2004;Rose et al, 1990). The cause of this increased energy consumption is unclear.…”

Section: Introductionmentioning

confidence: 99%

Spasticity reduction in children with cerebral palsy is not associated with reduced energy consumption during walking

Steele

et al. 2019

Preprint

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Word Count: 246 (250) Main Text Word Count: 2311 (4000) Declarations of interest: none Highlights • Energy consumption is not reduced after rhizotomy compared to matched peers • Spasticity has minimal contribution to elevated energy during walking • Matched control groups are critical in cerebral palsy research AbstractBackground: The average energy consumption during walking of children with cerebral palsy (CP) is over two times of that of typically developing (TD) children and fatigue is one of the top complaints of children with CP and their families. Spasticity has been theorized to contribute to increased energy consumption during walking in CP, but its role remains unclear.Methods: We retrospectively compared the energy consumption of walking in children with diplegic CP before and after selective dorsal rhizotomy (SDR), a surgery that reduces spasticity. A control group of participants with CP who also underwent gait analysis but did not undergo SDR was matched to the SDR group by pre-surgery age, spasticity, and energy consumption. Energy consumption and spasticity were compared at baseline and follow-up for both groups.Findings: As expected, the SDR group has a significantly greater decrease (-44%) in spasticity compared to matched peers with CP who did not undergo SDR (-16%, P<0.001). While both groups had a reduction in energy consumption between visits (12 % SDR and 14% no-SDR), there was no difference in the change in energy consumption between groups (P=0.4).Interpretation: Reducing spasticity did not contribute to greater reductions in energy consumption, suggesting that spasticity has minimal impact on elevated energy consumption during walking for children with CP. Energy consumption and spasticity decrease with age among children with CP. Identifying matched control groups of peers with CP is critical for research involving children with CP to account for changes due to development.

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“…Clinically, the volume of oxygen consumed per unit time, often called ‘energy consumption’, is a widely used indicator of exertion 4 . The energy consumption during walking for children with CP has been estimated to be two to three times that of typically developing peers 5–9 . The cause of increased energy consumption is unclear.…”

mentioning

confidence: 99%

“…For example, changes in walking patterns and speed 18 after SDR could change joint moments and muscle demands 6 . Energy consumption 5 and spasticity 19 are also known to decrease with age among children with CP. Evaluating energy consumption before and after procedures thus requires that covariate factors, such as speed and age, be considered.…”

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confidence: 99%

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Energy consumption does not change after selective dorsal rhizotomy in children with spastic cerebral palsy

Zaino

Steele

Donelan

et al. 2020

Develop Med Child Neuro

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Aim To determine whether energy consumption changes after selective dorsal rhizotomy (SDR) among children with cerebral palsy (CP). Method We retrospectively evaluated net nondimensional energy consumption during walking among 101 children with bilateral spastic CP who underwent SDR (59 males, 42 females; median age [5th centile, 95th centile] 5y 8mo [4y 2mo, 9y 4mo]) compared to a control group of children with CP who did not undergo SDR. The control group was matched by baseline age, spasticity, and energy consumption (56 males, 45 females; median age [5th centile, 95th centile] 5y 8mo [4y 1mo, 9y 6mo]). Outcomes were compared at baseline and follow‐up (SDR: mean [SD] 1y 7mo [6mo], control: 1y 8mo [8mo]). Results The SDR group had significantly greater decreases in spasticity compared to matched controls (–42% SDR vs –20% control, p<0.001). While both groups had a modest reduction in energy consumption between visits (–12% SDR, –7% control), there was no difference in change in energy consumption (p=0.11) or walking speed (p=0.56) between groups. Interpretation The SDR group did not exhibit greater reductions in energy consumption compared to controls. The SDR group had significantly greater spasticity reduction, suggesting that spasticity had minimal impact on energy consumption during walking in CP. These results support prior findings that spasticity and energy consumption decrease with age in CP. Identifying matched control groups is critical for outcomes research involving children with CP to account for developmental changes.

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Energy cost during walking in association with age and body height in children and young adults with cerebral palsy

Cited by 30 publications

References 20 publications

Selective dorsal rhizotomy in ambulant children with cerebral palsy

Selective dorsal rhizotomy in ambulant children with cerebral palsy

Spasticity reduction in children with cerebral palsy is not associated with reduced energy consumption during walking

Energy consumption does not change after selective dorsal rhizotomy in children with spastic cerebral palsy

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