Physical strain: a new perspective on walking in cerebral palsy

Publication date: Available online 6 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Astrid CJ. Balemans, Eline Bolster, Merel-Anne Brehm, Annet J. Dallmeijer
ObjectiveThe objectives of this study in children and adolescents with cerebral palsy (CP) were to 1) describe physical strain of walking, 2) describe the proportion of participants walking above the anaerobic threshold and 3) describe 4 phenotypes of physical strain of walking based on deviations in aerobic capacity and walking energy cost (EC).DesignCohortSettingAcademic medical centerParticipantsThirty-seven participants (13y5mo(4y0mo)) with CP (Gross Motor Function Classification System (GMFCS) levels I[n=13], II[N=17] and III[N=7]) and 20 typically developing participants (TD) (11y8mo(3y5mo)).InterventionsNot applicableMain Outcome Measure(s)Oxygen consumption (VO2walk), speed and EC were determined during walking at comfortable speed. Peak oxygen uptake (VO2peak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was decreased if <10^th percentile and EC was increased if >3SD's. Physical strain was defined as [VO2walk/VO2peak]*100.ResultsParticipants with CP had a higher physical strain (GMFCS levels I:55±12%, II:62±17% and III:78±14%) than TD (40±11%, p<0.001). 43% of the participants with CP showed a VO2walk at or higher than their anaerobic threshold compared to 10% in TD (p=0.007). Phenotypes showed that a decreased VO2peak [N=9] or an increased EC [N=9] lead to 18-20% higher physical strain, while a combination [N=12] leads to 40% increase.ConclusionsChildren and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable part walks around or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and/or a decreased VO2peak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in CP require different intervention strategies.



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