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Is oxygen cost stable across three self‐selected walking speeds in ambulant youth with cerebral palsy at GMFCS levels I, II and III?
Author(s) -
M O’NEIL,
M FRAGALA-PINKHAM,
S TROST
Publication year - 2017
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.53_13512
Subject(s) - cerebral palsy , physical medicine and rehabilitation , physical therapy , psychology , medicine
inexpensive, portable, and easy to use, and it has been widely used for assessing body composition. However, few studies have evaluated body composition according to function ability levels in those with CP using the BIA. Therefore, we performed this study to assess differences in body composition according to gross motor function in children with CP compared to a healthy control group using BIA. In addition, we evaluated the factors that significantly affect the body composition measurements. Study Design: Case control study, retrospective. Study Participants & Setting: One hundred consecutive patients with CP who were admitted for orthopedic surgery between May 2014 and March 2016, and 46 typically developing children (TDC) (mean age, 12.8 4.5y) were included. Children with a history of a genetic, metabolic, or neurodegenerative disease and children with medical conditions that affect growth were excluded. TDC with no condition who were not taking any medications that altered their body composition were included as the control group. Materials/Methods: By using BIA, the skeletal muscle mass (SMM), soft lean mass (SLM), fat free mass (FFM), body fat, body cell mass (BCM), bone mineral content (BMC), waisthip ratio, visceral fat area (VFA), and basal metabolic rate (BMR) were measured. The percent body fat was calculated to account for weight differences between children. To account for the effect of height, the SLM, FFM, SMM, BCM, BMC, and VFA were adjusted to obtain the SLM index FFM index (FFM/height^2), SMM index (SMM/height^2), BCM index (BCM/height^2), BMC index (BMC/height^2), and VFA index (VFA/height^2). Partial correlation analysis was used to determine associations between the body composition measures while controlling for the effects of age, sex, BMI, and the GMFCS level. For statistical analysis, children with CP were divided into two groups based on the GMFCS level: ambulatory children (GMFCS levels I, II, and III) and nonambulatory children (GMFCS levels IV and V). Multiple regression analysis was used to determine the significantly contributing factors to SLM and BMC. Results: Children with CP classified as GMFCS levels IV and V had a lower height, weight, and BMI than those classified as GMFCS levels I, II, and III. Children with CP had a lower height, weight, and BMI than TDC. Children with CP classified as GMFCS levels IV and V had a significantly lower SLM, SLM index, FFM, FFM index, SMM, SMM index, BCM, BMC index, BMC, BMC index, and BMR than TDC and children with CP with GMFCS levels I to III. According to the results of multiple regression analysis, age (p<0.001), sex (p=0.012), BMI (p=0.003), and the GMFCS level (p<0.001) were significant factors that contributed to SLM (adjusted R=0.777). In addition, age (p<0.001) and the GMFCS level (p<0.001) were significant factors that contributed to BMC (adjusted R=0.751). Conclusions/Significance: Our body composition analysis using the BIA method showed that non-ambulatory children with CP had significantly lower FFM, SLM, SMM, BCM, and BMC than ambulatory children with CP and TDC. In addition, GMFCS level was a significant contributing factor to SLM and BMC. However, further study is required before the BIA method can be used as a valid nutritional assessment tool in patients with CP.