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Control of Walking Speed in Children With Cerebral Palsy

Davids, Jon R. MD; Cung, Nina Q. BA, BS; Chen, Suzy MD; Sison-Williamson, Mitell MS; Bagley, Anita M. PhD, MPH

Journal of Pediatric Orthopaedics: September 2019 - Volume 39 - Issue 8 - p 429–435
doi: 10.1097/BPO.0000000000000978
Cerebral Palsy

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.

Shriners Hospital for Children Northern California, Sacramento, CA

The authors received no outside funding for this study.

The authors declare no conflicts of interest.

Reprints: Jon R. Davids, MD, Orthopaedics, Motion Analysis Laboratory, Shriners Hospital for Children, 2425 Stockton Boulevard, Sacramento, CA 95817. E-mail:

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