Balemans Astrid C, Bolster Eline A, Brehm Merel-Anne, Dallmeijer Annet J
Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Public Health, VU University Medical Center, Amsterdam, The Netherlands; Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center, Utrecht, The Netherlands; De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Public Health, VU University Medical Center, Amsterdam, The Netherlands.
Arch Phys Med Rehabil. 2017 Dec;98(12):2507-2513. doi: 10.1016/j.apmr.2017.05.004. Epub 2017 Jun 6.
To describe (1) physical strain of walking, (2) the proportion of participants walking above the anaerobic threshold, and (3) 4 phenotypes of physical strain of walking on the basis of deviations in aerobic capacity and walking energy cost (EC) in children and adolescents with cerebral palsy (CP).
Cohort study.
Academic medical center.
A sample (N=57) of participants (n=37; mean age, 13.5±4.0y) with CP (Gross Motor Function Classification System [GMFCS] levels I [n=13], II [n=17], and III [n=7]) and typically developing (TD) participants (n=20; mean age, 11.8±3.5y).
Not applicable.
Oxygen consumption (Vowalk), speed, and EC were determined during walking at a comfortable speed. Peak oxygen consumption (Vopeak) and anaerobic threshold were measured during a maximal cycling exercise test. Aerobic capacity was reduced if lower than the 10th percentile, and EC was increased if higher than 3SD. Physical strain was defined as follows: (Vowalk/Vopeak)×100.
Participants with CP had a higher physical strain (GMFCS level I, 55%±12% GMFCS level II, 62%±17%; GMFCS level III, 78%±14%) than did TD participants (40%±11%) (P<.001). Forty-three percent of participants with CP showed a Vowalk at or above their anaerobic threshold as compared with 10% of TD participants (P=.007). Phenotypes showed that a reduced Vopeak (n=9) or an increased EC (n=9) lead to an 18% to 20% higher physical strain, whereas a combination (n=12) leads to a 40% increase.
Children and adolescents with CP walk at a high physical strain, approximating intense exercise and a considerable proportion walks close to or above their anaerobic threshold, probably explaining fatigue and reduced walking distance. Both an increased EC and a reduced Vopeak contribute to high physical strain in children or adolescents with CP. The different causes of high physical strain in individuals with CP require different intervention strategies.
描述（1）行走时的身体应变，（2）行走时高于无氧阈值的参与者比例，以及（3）基于脑瘫（CP）儿童和青少年有氧能力和行走能量消耗（EC）偏差的4种行走身体应变表型。
队列研究。
学术医疗中心。
样本（N = 57），其中CP参与者（n = 37；平均年龄，13.5±4.0岁）（粗大运动功能分类系统[GMFCS] I级[n = 13]、II级[n = 17]和III级[n = 7]）以及发育正常（TD）的参与者（n = 20；平均年龄，11.8±3.5岁）。
不适用。
在以舒适速度行走期间测定耗氧量（Vowalk）、速度和EC。在最大自行车运动试验期间测量峰值耗氧量（Vopeak）和无氧阈值。如果低于第10百分位数，则有氧能力降低；如果高于3个标准差，则EC增加。身体应变定义如下：（Vowalk/Vopeak）×100。
CP参与者的身体应变（GMFCS I级，55%±12%；GMFCS II级，62%±17%；GMFCS III级，78%±14%）高于TD参与者（40%±11%）（P <.001）。43%的CP参与者的Vowalk达到或高于其无氧阈值，而TD参与者为10%（P =.007）。表型显示，Vopeak降低（n = 9）或EC增加（n = 9）会导致身体应变高18%至20%，而两者结合（n = 12）会导致身体应变增加40%。
CP儿童和青少年行走时身体应变高，接近剧烈运动，相当一部分人行走接近或高于其无氧阈值，这可能解释了疲劳和行走距离缩短的原因。EC增加和Vopeak降低均导致CP儿童或青少年身体应变高。CP个体身体应变高的不同原因需要不同的干预策略。
