脑瘫患儿步行速度的控制

Control of Walking Speed in Children With Cerebral Palsy.

作者信息

Davids Jon R, Cung Nina Q, Chen Suzy, Sison-Williamson Mitell, Bagley Anita M

机构信息

Shriners Hospital for Children Northern California, Sacramento, CA.

出版信息

J Pediatr Orthop. 2019 Sep;39(8):429-435. doi: 10.1097/BPO.0000000000000978.

DOI:10.1097/BPO.0000000000000978

PMID:31393305

Abstract

BACKGROUND

Children's ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels.

METHODS

A retrospective review of time-distance parameters (TDPs) for 212 subjects with CP and 34 typically developing subjects walking at free and fast speeds was performed. Only children who could increase their gait speed above the minimal clinically important difference were defined as having a fast walk. Analysis of variance was used to compare TDPs of children with CP, among Gross Motor Function Classification System (GMFCS) levels, and children in typically developing group.

RESULTS

Eight-five percent of the CP group (GMFCS I, II, III; 96%, 99%, and 34%, respectively) could increase gait speed on demand. At free speed, children at GMFCS I and II were significantly faster than children at GMFCS level III. At free speed, children at GMFCS I and II had significantly greater stride length than those at GMFCS levels III. At free speed, children at GMFCS level III had significantly lower cadence than those at GMFCS I and II. There were no significant differences in cadence among GMFCS levels at fast speeds. There were no significant differences among GMFCS levels for percent change in any TDP between free and fast walking.

DISCUSSION

Almost all children with CP at GMFCS levels I and II can control the speed of gait, however, only one-third at GMFCS III level have this ability. This study suggests that children at GMFCS III level can be divided into 2 groups based on their ability to control gait speed; however, the prognostic significance of such categorization remains to be determined.

LEVEL OF EVIDENCE

Diagnostic level II.

摘要

背景

儿童控制步态速度的能力对于广泛的活动都很重要。人们认为，脑瘫（CP）患儿提高步态速度的能力很常见。本研究考虑了3个假设：（1）大多数能行走的脑瘫患儿可以提高步态速度；（2）自由（自我选择）行走和快速行走的特征与运动障碍水平有关；（3）在这些水平之间，用于提高步态速度的策略是不同的。

方法

对212例脑瘫患儿和34例正常发育儿童以自由和快速速度行走时的时间-距离参数（TDP）进行回顾性分析。只有那些能够将步态速度提高到高于最小临床重要差异的儿童才被定义为能够快速行走。采用方差分析比较脑瘫患儿、粗大运动功能分类系统（GMFCS）各水平患儿以及正常发育组儿童的TDP。

结果

85%的脑瘫组患儿（GMFCS I、II、III级，分别为96%、99%和34%）能够根据需要提高步态速度。在自由速度下，GMFCS I级和II级的儿童明显比GMFCS III级的儿童快。在自由速度下，GMFCS I级和II级的儿童步幅明显大于GMFCS III级的儿童。在自由速度下，GMFCS III级的儿童步频明显低于GMFCS I级和II级的儿童。在快速速度下，GMFCS各水平之间的步频没有显著差异。在自由行走和快速行走之间，任何TDP的百分比变化在GMFCS各水平之间没有显著差异。