Affiliations: Shriners Hospitals For Children, Portland, OR, USA
Note: [] Corresponding author: Susan Sienko Thomas, MA, Shriners
Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Tel.: +1 503 221 3481; Fax: +1 503 221 3490; E-mail: SST@SHCC.org
Abstract: For ambulatory children with cerebral palsy, the assessment of
walking energy efficiency is utilized to determine functional changes following
surgical, pharmacologic, or orthotic interventions. While the assessment of
energy efficiency is considered a useful outcome tool, minimal information
exists about the changes in energy efficiency over one year in children with
cerebral palsy at different gross motor function classification system (GMFCS)
levels and whether the patterns of change are similar to their able-bodied
peers. The purpose of this study was to determine whether energy efficiency
variables change similarly over one year in children with cerebral palsy by
GMFCS level and whether they differ from their age-matched peers. Forty-five
able-bodied children and 34 children with cerebral palsy, GMFCS levels I-III
participated in the study. Energy efficiency variables were measured at
baseline and at 12 months using a Cosmed K4b^{2}. All
subjects walked at their self-selected velocity for testing around a 33m track.
Baseline velocity and net non-dimensional cost (NNcost) differed by GMFCS level
and between the able-bodied peers and all GMFCS levels. Children in GMFCS level
III had the highest cost and the slowest velocity. When controlling for age and
baseline values, significant differences in the magnitude of change were seen
in velocity between children in GMFCS level III and children in GMFCS level I
and II and their able-bodied peers. In comparison to their able-bodied peers,
all GMFCS levels had an increase in NNcost over one year when controlling for
age and baseline NNcost, with the difference in magnitude increasing by GMFCS
level. Consistent with the literature, children with cerebral palsy had an
increase in NNcost over one year in comparison to their able-bodied peers,
which increased with GMFCS level. This finding demonstrates that when
evaluating the change in walking energy efficiency with maturation and
therapeutic intervention, comparisons should be made by GMFCS level.
Keywords: Cerebral palsy, energy cost, GMFCS level
