The effect of maturation on energy cost in children with cerebral palsy and age- matched controls

The effect of maturation on energy cost in children with cerebral palsy and age- matched controls
SS THOMAS MA, CE BUCKON MS, BS RUSSMAN MD, MD SUSSMAN MD , MD AIONA MD
Shriners Hospitals for Children, Portland, OR, USA


Background/Objectives: To determine the change in the energy cost of walking over one year in children with cerebral palsy by GMFCS level and relative to age –match controls.
Design: prospective longitudinal study.
Participants and setting: Forty –five children in the control group (22 female, 23 male, mean age 11 years, range 5-18)<and 34 children with spastic diplegia GMFCS levels I-III (11 female ,23 male, mean age 12 years ,range 6-18), from a pediatric orthopaedic hospital.
Materials/Methods: A Cosmed k4b2 energy consumption unit was used to determine the net non-dimensional energy cost of walking (NNcost) at baseline and 1 year. Subject walked at their self –selected velocity. T-tests were used to determine differences in height (ht),weight (wt), velocity and NNcost between baseline and 1year .Significance was set at p<0.05.Linear regression was used to determine whether functional functional level or age predicted the change in energy cost over 1 year.
Results: Height and weight increased significantly over 1 year for both children with cerebral palsy and their able bodied peers. No significant differences in velocity over 1 year were noted for the able-bodied children or the children with cerebral palsy. While all groups demonstrated decreases in NNcost over 1 year, only the able-bodied children decreased significantly. The change in energy cost over 1 year could not be explained by the type of subject or by age, with type of subject explaining less than 1% of the variance and age explaining only 3% of the variance.
Conclusions/Significance: Conclusions; In this study able-bodied children demonstrated a 15% decrease in cost over 1 year, the children with cerebral palsy only demonstrated only a 5% decrease. The findings of this study demonstrate that the energy cost of children with cerebral palsy does not increase with age as reported previously; which may indicate differences in physiological maturation between children with cerebral palsy and their able-bodied peers. A greater number of children with cerebral palsy within each of the three GMFCS levels are needed to determine whether the rate of change differs by GMFCS level as the children increase in age.

 
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