1. Relationship Between Gait Efficiency, Gait Kinematics and Muscular Strength in Children With Cerebral Palsy
Laurent Ballaz1, 2; Suzanne Plamondon 1; Martin Lemay1;
1Research Centre, CHU Sainte-Justine, Montréal, QC
2Centre for Multidisciplinary Research in Rehabiliation of Greater Montreal – REPAR, Montreal, QC
INTRODUCTION : Gait efficiency in children with cerebral palsy is weak, related to a poor walking speed and an important energy consumption [1] . In this population, lower limb muscular strength are related to gait kinematic and spatiotemporal gait parameters [2]. Gait patterns are very different among children with cerebral palsy and the major factors related to gait efficiency in cildren with cerebral palsy are unknow.
AIM : To assess relationship between gait efficiency, gait kinematic, lower limb muscular strength and gross motor function in children with spastic cerebral palsy.
METHODS :
A. Participants (n=10)
B. measurements
5-minute walking test
Distance cover  Vwalk
Heat rate during the last minute (HRwalk)
Rest heart rate (HRrest)
3D Kinematic analysis of gait
(VICON 512; Polygon™)
Muscular strength : maximal knee isométric flexion/extension strength (Hand dynamometer) [3]
Spasticity of quadriceps muscle : pendulum test
Maximal rotation velocity of the lower limb during [4]
Functional level « Gross Motor Function Measurement » (GMFM D-E)
RÉSULTS :
Kinematics: EEI (1,5±0,7 bat/m, range 0,6-2,6) is correlated with the kinematic parameters reported in table 2 and illustrated in figure 1 (Pearson product moment correlation),.
Strength:Maximal isometric knee flexion is the only strength measurement significantly correlated (r =-0,85;P<0,01) with EEI (figure 2).
Functional level: GMFM dimensions D and E are correlated with EEI (r =-0,94; P<0,001 et r =-0,80; P<0,001, respectively) and with maximal isometric knee flexion strength (r =0,91; P<0,001 et r =0,93; P<0,05, respectivement). GMFM dimensions D et E are correlated with ankle ROM during gait (r =0,82; P<0,001 et r = 0,73; P<0,05, respectivement).
Subjects
Age
Type CP
GMFCS
Primary mobility device 1 17 H II
None 2 18 Q I 3 14 D 4 20
III
Crutches 5 21 6 7 8
Walker 9 16 10 13
Comparison r P
Self-selected walking speed
-0.82**
0.004
Step length
-0.70*
0.023
Gait cadence
-0.54
0.108
Hip ROMduring gait
-0.35
0.33
Maximal hip extension during gait
0.54
0.11
Knee ROM during gait
-0.71*
Maximal knee extension during gait
0.34
Ankle ROMduring gait
Maximal plantar flexion during gait
0.73*
0.016
Energy expenditure index (bat/m)
r =-0,82
D, diplegia; H, hemiplegia; Q, quadriplegia
Table 1: Characteristics of the participants
Ankle ROM
Energy Expenditure Index [1]
EEI = (HRwalk-HRrest)/Vwalk
Table 2: correlation between gait kinematic parameter and EEI
Figure 1: Ankle ROM vs EEI
r =-0,85
r =-0,80
Energy expenditure index (bat/m)
Energy expenditure index (bat/m)
Knee flexion isometric strength (N)
GMFM dimension E
Figure 2: Maximal isometric knee flexion strength vs EEI
Figure 3: GMFM-E vs EEI
ωmax
CONCLUSION – PERSPECTIVE
Ankle ROM during gait and maximal knee flexion strength are two major factors to maintain gait efficiency and a high fonctional level in children with cerebral palsy. This point must be taken in to account for therapy choice. Specific physical training may be engaged to improve these parameters.
REFERENCES :
[1] Rose J, Gamble JG, Lee J, Lee R, Haskell WL. The energy expenditure index: a method to quantitate and compare walking energy expenditure for children and adolescents. Journal of pediatric orthopedics 1991;11(5): [2] Eek MN, Beckung E. Walking ability is related to muscle strength in children with cerebral palsy. Gait & posture 2008;28(3): [3] Bohannon RW. Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Physical therapy 1986;66(2): [4] Fowler EG, Nwigwe AI, Ho TW. Sensitivity of the pendulum test for assessing spasticity in persons with cerebral palsy. Developmental medicine and child neurology 2000;42(3):182-9.