Physical capacity in individuals with cerebral palsy : problems, needs and resources, with special emphasis on locomotion

Many individuals with cerebral palsy (CP) have difficulties in walking independently because of impaired postural control, abnormal tone and pathological muscular coordination. Walkers are often a prerequisite and are often prescribed for assisting and providing the stability necessary for ambulation. There are not many studies published concerning adults with CP and their physical capacity, problems, needs, and resources, especially regarding walking ability, walking aids, effects of training and reliable assessment tools.

Aims: The aims of these studies were to survey physical capacity in individuals with CP and their problems, needs, and resources, with special emphasis on locomotion, and to study the effects of walking with different kinds of walking aids (Study I and II). The aims were alsoto study the effects of training and to determine the reliability of the SixMinute Walk Test (6MWT).

Study I: A questionnaire was constructed. It consisted of 33 questions. The questionnaire was mailed to 363 adults with CP living in the County of Stockholm. Two hundred and twenty-one individuals answered the questionnaire. 84 % lived in own apartments, alone or together with partner and/or children, 24 % worked full-time, 64 % were able to walk with or without walking aids, 35 % reported decreased walking ability, 27 % had never been able to walk, and 9 % had stopped walking.

Study II: Ten children with CP participated in a study comparing two different kinds of walkers (anterior and posterior). Oxygen cost was measured by an argon gas method. Spasticity was estimated according to the modified Ashworth scale. Perceived exertion was expressed by pointing to a five-point face scale. The results showed no differences in the measured variables when walking with the two walkers. Most children preferred the posterior walker, which was recommended as it contributed to a more upright posture.

Study III: Ten adults with CP represented a training group and eight a control group in a progressive strength training programme during 10 weeks. Isokinetic and isometric muscle strength was measured by KIN-COM 500 H dynamometer, and isometric muscle strength with a hand-held dynamometer (Nicholas). Range of motion was measured with a goniometer and spasticity was estimated according to the modified Ashworth scale. Walking ability was assessed with Gross Motor Function Measure (GMFM), Timed Up and Go (TUG) and 6MWT. Perceived exertion was estimated according to the Borg scale (RPE 6-20). Significant increase of muscle strength, range of motion, and walking ability was only seen in the training group. No increase in spasticity was noted.

Study IV: Twenty-five adults with CP participated in a study with the aim to determine reliability on the Six-Minute Walk Test (6MWT). The individuals were in four tests instructed to walk as far as possible for six minutes. The distance walked, heart rate and perceived exertion were assessed. The walked metre averaged 316 (range 74-579), 336 (range 65621), 341 (range 83-626) and 345 (range 88-640) m. 6MWT showed high reliability, with ICC 0.99 and with a repeatability (clinical measurement error) of 40 m. One practice walk was recommended as the walking distance in the first test was significantly shorter (p<0.01) compare to the other tests.

List of scientific papers

I. Andersson C, Mattsson E (2001). Adults with cerebral palsy: a survey describing problems, needs, and resources, with special emphasis on locomotion. Dev Med Child Neurol. 43(2): 76-82.
https://doi.org/10.1017/S0012162201

II. Mattsson E, Andersson C (1997). Oxygen cost, walking speed, and perceived exertion in children with cerebral palsy when walking with anterior and posterior walkers. Dev Med Child Neurol. 39(10): 671-6.
https://pubmed.ncbi.nlm.nih.gov/9352728

III. Andersson C, Grooten W, Hellsten M, Kaping K, Mattsson E (2003). Adults with cerebral palsy: walking ability after progressive strength training. Dev Med Child Neurol. 45(4): 220-8.
https://doi.org/10.1017/S0012162203000446

IV. Andersson C, Asztalos L, Mattsson E (2005). Six-minute walk test in adults with cerebral palsy. A study reliability. Clinical Rehabilitation. [Accepted]
https://doi.org/10.1191/0269215506cr964oa