Johnston Therese E, Moore Stephanie E, Quinn Lance T, Smith Brian T
Shriners Hospitals for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA.
Dev Med Child Neurol. 2004 Jan;46(1):34-8. doi: 10.1017/s0012162204000064.
This study compared the energy cost of walking in children with cerebral palsy (CP) classified at different levels of the Gross Motor Function Classification System (GMFCS) with that in children with typical development. Sixteen female and 14 male children with CP (mean age 9 years 6 months, SD 2 years 4 months, range 6 years 4 months to 13 years 4 months) and 14 male and 13 female typically developing children (mean age 10 years, SD 1 year 6 months, range 7 years 1 month to 12 years 11 months) participated. Children with CP were classified at GMFCS level I, n=5; level II, n=10; level II, n=9; and level IV, n=6. Energy cost was assessed by the gas dilution method as each child walked around an oval track wearing a dilution mask. Significant differences were found across GMFCS levels (p<0.0001) and between adjacent levels (p<0.013). Children with CP displayed a higher energy cost of walking than the typically developing children (p<0.0001). A strong correlation (0.87) was found between the energy cost of walking and GMFCS level (p<0.01) when children with typical development were assigned a GMFCS level of zero to allow statistical analysis. This indicates increasing energy cost of walking with increasing severity of functional involvement. These differences in energy cost across GMFCS levels provide another distinguishing factor between GMFCS levels and further emphasize the importance of considering metabolic demand in determining treatment options.
本研究比较了不同粗大运动功能分类系统（GMFCS）水平的脑瘫（CP）儿童与正常发育儿童行走时的能量消耗。16名患脑瘫女童和14名患脑瘫男童（平均年龄9岁6个月，标准差2岁4个月，范围6岁4个月至13岁4个月）以及14名发育正常男童和13名发育正常女童（平均年龄10岁，标准差1岁6个月，范围7岁1个月至12岁11个月）参与了研究。患脑瘫儿童的GMFCS分级为：I级，n = 5；II级，n = 10；III级，n = 9；IV级，n = 6。能量消耗通过气体稀释法评估，即每个孩子戴着稀释面罩在椭圆形跑道上行走时进行测量。研究发现，GMFCS各水平之间存在显著差异（p < 0.0001），相邻水平之间也存在显著差异（p < 0.013）。患脑瘫儿童行走时的能量消耗高于正常发育儿童（p < 0.0001）。当给发育正常儿童指定GMFCS等级为零时进行统计分析，发现行走能量消耗与GMFCS等级之间存在强相关性（0.87）（p < 0.01）。这表明随着功能障碍严重程度的增加，行走的能量消耗也在增加。GMFCS各水平之间能量消耗的这些差异为GMFCS各水平之间提供了另一个区分因素，并进一步强调了在确定治疗方案时考虑代谢需求的重要性。
