Quantifying Energetic Demands of Walking for People With Cerebral Palsy

Study Overview
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Brief Summary
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The purpose of this study is to examine the underlying mechanisms that contribute to high energy costs for people with cerebral palsy (CP) as they walk. The investigators will characterize the cost landscape of children with CP, quantifying the magnitude of cost (net nondimensional oxygen consumption) associated with walking and common sub-tasks of walking, such as supporting and stabilizing the body.

Detailed Description
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Children with CP use large amounts of energy to walk and move, leading to fatigue and limiting participation. For people with CP the energetic cost of walking is on average over two times higher than typically-developing (TD) peers. This means that for people with CP, walking is as tiring as jogging or climbing stairs. An energetic cost of this magnitude restricts activities of daily living (ADL) and causes exhaustion. While the investigators and many others have sought to reduce these energetic costs through surgical interventions, rehabilitation, orthotics, or other assistive devices, these strategies have failed to result in meaningful reductions in energy. To design strategies that successfully reduce walking costs, the investigators must first understand the underlying mechanisms contributing to elevated cost in people with CP. This basic-science research will provide the foundation to create evidence-based strategies to decrease energy costs, minimize fatigue, and increase quality of life for people with CP and other neurologic injuries.

Official Title
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Quantifying Energetic Demands of Walking for People With Cerebral Palsy

Conditions
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Cerebral Palsy

Intervention / Treatment
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* Other: Varying levels of harness support during walking


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for Cases: 8-17 years old Diagnosed with bilateral cerebral palsy Gross Motor Function Classification System II No surgery within the last 9 months No current baclofen pump or explantation in the last 2 months No botulinum toxin or phenol injections in the last 2 months Had a prior gait and motion analysis at Gillette Children's Specialty Healthcare Participant and caregiver able to speak and read English Ability to follow instructions Inclusion Criteria for Controls: 8-17 years old Participant and caregiver able to speak and read English Ability to follow instructions

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Children with Cerebral Palsy (Cases)<br>Children meeting inclusion/exclusion criteria with a diagnosis of cerebral palsy. | Other: Varying levels of harness support during walking<br>* Participants will complete a standard gait and motion analysis at varying levels of harness support and stabilization (low, moderate, and high levels).<br>|
| Other: Typically Developing Children (Controls)<br>Children meeting inclusion/exclusion criteria without a diagnosis of cerebral palsy or other condition. | Other: Varying levels of harness support during walking<br>* Participants will complete a standard gait and motion analysis at varying levels of harness support and stabilization (low, moderate, and high levels).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Net nondimensional oxygen consumption | Compare net nondimensional oxygen consumption with varying levels of harness support | One-time research visit (1 hour) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Three-dimensional gait kinematics | Three-dimensional gait kinematics to estimate body position and orientation, including trunk and lower limb | One-time research visit (1 hour) | 
| Three-dimensional gait kinetics | Three-dimensional gait kinetics to estimate joint moments (Nm/kg) of the hip, knee, and ankle | One-time research visit (1 hour) | 
| Passive joint range of motion | Compare passive joint range of motion (degrees) measured by lower extremity physical exam | One-time research visit (15 minutes) | 
| Spasticity | Spasticity measured by Modified Ashworth Scale (0 no increase in tone - 4 rigid in flexion or extension) | One-time research visit (15 minutes) | 
| Selective motor control | Selective motor control (0 patterned movement - 2 complete isolated movement) | One-time research visit (15 minutes) | 
| Lower extremity strength | Lower extremity strength measures by the manual muscle test (0 no muscle contraction - 5 typical muscle function) | One-time research visit (15 minutes) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Energetic cost