Aerobic Conditioning and Walking Activity Assessment in Cerebral Palsy: Energy Cost and Quantity of Walking

Abstract

Almost all individuals with cerebral palsy (CP) have an impairment in the mechanical function of their gait. We have very extensive mechanisms including physical examination, dynamic video analysis, three-dimensional gait analysis, and pedobarography to evaluate these mechanical impairments. The mechanical impairments of gait have a primary etiology in the neuromotor control and growth of the individual. The most common method for classifying individuals with CP is the Gross Motor Function Classification System (GMFCS) which is based on the impact of the mechanical impairment on mobility and gait. For normal community ambulation, an individual needs to have adequate cardiovascular endurance to sustain ambulatory community activity. Developing adequate cardiovascular endurance requires opportunities to be active and to exercise. Conversely, normal daily physical activity is important to maintain cardiovascular endurance. The primary understanding of gait pathology in individuals with CP has been focused on the mechanicalstructural abnormalities as they apply to the individual body function. A separate area of assessment, the energy cost of walking and cardiovascular conditioning, was initially focused on the potential to improve the energy cost of walking by improving the mechanics of gait. This was evaluated by measurement of the amount of oxygen consumed per meter of walking. Recently, there has been more focus on the cardiovascular conditioning aspect of this problem and the amount of actual physical activity that an individual has during daily life. The goal of this chapter is to describe the measurement techniques for assessing the energy cost of walking, aerobic (cardiovascular) conditioning, and walking activity in the community.