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The Effect of Simulating Weight Gain on the Energy Cost of Walking in Unimpaired Children and Children With Cerebral Palsy

      Abstract

      Plasschaert F, Jones K, Forward M. The effect of simulating weight gain on the energy cost of walking in unimpaired children and children with cerebral palsy.

      Objective

      To examine the effect of simulating weight gain on the energy cost of walking in children with cerebral palsy (CP) compared with unimpaired children.

      Design

      Repeated measures, matched subjects, controlled.

      Setting

      University hospital clinical gait and movement analysis laboratory.

      Participants

      Children (n=42) with CP and unimpaired children (n=42).

      Interventions

      Addition of 10% of body mass in weight belt.

      Main Outcome Measures

      Energy cost of walking parameters consisting of walking speed, Physiological Cost Index, Total Heart Beat Index, oxygen uptake (V̇o2), gross oxygen cost, nondimensional net oxygen cost, and net oxygen cost with speed normalized to height were measured by using a breath-by-breath gas analysis system (K4b2) and a light beam timing gate system arranged around a figure 8 track. Two walking trials were performed in random order, with and the other without wearing a weighted belt.

      Results

      Children with CP and their unimpaired counterparts responded in fundamentally different ways to weight gain. The unimpaired population maintained speed and V̇o2 but the children with CP trended toward a drop in their speed and an increase in their V̇o2. The oxygen consumption of children with CP showed a greater dependence on mass than the unimpaired group (P=.043).

      Conclusions

      An increase of a relatively small percentage in body mass began to significantly impact the energy cost of walking in children with CP. This result highlights the need for weight control to sustain the level of functional walking in these children.

      Key Words

      List of Abbreviations:

      CP (cerebral palsy), PCI (Physiological Cost Index), THBI (Total Heart Beat Index), V̇o2 (oxygen uptake)
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      References

        • Odding E.
        • Roebroeck M.E.
        • Stam H.J.
        The epidemiology of cerebral palsy: incidence, impairments and risk factors.
        Disabil Rehabil. 2006; 28: 183-191
        • Keen M.
        Early development and attainment of normal mature gait.
        J Prosthet Orthot. 1993; 5: 35
        • Gage J.R.
        Gait analysis in cerebral palsy.
        Cambridge Univ Pr, New York1991
        • Winter D.A.
        Biomechanics of human movement.
        John Wiley and Sons, Toronto1979
        • Mian O.S.
        • Thom J.M.
        • Ardigò L.P.
        • Narici M.V.
        • Minetti A.E.
        Metabolic cost, mechanical work, and efficiency during walking in young and older men.
        Acta Physiol (Oxf). 2006; 186: 127-139
        • Irsigler K.
        • Veitl V.
        • Sigmund A.
        • Tschegg E.
        • Kunz K.
        Calorimetric results in man: energy output in normal and overweight subjects.
        Metabolism. 1979; 28: 1127-1132
        • MacGregor J.
        The objective measurement of physical performance with long term ambulatory physiological surveillance equipment (LAPSE).
        in: Stott F.D. Raferty E.B. Goulding L. Proceedings of 3rd International Symposium on Ambulatory Monitoring. Academic Pr, London1979: 29-39
        • Bowen T.
        • Cooley S.R.
        • Castagno P.
        • Miller F.
        • Richards J.
        A method for normalisation of oxygen cost and consumption in normal children while walking.
        J Pediatr Orthop. 1998; 18: 589-593
        • Baker R.
        • Hausch A.
        • McDowell B.
        Reducing the variability of oxygen consumption measurements.
        Gait Posture. 2001; 13: 202-209
        • Schwartz M.H.
        • Koop S.E.
        • Bourke J.L.
        • Baker R.
        A nondimensional normalization scheme for oxygen utilization data.
        Gait Posture. 2006; 24: 14-22
        • Hood V.L.
        • Granat M.H.
        • Maxwell D.J.
        • Hasler J.P.
        A new method of using heart rate to represent energy expenditure: the Total Heart Beat Index.
        Arch Phys Med Rehabil. 2002; 83: 1266-1273
        • Maher C.A.
        • Williams M.T.
        • Olds T.
        • Lane A.E.
        Physical and sedentary activity in adolescents with cerebral palsy.
        Dev Med Child Neurol. 2007; 49: 450-457
        • Andersen R.E.
        • Crespo C.J.
        • Bartlett S.J.
        • Cheskin L.J.
        • Pratt M.
        Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey.
        JAMA. 1998; 279: 938-942
        • Holm K.
        • Li S.
        • Spector N.
        • Hicks F.
        • Carlson E.
        • Lanuza D.
        Obesity in adults and children: a call for action.
        J Adv Nurs. 2001; 36: 266-269
        • Agre J.C.
        The role of exercise in the patient with post-polio syndrome.
        Ann N Y Acad Sci. 1995; 753: 321-334
        • Gazzani F.
        • Bernardi M.
        • Macaluso A.
        • et al.
        Ambulation training of neurological patients on the treadmill with a new Walking Assistance and Rehabilitation Device (WARD).
        Spinal Cord. 1999; 37: 336-344
        • Brown J.P.
        Orthopaedic care of children with spina bifida: you've come a long way, baby!.
        Orthop Nurs. 2001; 20: 51-58
        • Palisano R.
        • Rosenbaum P.
        • Walter S.
        • Russell D.
        • Wood E.
        • Galuppi B.
        Development and reliability of a system to classify gross motor function in children with cerebral palsy.
        Dev Med Child Neurol. 1997; 39: 214-223
        • Palisano R.
        • Rosenbaum P.
        • Bartlett D.
        • Livingston M.
        GMFCS - E & R.
        (Accessed August 26, 2008)
        • Corry I.S.
        • Duffy C.M.
        • Cosgrave A.P.
        • Graham H.K.
        Measurement of oxygen consumption in disabled children by cosmed K2 portable telemetry system.
        Dev Med Child Neurol. 1996; 38: 585-593
        • Waters R.L.
        • Hislop H.J.
        • Thomas L.
        • Campbell J.
        Energy cost of walking in normal children and teenagers.
        Dev Med Child Neurol. 1983; 25: 184-188
        • Waters R.L.
        • Lunsford B.R.
        • Perry J.
        • Byrd R.
        Energy-speed relationship of walking: standard tables.
        J Orthop Res. 1988; 6: 215-222
        • Charteris J.
        • Scott P.A.
        • Nottrodt J.W.
        Metabolic and kinematic responses of African women headload carriers under controlled conditions of load and speed.
        Ergonomics. 1989; 32: 1539-1550
        • Hanson J.S.
        Exercise responses following production of experimental obesity.
        J Appl Physiol. 1973; 5: 587-591
        • Unnithan V.B.
        • Dowling J.J.
        • Frost G.
        • Bar-Orr O.
        Role of mechanical power estimates in the O2 cost of walking in children with cerebral palsy.
        Med Sci Sports Exerc. 1999; 31: 1703-1709
        • Unnithan V.B.
        • Dowling J.J.
        • Frost G.
        • Bar-Or O.
        Role of co-contraction in the O2 cost of walking in children with cerebral palsy.
        Med Sci Sports Exerc. 1996; 28: 1498-1504