Physiological cost index in cerebral palsy: Its role in evaluating the efficiency of ambulation

K. Raja, B. Joseph, S. Benjamin, V. Minocha, B. Rana

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

The study was undertaken to evaluate whether the Physiological Cost Index (PCI) can be used as a reliable index of efficiency of gait and as an outcome measure in cerebral palsy (CP). Physiological Cost Index was calculated in normal subjects by recording the heart rate manually and with electrocardiograph recording, and the values compared. In another group of subjects, PCI was calculated after they walked 3 different distances (50, 100, and 150 m). The PCI of normal children and children with CP was then estimated by manual recording of the pulse, with the children walking 50 m indoors and 50 m on an uneven surface outdoors. The reproducibility of calculation of PCI was evaluated. The PCI value of each patient was compared to the corresponding Functional Mobility Score. In a group of children with CP, PCI was calculated before and after therapeutic intervention. The PCI values were comparable with either method of heart rate measurement and for the 3 distances walked. The reproducibility of measurement of PCI was satisfactory (Intraclass Correlation Coefficients, 0.80-0.88). The PCI of normal children was 0.1 beats per meter, whereas children with CP had 6 times higher values of PCI, with the highest values in children with a crouch gait. In normal children, 10% greater PCI values were noted when they walked outdoors compared to a 100% increase in children with CP. The higher the PCI values, the lower the Functional Mobility Scores. Therapeutic interventions altered PCI values, and interventions that effectively reduced energy consumption could be identified. We conclude that PCI may be used as a reliable outcome measure of gait efficiency in children with CP. © 2007 Lippincott Williams & Wilkins, Inc.
Original languageEnglish
Pages (from-to)130-136
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume27
Issue number2
DOIs
Publication statusPublished - 2007
Externally publishedYes

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Cerebral Palsy
Walking
Costs and Cost Analysis
Gait
Heart Rate
Outcome Assessment (Health Care)
Pulse
Electrocardiography

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Raja, K. ; Joseph, B. ; Benjamin, S. ; Minocha, V. ; Rana, B. / Physiological cost index in cerebral palsy: Its role in evaluating the efficiency of ambulation. In: Journal of Pediatric Orthopaedics. 2007 ; Vol. 27, No. 2. pp. 130-136.
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abstract = "The study was undertaken to evaluate whether the Physiological Cost Index (PCI) can be used as a reliable index of efficiency of gait and as an outcome measure in cerebral palsy (CP). Physiological Cost Index was calculated in normal subjects by recording the heart rate manually and with electrocardiograph recording, and the values compared. In another group of subjects, PCI was calculated after they walked 3 different distances (50, 100, and 150 m). The PCI of normal children and children with CP was then estimated by manual recording of the pulse, with the children walking 50 m indoors and 50 m on an uneven surface outdoors. The reproducibility of calculation of PCI was evaluated. The PCI value of each patient was compared to the corresponding Functional Mobility Score. In a group of children with CP, PCI was calculated before and after therapeutic intervention. The PCI values were comparable with either method of heart rate measurement and for the 3 distances walked. The reproducibility of measurement of PCI was satisfactory (Intraclass Correlation Coefficients, 0.80-0.88). The PCI of normal children was 0.1 beats per meter, whereas children with CP had 6 times higher values of PCI, with the highest values in children with a crouch gait. In normal children, 10{\%} greater PCI values were noted when they walked outdoors compared to a 100{\%} increase in children with CP. The higher the PCI values, the lower the Functional Mobility Scores. Therapeutic interventions altered PCI values, and interventions that effectively reduced energy consumption could be identified. We conclude that PCI may be used as a reliable outcome measure of gait efficiency in children with CP. {\circledC} 2007 Lippincott Williams & Wilkins, Inc.",
author = "K. Raja and B. Joseph and S. Benjamin and V. Minocha and B. Rana",
note = "Cited By :25 Export Date: 10 November 2017 CODEN: JPORD Correspondence Address: Joseph, B.; Paediatric Orthopaedic Service, Department of Orthopaedics, Kasturba Medical College, Manipal 576104, Karnataka State, India; email: benjamin.joseph@manipal.edu References: Bowen, T.S., Miller, F., Mackenzie, W., Comparison of oxygen consumption measurements in children with cerebral palsy to children with muscular dystrophy (1999) J Pediatr Orthop, 19, pp. 133-136; Maltais, D.B., Pierrynowski, M.R., Galea, V.A., Physical activity level is associated with the O2 cost of walking in cerebral palsy (2005) Med Sci Sports Exerc, 37, pp. 347-353; Robb, J.E., Brunner, R., Orthopaedic management of cerebral palsy (2002) Children's Orthopaedics and Fractures, pp. 273-292. , Benson MKD, Fixsen JA, Macnicol MF, Parsch K, eds, 2nd ed. London: Churchill Livingstone; MacGregor, J., The evaluation of patient performance using long term ambulatory monitoring technique in the domiciliary environment (1981) Physiotherapy, 67 (2), pp. 30-33; Bailey, M.J., Ratcliffe, C.M., Reliability of physiological cost index measurements in walking normal subjects using steady-state, non-steady-state and post-exercise heart rate recording (1995) Physiotherapy, 81 (10), pp. 618-623; Bar-On, Z.H., Nene, A.V., Relationship between heart rate and oxygen uptake in thoracic level paraplegics (1990) Paraplegia, 23, pp. 87-95; Bartlett, D.J., Testing gait efficiency of limb-deficient children using the physiological cost index (1989) J Assoc Child Prosthet Orthot Clin, 24 (2), pp. 51-52; Corry, I.S., Duffy, C.M., Cosgrave, A.P., Measurement of oxygen consumption in disabled children by the Cosmed K2 portable telemetry system (1996) Dev Med Child Neurol, 38, pp. 585-593; Nene, A.V., Physiological cost index of walking in able-bodied adolescents and adults (1993) Clin Rehabil, 7, pp. 319-336; Norman, J.F., Bossman, S., Gardner, P., Comparison of the energy expenditure index and oxygen consumption index during self-paced walking in children with spastic diplegia cerebral palsy and children without physical disabilities (2004) Pediatr Phys Ther, 16, pp. 206-211; Rose, J., Medeiros, J.M., Parker, R., Energy cost index as an estimate of energy expenditure of cerebral-palsied children during assisted ambulation (1985) Dev Med Child Neurol, 27, pp. 485-490; Rose, J., Gamble, J.G., Lee, J., The energy expenditure index: A method to quantitate and compare walking energy expenditure for children and adolescents (1991) J Pediatr Orthop, 11, pp. 571-578; Unnithan, V.B., Dowling, J.J., Frost, G., Role of cocontraction in the O2 cost of walking in children with cerebral palsy (1996) Med Sci Sports Exerc, 28, pp. 1498-1504; Bowen, T.R., Lennon, N., Castagno, P., Variability of energy-consumption measures in children with cerebral palsy (1998) J Pediatr Orthop, 18, pp. 738-742; IJzerman, M.J., Nene, A.V., Feasibility of the physiological cost index as an outcome measure for the assessment of energy expenditure during walking (2002) Arch Phys Med Rehabil, 83, pp. 1777-1782; Keefer, D.J., Tseh, W., Caputo, J.L., Comparison of direct and indirect measures of walking energy expenditure in children with hemiplegic cerebral palsy (2004) Dev Med Child Neurol, 46 (5), pp. 320-324; Mossberg, K.A., Linton, K.A., Friske, K., Ankle-foot ortheses: Effect on energy expenditure of gait in spastic diplegic children (1990) Arch Phys Med Rehabil, 71, pp. 490-494; Nene, A.V., Jennings, S.J., Physiological cost index of paraplegic locomotion using the ORLAU parawalker (1992) Paraplegia, 30, pp. 246-252; Nene, A.V., Evans, G.A., Patrick, J.H., Simultaneous multiple operations for spastic diplegia (1993) J Bone Joint Surg, 75-B, pp. 488-494; Rose, J., Gamble, J.G., Burgos, A., Energy expenditure index of walking for normal children and for children with cerebral palsy (1990) Dev Med Child Neurol, 32, pp. 333-340; Maltais, D., Bar-Or, O., Galea, V., Use of orthosis lowers the O 2 cost of walking in children with spastic cerebral palsy (2001) Med Sci Sports Exerc, 33, pp. 32-325; Graham, H.K., Harvey, A., Rodda, J., The Functional Mobility Scale (FMS) (2004) J Pediatr Orthop, 24, pp. 514-520; Bland, J.M., Altman, D.G., Statistical methods of assessing agreement between two methods of clinical measurements (1986) Lancet, 1 (8476), pp. 307-310; Butler, P., Engelbrecht, M., Major, R.E., Physiological cost index of walking for normal children and its use as an indicator of physical handicap (1984) Dev Med Child Neurol, 26, pp. 607-612; Gage, J.R., Gait analysis in cerebral palsy (1991) Clinics in developmental medicine, 121, pp. 71-73",
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pages = "130--136",
journal = "Journal of Pediatric Orthopaedics",
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}

Physiological cost index in cerebral palsy: Its role in evaluating the efficiency of ambulation. / Raja, K.; Joseph, B.; Benjamin, S.; Minocha, V.; Rana, B.

In: Journal of Pediatric Orthopaedics, Vol. 27, No. 2, 2007, p. 130-136.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Physiological cost index in cerebral palsy: Its role in evaluating the efficiency of ambulation

AU - Raja, K.

AU - Joseph, B.

AU - Benjamin, S.

AU - Minocha, V.

AU - Rana, B.

N1 - Cited By :25 Export Date: 10 November 2017 CODEN: JPORD Correspondence Address: Joseph, B.; Paediatric Orthopaedic Service, Department of Orthopaedics, Kasturba Medical College, Manipal 576104, Karnataka State, India; email: benjamin.joseph@manipal.edu References: Bowen, T.S., Miller, F., Mackenzie, W., Comparison of oxygen consumption measurements in children with cerebral palsy to children with muscular dystrophy (1999) J Pediatr Orthop, 19, pp. 133-136; Maltais, D.B., Pierrynowski, M.R., Galea, V.A., Physical activity level is associated with the O2 cost of walking in cerebral palsy (2005) Med Sci Sports Exerc, 37, pp. 347-353; Robb, J.E., Brunner, R., Orthopaedic management of cerebral palsy (2002) Children's Orthopaedics and Fractures, pp. 273-292. , Benson MKD, Fixsen JA, Macnicol MF, Parsch K, eds, 2nd ed. London: Churchill Livingstone; MacGregor, J., The evaluation of patient performance using long term ambulatory monitoring technique in the domiciliary environment (1981) Physiotherapy, 67 (2), pp. 30-33; Bailey, M.J., Ratcliffe, C.M., Reliability of physiological cost index measurements in walking normal subjects using steady-state, non-steady-state and post-exercise heart rate recording (1995) Physiotherapy, 81 (10), pp. 618-623; Bar-On, Z.H., Nene, A.V., Relationship between heart rate and oxygen uptake in thoracic level paraplegics (1990) Paraplegia, 23, pp. 87-95; Bartlett, D.J., Testing gait efficiency of limb-deficient children using the physiological cost index (1989) J Assoc Child Prosthet Orthot Clin, 24 (2), pp. 51-52; Corry, I.S., Duffy, C.M., Cosgrave, A.P., Measurement of oxygen consumption in disabled children by the Cosmed K2 portable telemetry system (1996) Dev Med Child Neurol, 38, pp. 585-593; Nene, A.V., Physiological cost index of walking in able-bodied adolescents and adults (1993) Clin Rehabil, 7, pp. 319-336; Norman, J.F., Bossman, S., Gardner, P., Comparison of the energy expenditure index and oxygen consumption index during self-paced walking in children with spastic diplegia cerebral palsy and children without physical disabilities (2004) Pediatr Phys Ther, 16, pp. 206-211; Rose, J., Medeiros, J.M., Parker, R., Energy cost index as an estimate of energy expenditure of cerebral-palsied children during assisted ambulation (1985) Dev Med Child Neurol, 27, pp. 485-490; Rose, J., Gamble, J.G., Lee, J., The energy expenditure index: A method to quantitate and compare walking energy expenditure for children and adolescents (1991) J Pediatr Orthop, 11, pp. 571-578; Unnithan, V.B., Dowling, J.J., Frost, G., Role of cocontraction in the O2 cost of walking in children with cerebral palsy (1996) Med Sci Sports Exerc, 28, pp. 1498-1504; Bowen, T.R., Lennon, N., Castagno, P., Variability of energy-consumption measures in children with cerebral palsy (1998) J Pediatr Orthop, 18, pp. 738-742; IJzerman, M.J., Nene, A.V., Feasibility of the physiological cost index as an outcome measure for the assessment of energy expenditure during walking (2002) Arch Phys Med Rehabil, 83, pp. 1777-1782; Keefer, D.J., Tseh, W., Caputo, J.L., Comparison of direct and indirect measures of walking energy expenditure in children with hemiplegic cerebral palsy (2004) Dev Med Child Neurol, 46 (5), pp. 320-324; Mossberg, K.A., Linton, K.A., Friske, K., Ankle-foot ortheses: Effect on energy expenditure of gait in spastic diplegic children (1990) Arch Phys Med Rehabil, 71, pp. 490-494; Nene, A.V., Jennings, S.J., Physiological cost index of paraplegic locomotion using the ORLAU parawalker (1992) Paraplegia, 30, pp. 246-252; Nene, A.V., Evans, G.A., Patrick, J.H., Simultaneous multiple operations for spastic diplegia (1993) J Bone Joint Surg, 75-B, pp. 488-494; Rose, J., Gamble, J.G., Burgos, A., Energy expenditure index of walking for normal children and for children with cerebral palsy (1990) Dev Med Child Neurol, 32, pp. 333-340; Maltais, D., Bar-Or, O., Galea, V., Use of orthosis lowers the O 2 cost of walking in children with spastic cerebral palsy (2001) Med Sci Sports Exerc, 33, pp. 32-325; Graham, H.K., Harvey, A., Rodda, J., The Functional Mobility Scale (FMS) (2004) J Pediatr Orthop, 24, pp. 514-520; Bland, J.M., Altman, D.G., Statistical methods of assessing agreement between two methods of clinical measurements (1986) Lancet, 1 (8476), pp. 307-310; Butler, P., Engelbrecht, M., Major, R.E., Physiological cost index of walking for normal children and its use as an indicator of physical handicap (1984) Dev Med Child Neurol, 26, pp. 607-612; Gage, J.R., Gait analysis in cerebral palsy (1991) Clinics in developmental medicine, 121, pp. 71-73

PY - 2007

Y1 - 2007

N2 - The study was undertaken to evaluate whether the Physiological Cost Index (PCI) can be used as a reliable index of efficiency of gait and as an outcome measure in cerebral palsy (CP). Physiological Cost Index was calculated in normal subjects by recording the heart rate manually and with electrocardiograph recording, and the values compared. In another group of subjects, PCI was calculated after they walked 3 different distances (50, 100, and 150 m). The PCI of normal children and children with CP was then estimated by manual recording of the pulse, with the children walking 50 m indoors and 50 m on an uneven surface outdoors. The reproducibility of calculation of PCI was evaluated. The PCI value of each patient was compared to the corresponding Functional Mobility Score. In a group of children with CP, PCI was calculated before and after therapeutic intervention. The PCI values were comparable with either method of heart rate measurement and for the 3 distances walked. The reproducibility of measurement of PCI was satisfactory (Intraclass Correlation Coefficients, 0.80-0.88). The PCI of normal children was 0.1 beats per meter, whereas children with CP had 6 times higher values of PCI, with the highest values in children with a crouch gait. In normal children, 10% greater PCI values were noted when they walked outdoors compared to a 100% increase in children with CP. The higher the PCI values, the lower the Functional Mobility Scores. Therapeutic interventions altered PCI values, and interventions that effectively reduced energy consumption could be identified. We conclude that PCI may be used as a reliable outcome measure of gait efficiency in children with CP. © 2007 Lippincott Williams & Wilkins, Inc.

AB - The study was undertaken to evaluate whether the Physiological Cost Index (PCI) can be used as a reliable index of efficiency of gait and as an outcome measure in cerebral palsy (CP). Physiological Cost Index was calculated in normal subjects by recording the heart rate manually and with electrocardiograph recording, and the values compared. In another group of subjects, PCI was calculated after they walked 3 different distances (50, 100, and 150 m). The PCI of normal children and children with CP was then estimated by manual recording of the pulse, with the children walking 50 m indoors and 50 m on an uneven surface outdoors. The reproducibility of calculation of PCI was evaluated. The PCI value of each patient was compared to the corresponding Functional Mobility Score. In a group of children with CP, PCI was calculated before and after therapeutic intervention. The PCI values were comparable with either method of heart rate measurement and for the 3 distances walked. The reproducibility of measurement of PCI was satisfactory (Intraclass Correlation Coefficients, 0.80-0.88). The PCI of normal children was 0.1 beats per meter, whereas children with CP had 6 times higher values of PCI, with the highest values in children with a crouch gait. In normal children, 10% greater PCI values were noted when they walked outdoors compared to a 100% increase in children with CP. The higher the PCI values, the lower the Functional Mobility Scores. Therapeutic interventions altered PCI values, and interventions that effectively reduced energy consumption could be identified. We conclude that PCI may be used as a reliable outcome measure of gait efficiency in children with CP. © 2007 Lippincott Williams & Wilkins, Inc.

U2 - 10.1097/01.bpb.0000242440.96434.26

DO - 10.1097/01.bpb.0000242440.96434.26

M3 - Article

VL - 27

SP - 130

EP - 136

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 2

ER -