Factors of Influence on the Walking Ability of Children with Spastic Cerebral Palsy

Abstract

Abstract. Children with spastic cerebral palsy (CP) have a strictly individual gait with numerous variations, which is also characterized by increased tonus and hyperreflexion of the muscles. These factors lead to a gait pattern that is inefficient in terms of consumption of energy. The purpose of this study was to clarify the major factor of the deterioration of walking ability on patients with cerebral palsy. Eighteen children (ten boys, eight girls, average age 12.7 years) with CP participated in the study. The children were divided into groups: the independent walking group and the walking aid group (walking with crutches and wheeled walkers); and the diplegia group and the hemiplegia group. The physiological cost index (PCI) for a 3 minute walk at comfortable speed was measured. PCI was compared to the reaction of the cardio-pulmonary system in basic motions (standing up from a table and 10 m walking). Through this test, the whole heart rate and 10 m walking time were measured. PCI and 10 m walking time in the independent walking group and the hemiplegia group were significantly lower than in the walking aid group and the diplegia group, but there was no difference in the endurance index between them. PCI had a significantly positive correlation with the 10 m walking time. However, PCI did not correlate with repetitions and difference in heart rate between before and after standing ups. From these results, it was concluded that the contracture, muscles weakness in the lower limbs, had a strong influence on ambulation level and energy expenditure in spastic CP.

Better Walking Performance in Older Children With Cerebral Palsy

“…Normal walking is extremely efficient and advances the body safely from place to place with a minimum of energy [ 8 ]. Children with CP often start to walk later than nondisabled children [ 20 ] and they walk with a slower speed and higher energy cost [ 7 ]. There is a strong correlation between the energy cost of walking and the degree of motor impairment [ 19 , 31 ].…”

Estimating Energy Expenditure for Different Assistive Devices in the School Setting

“…24 For example, Furukawa et al 24 found that deterioration of walking endurance in children with CP as they age may be due to difficulty with walking coordination and stability from joint deformity, spasm, or muscle weakness as opposed to a reduction of pulmonary-cardiac function. While our EEI findings are consistent with the literature, caution should be exercised when using the EEI, as heart rate can be influenced by external factors such as emotional stress 10 and the student's age.…”

A pilot study to compare the use of prototypes of multipositional paediatric walking sticks and tripods with conventional sticks and tripods by children with cerebral palsy

“…Logan and colleagues (1990) showed that there were significant improvements in postural alignment with the posterior walker, and Park and colleagues (2001) showed that the flexion angles of trunk, hip and knee were lower. Furukawa and colleagues (1998) in their research concluded that contractures and muscle weakness in the lower limbs had a strong influence on ambulation level and energy expenditure in spastic CP.…”