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Purpose: This study aims to validate and report responsiveness of Energy Expenditure Index (EEI) during walking on outdoor uneven surface in individuals with cerebral palsy (CP). Methods: Eighty ambulant children with spastic diplegia (Gross Motor Function Classification System II & III) aged between six and 18 years and 58 age matched typically developing children were recruited for ascertaining reliability and validation of EEI during outdoor walking. Responsiveness of EEI was ascertained using anchor-based approach using Functional Mobility Scale in 29 children with CP who were recruited for surgical intervention. Results: EEI had acceptable test-retest reliability and agreement in both typically developing and children with CP. Friedman's analysis of variance of 29 children with CP showed a significant difference in EEI ( χ 2  = 10.15, p  = 0.006), Functional Mobility Scale - 50 m ( χ 2 = 18.77, p EEI during walking on outdoor uneven surface is a stable, valid and reliable measure of energy efficiency in individuals with CP and is responsive to orthopedic intervention in CP.IMPLICATIONS FOR REHABILITATIONEnergy Expenditure Index during outdoor walking on uneven surface is a valid, reliable and responsive outcome measure for documenting changes in walking efficiency to post-surgical interventions employed to improve walking in individuals with cerebral palsy.Rehabilitation professionals should document the efficiency during outdoor walking on all the post-operative visits.Energy Expenditure Index during outdoor walking can serve as surveillance tool for deterioration in outdoor walking ability.χ 2  = 40.19, p  = 0.000) scores at 6 and 12 months when compared with baseline. The minimal clinical important difference of EEI during walking on uneven outdoor surface with a concomitant change in functional mobility scale (500 m) at 6 and 12 months was 0.29 and 0.37 beats/m, respectively. Conclusions: EEI during walking on outdoor uneven surface is a stable, valid and reliable measure of energy efficiency in individuals with CP and is responsive to orthopedic intervention in CP.IMPLICATIONS FOR REHABILITATIONEnergy Expenditure Index during outdoor walking on uneven surface is a valid, reliable and responsive outcome measure for documenting changes in walking efficiency to post-surgical interventions employed to improve walking in individuals with cerebral palsy.Rehabilitation professionals should document the efficiency during outdoor walking on all the post-operative visits.Energy Expenditure Index during outdoor walking can serve as surveillance tool for deterioration in outdoor walking ability.

Objective: The aim of this study was to report the responsiveness and minimal clinically important difference of the Edinburgh Visual Gait Score (EVGS), used to measure gait deviations in children with cerebral palsy., Design: Fifty ambulant children with spastic diplegia (Gross Motor Function Classification System levels II and III) aged between 6 and 19 yrs were recruited for this longitudinal study. The participants were evaluated before surgery and at 6 and 12 mos after surgery. The change in EVGS at these time points was used to calculate effect sizes and minimal clinically important differences., Results: Friedman analysis of variance showed a significant difference (χ2 = 60.69, P = 0.000) in the EVGS scores at 6 and 12 mos when compared with baseline. Effect sizes at 6 and 12 mos were large (1.19 and 1.22, respectively), indicating a visible difference in gait .The minimal clinically important differences of EVGS at 6 and 12 mos were 11 and 15, respectively., Conclusions: The EVGS is an outcome measure that can be used to evaluate the effect of orthopedic surgical intervention in children with cerebral palsy. Differences of 11 and 15 points on the EVGS are required to suggest that changes in gait are attributable to intervention when group means are considered.

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.

A 3-mo prospective descriptive study of 50 Indian ambulant children with cerebral palsy using different types of walkers or elbow crutches was done to determine compliance with use of the prescribed device. Children were between 6 and 16 yrs of age and of either sex. Data were collected by means of proxy log entries made by the child's caregivers throughout the day. The data collected consisted of the number of times and the distance the child walked each time with or without the prescribed walking aid. Compliance was taken as the number of times the child used the walking aid during ambulation. Overall mean compliance was 49.1%. Children using the reciprocal walker showed the greatest compliance (60.2%), whereas those using elbow crutches (34.9%) and walkers with gutter attachments (14.8%) showed the least. Compliance was greatest for distances of 50-100 m (57.5%), whereas it was the least for distances of >150 m (25.9%).

Purpose: To devise a viable programme of intervention for older people with Cerebral Palsy (CP). Method: Using focus group interviews, a 'top down' model of intervention was devised among older children and adolescents with CP. Ten participants volunteered and a custom tailored approach was employed, in keeping with the participants' goals. Results: The outcomes are described qualitatively. Conclusion: There are preliminary indications that the programme is versatile and feasible. Further trials must be conducted before conclusive comments can be made. [ABSTRACT FROM AUTHOR]