Pediatric Physical Therapy:
Section Information: Abstracts of Platform and Poster Presentations for the 2005 Combined Sections Meeting: Platform Presentations
Physical Therapy, University of Hartford, West Hartford, CT, USA (Gagnaire, Gawron, Hogue, Julewicz, Marchion, Tackel, Gannotti)
Motion Lab and Physical Therapy Departments, Shriners Hospitals for Children, Springfield, MA, USA (Gorton, Nahorniak)
PURPOSE/HYPOTHESIS: We hypothesized that as children with cerebral palsy (CP) age, body mass index (BMI) increases and is associated with decreased gait velocity and increased crouch.
NUMBER OF SUBJECTS: Thirty-two children with CP with multilevel orthopaedic surgery and pre- and five-year post-operative gait analyses and three-hundred ninety-eight children with CP with a baseline gait analysis.
MATERIALS/METHODS: Retrospective longitudinal and cross-sectional data about subjects’ height, limb length, weight, gait velocity, assistive device use, mean knee flexion in stance, and GMFCS score. Paired t tests and backward step-wise regression were used to test the hypothesis.
RESULTS: For the 32 children, improvements in mean knee flexion in stance 5 years post-operatively were seen in children who had surgery at a younger age, smaller changes in leg length, and were more severely involved (regression, R2 = 0.55, P < 0.025). All children had significantly increased BMI (paired t test, P = 0.000), with no change in gait velocity. For the 398 children, increased mean knee flexion was predicted by slower velocity, longer leg length, increased level of severity, and those who used an orthosis (regression, R2 = 0 0.16, P < 0.025). Decreased velocity was predicted in older children with increased level of severity who used assistive devices, had increased mean knee flexion in stance, were female, and were shorter (regression, R2 = 0.78, P < 0.009).
CONCLUSIONS: We expected BMI to significantly impact crouch and velocity due to the relationship between anti-gravity strength and body mass. Level of severity is the most important factor for predicting crouch and velocity. BMI was not significant. Age was significant only for velocity.
CLINICAL RELEVANCE: The natural progression of children with CP is to walk more slowly with increasing crouch. As level of severity increases the importance of age for predicting this decline decreases. To maximize long-term outcomes of children with CP, PT should address determinants of crouch not associated with changes in BMI.