Although heart rate is closely related to oxygen uptake and oxygen uptake to aerobic energy expenditure, energy expenditure is also dependent on the type of fuel utilised and possible anaerobic processes. While evaluated through heart rate changes, co-activation in the thigh muscles was negatively related to walking energy expenditure. Evaluated through oxygen uptake, leg and thigh muscle co-activation have shown to be positively related or not related to walking energy expenditure. However, previous research on the relation between walking energy expenditure and lower limb muscle co-activation in children with CP have methodological limitations and present contradictory findings. On the other hand, excessive and prolonged co-activation may deteriorate movement and increase energy expenditure by decreasing flexibility and adaptability and increase the total muscle force involved in generating joint moments. It has functional benefits by increasing joint stabilization, co-ordination, and the ability to perform challenging tasks, such as walking. Muscle co-activation may be defined as concurrent activity of agonist and antagonist muscles crossing the same joint. Moreover, the excessive lower limb muscle co-activation reported in children with CP during walking may also play a role in increased energy expenditure. However, there is still uncertainty how an asymmetric gait pattern affects energy expenditure during walking in children with CP. An asymmetric gait pattern is reported to be more energy demanding than symmetric walking in the normal population and in stroke patients. Īnother gait characteristic affected by CP is asymmetry, reflected both in joint kinematics and spatiotemporal gait parameters. Increased walking energy expenditure has been associated with kinematic deviations. The gait pattern in children with CP is characterized by deviations in joint kinematics that may be present at several levels (pelvis, hip, knee, ankle, foot) and in all three movement planes. Moreover, the ambulant children with CP (GMFCS I to III), have an increasing energy expenditure during walking with decreasing motor function. These features impair gross motor function in general and gait in particular as reflected in the Gross Motor Function Classification System (GMFCS). Knowledge about factors affecting walking energy expenditure in this young patient group will thus aid clinical decision making and planning of a suitable course of treatment to achieve this goal.Ĭhildren with CP have impaired motor control and balance, and reduced muscle strength. Therefore, an often used treatment goal for these children with CP is to make walking less energy demanding. Cerebral palsy (CP) is the most common cause of neuromuscular disability in childhood and ambulant children with CP have increased energy expenditure during walking compared to typically developing children. Increased energy expenditure during walking may lead to activity limitations and reduced participation in daily life. This cross-sectional study indicates that increased gait deviation contributes to increased energy cost of walking in children with GMFCS level I and II. No significant contribution was found for gait asymmetry or co-activation index. Gait deviation and height combined explained about 40% of the variance in gross energy cost. Height was included to control for growth-related variation. The relation between energy cost and GDI, GDI asymmetry, and co-activation index of the lower limb muscles was evaluated through mixed model analyses. From a 3-dimensional gait analyses, kinematic variables and electromyography were extracted to calculate the gait deviation index (GDI) and co-activation index. Gross energy cost (J/kg/m) was measured during a 5-min walk test at self-selected speed. Methodsįorty ambulant children with CP, with Gross Motor Function Classification System (GMFCS) level I ( N = 35) and II ( N = 5), aged between 5-17y, were tested at one or two occasions with 24 weeks in between, resulting in 71 observations. The aim of this study was to investigate the relation between energy cost of walking with gait deviation, asymmetry, and muscle co-activation in children with CP. Insight into whether the also deviating and more asymmetric gait with increased muscle co-activation contributes to this increased energy expenditure is important for clinical decision making. Compared to typically developing children, children with cerebral palsy (CP) have increased energy expenditure during walking, limiting activity and participation.
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