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Vol. 22. Num. 1.01 January 2018
Pages 1-94
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Vol. 22. Num. 1.01 January 2018
Pages 1-94
Original Research
DOI: 10.1016/j.bjpt.2017.06.015
Mechanisms contributing to gait speed and metabolic cost in children with unilateral cerebral palsy
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Tatiana Pessoa Silva Pinto, Sérgio Teixeira Fonseca, Rejane Vale Gonçalves, Thales Rezende Souza, Daniela Virgínia Vaz, Paula Lanna Pereira Silva, Marisa Cotta Mancini
Corresponding author
mcmancini@ufmg.br
marisacmancini@gmail.com

Corresponding author at: Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, CEP: 31270-010, Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais (UFMG), School of Physical Education, Physical Therapy and Occupational Therapy, Graduate Program in Rehabilitation Sciences, Belo Horizonte, MG, Brazil
Highlights

  • Gait speed in unilateral CP is explained by energy-conserving mechanisms.

  • Co-contraction contributes to gait speed in CP, but increases gait metabolic cost.

  • Intervention should target the non-affected limb and lower limb eccentric training.

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Figures (1)
Tables (3)
Table 1. Participant's characteristics.
Table 2. Correlation coefficient (r) matrix showing the bivariate associations of the study's variables.
Table 3. Primary and secondary regression models.
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Abstract
Background

Gait speed and metabolic cost are indicators of functional capacity in children with cerebral palsy. Uncovering their mechanisms helps guide therapeutic actions.

Objectives

To investigate the contributions of energy-generating and energy-conserving mechanisms to gait speed and metabolic cost of children with unilateral cerebral palsy.

Methods

Data on eccentric and concentric muscle work, co-contraction, elastic torque and vertical stiffness of the affected-limb, forcing torque of the non-affected limb, gait speed and metabolic cost were collected from 14 children with unilateral cerebral palsy, aged 6–12 years. Analyses included two groups of multiple regression models. The first group of models tested the association between each dependent variable (i.e., speed and metabolic cost) and the independent variables that met the input criteria. The second group verified the contribution of the non-selected biomechanical variables on the predictors of the first model.

Results

Gait speed (R2=0.80) was predicted by elastic torque (β=0.62; 95%CI: 0.60, 0.63), vertical stiffness (β=−0.477; 95%CI: −0.479, −0.474) and knee co-contraction (β=0.27; 95%CI: −1.96, 2.49). The production of eccentric work by the affected limb proved relevant in adjusting the vertical stiffness (R2=0.42; β=−0.64; 95%CI: 0.86, −0.42); elastic torque of the affected-leg was associated with impulsive torque of the non-affected leg (R2=0.31; β=0.55; 95%CI: 0.46, 0.64). Metabolic cost of gait (R2=0.48) was partially predicted by knee co-contraction (β=0.69; 95%CI: 0.685, 0.694).

Conclusions

The chain of associations revealed by the two steps models helped uncover the mechanisms involved in the locomotion of children with unilateral cerebral palsy. Intervention that changes specific energy conserving and generating mechanisms may improve gait of these children.

Keywords:
Cerebral palsy
Motor control
Gait
Mobility
Energy conserving mechanisms
Energy generating mechanisms

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