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NCHPAD - Building Healthy Inclusive Communities

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Energy Cost of Walking in Children with Cerebral Palsy


Rose and colleagues conducted three studies on the energy cost of walking in children with cerebral palsy. In their first investigation, they compared the energy cost of using a wheeled walker versus bilateral quad canes in 12 children with quadriplegic or diplegic spastic cerebral palsy, ages 4 to 12 years. For each trial, the child's average heart rate, walking speed and the number of heartbeats per unit distance walked were calculated. In order to account for the variations in speed of each child, an energy cost index was derived based upon the average number of heartbeats per unit distance walked (heart beats per minute divided by meters per minute). The investigators found that in general, the children elicited extremely high heart rates and slow walking speeds during ambulation with the two assistive devices. The mean heart rate with the walkers was 164 bpm, and with the canes, 157 bpm, as compared to 114 bpm for the non-disabled children ambulating without an aid.

In their second study, Rose et al., measured the energy cost of walking in 31 non-disabled children and compared them to 13 ambulatory children with spastic cerebral palsy (hemiplegia or diplegia), ages 7 to 17 years. To be eligible for the study, the subjects with cerebral palsy had to be able to walk on a treadmill with or without using the handrails. The investigators found that the relationship between heart rate and oxygen uptake at different walking speeds was linear in both the nondisabled subjects and the subjects with cerebral palsy.

In their third study, Rose et al. used the same data set as in their previous study (18 nondisabled children and 13 children with spastic cerebral palsy) to further determine if heart rate provided an accurate estimate of energy expenditure. An energy expenditure index (EEI) was calculated based on oxygen uptake and heart rate. The formula for EEI was heart rate minus resting heart rate, divided by walking speed. Values were plotted at different walking speeds. The investigators concluded that heart rate is an accurate indicator of energy expenditure in children with cerebral palsy and can be used in clinical settings to evaluate the energy cost of different locomotor activities.

The work of Rose and colleagues involving children with cerebral palsy has essentially demonstrated that there is a linear relationship between heart rate and oxygen consumption similar to what is observed in persons without disabilities. Therefore, an exercise prescription based on heart rate intensity formulas should be accurate for persons with cerebral palsy.


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