Predictors of Walking Efficiency in Children With Cerebral Palsy: Lower-Body Joint Angles, Moments, and Power.
Marika Noorkoiv, Grace Lavelle, Nicola Theis and 6 others
PMID 31155663WHAT IT FOUND
In adolescents with cerebral palsy, less knee and hip extension while walking was linked to higher oxygen cost.
Age changed which joint angles mattered, but the tested variables did not independently predict walking efficiency.
Key findings
01After adjusting for age, sex and GMFCS level, maximum knee extension angle, hip angle at midstance and maximum hip extension angle were associated with walking efficiency (NNcost).
02Age modified the association between maximum knee extension angle and walking efficiency (NNcost), with no association at age 10 years and a negative association at age 19 years.
03When the variables associated at the 10% level were placed together, none independently predicted walking efficiency (NNcost), and the model explained 40% of the variation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Six participants had no NNcost data, and some variables were analysed in 43 to 58 participants rather than all 58. The study reports associations, not treatment effects, so it does not show that changing joint angles, moments or powers would improve walking efficiency. Joint moments and power were measured only in the sagittal plane, so compensation in other directions may have been missed. Peak angles, moments and power were taken from one gait cycle, and timing varied between participants, so the selected value may not represent the functionally meaningful gait instance for each person. The combined model did not identify independent predictors, so the tested variables alone did not sufficiently explain NNcost. Only adolescents able to walk independently at GMFCS levels I to III were included, so results may not apply to children who cannot walk independently.
Declared interests
Funding was from the Henry Smith Charity, and the paper states the funding source had no role in design, execution, analyses, interpretation, or decision to submit results.
The easy way to misread this
Do not read the knee and hip angle associations as proof that changing those angles will improve walking efficiency. The study reports associations, and when variables were combined none independently predicted walking efficiency.