Nelson Jennifer A, Boyer Elizabeth R
Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA.
Department of Orthopedic Surgery, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA.
Phys Ther. 2021 Jul 1;101(7). doi: 10.1093/ptj/pzab102.
Impairments associated with cerebral palsy (CP) can affect gait quality and limit activity and participation. The purpose of this study was to quantify (1) which of 6 factors (pain, weakness, endurance, mental ability, safety concerns, balance) were perceived to limit walking ability the most in individuals with CP and (2) whether age or Gross Motor Function Classification System (GMFCS) level is related to that perception.
This cross-sectional study queried data from a gait laboratory database. Perceived walking limitation was quantified using a 5-point Likert scale ("never" to "all of the time"). Included were 1566 children and adults (mean age = 10.9 y [SD = 6.8]; range = 3.0-72.1 y) with CP (GMFCS level I: 502; II: 564; III: 433; IV: 67).
Patients or caregivers perceived balance to limit walking ability to the greatest extent, followed by endurance, weakness, safety, mental ability, and pain. Balance was perceived to always limit walking ability in 8%, 22%, 30%, and 34% of individuals in GMFCS levels I through IV, respectively. Endurance was perceived to always limit walking ability in 5%, 13%, 13%, and 27% of individuals in GMFCS levels I through IV, respectively. There were minor differences in the perceived extent of limitation caused by the factors by GMFCS level. Only weak associations between age and pain, mental ability, safety, and balance were observed (Spearman rho = -0.13 to 0.24).
Patients or caregivers perceived decreased balance and endurance to most strongly limit walking ability. Efforts should be made to clinically track how both perceived and objective measures of these limiting factors change with age and intervention.
Following a patient- and family-centered care model, therapy that places greater emphasis on balance and cardiovascular endurance may have the greatest effect on walking ability for individuals with CP. Future research should quantify which therapeutic, surgical, and pharmacologic interventions minimize these impairments and optimize activity and participation.
Balance and endurance are perceived to be the greatest factors limiting walking in people with CP. If you have CP, your physical therapist might emphasize balance and cardiovascular endurance to improve your walking ability.
与脑瘫（CP）相关的功能障碍会影响步态质量，并限制活动和参与度。本研究的目的是量化：（1）在6个因素（疼痛、虚弱、耐力、心理能力、安全担忧、平衡）中，哪些因素被认为对CP患者的行走能力限制最大；（2）年龄或粗大运动功能分级系统（GMFCS）水平是否与这种认知相关。
这项横断面研究查询了步态实验室数据库中的数据。使用5点李克特量表（“从不”到“一直”）对感知到的行走限制进行量化。纳入了1566名患有CP的儿童和成人（平均年龄=10.9岁[标准差=6.8]；范围=3.0 - 72.1岁）（GMFCS水平I：502人；II：564人；III：433人；IV：67人）。
患者或照料者认为平衡对行走能力的限制最大，其次是耐力、虚弱、安全、心理能力和疼痛。在GMFCS水平I至IV的个体中，分别有8%、22%、30%和34%的人认为平衡一直限制行走能力。在GMFCS水平I至IV的个体中，分别有5%、13%、13%和27%的人认为耐力一直限制行走能力。GMFCS水平导致的各因素限制程度认知存在微小差异。仅观察到年龄与疼痛、心理能力、安全和平衡之间存在微弱关联（斯皮尔曼等级相关系数=-0.13至0.24）。
患者或照料者认为平衡和耐力下降对行走能力的限制最大。应努力在临床上追踪这些限制因素的感知指标和客观指标如何随年龄和干预而变化。
遵循以患者和家庭为中心的护理模式，更加强调平衡和心血管耐力的治疗可能对CP患者的行走能力产生最大影响。未来的研究应量化哪些治疗、手术和药物干预可将这些损伤降至最低，并优化活动和参与度。
平衡和耐力被认为是限制CP患者行走的最大因素。如果你患有CP，你的物理治疗师可能会强调平衡和心血管耐力以提高你的行走能力。
