Causal modelling demonstrates metabolic power is largely affected by gait kinematics and motor control in children with cerebral palsy.
Causal modelling demonstrates metabolic power is largely affected by gait kinematics and motor control in children with cerebral palsy.
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DOI：
10.1371/journal.pone.0285667
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Schwartz MH
中科院分区：
文献类型：
--
作者：
Gill PK;Steele KM;Donelan JM;Schwartz MH
平均而言，脑瘫（CP）儿童的代谢能力（每单位时间步行时消耗的净能量）比正常发育的同龄人高出两到三倍，导致身体疲劳更严重，身体活动水平更低，心血管疾病风险更大。本研究的目的是确定可能导致CP儿童高代谢能力需求的临床因素的因果影响。我们纳入了以下儿童：1）在2000年后访问吉列儿童专科医疗保健进行定量步态评估，2）正式诊断为CP，3）根据粗大运动功能分类系统分类为I-III级，4）18岁或以下。我们创建了一个结构因果模型，该模型指定了儿童步态模式的假设关系（即，步态偏离指数，GDI）和常见损伤（即，动态和选择性运动控制、力量和痉挛状态）与代谢功率。我们使用贝叶斯加性回归树估计因果效应，并对因果模型确定的因素进行调整。有2157名儿童符合我们的标准。我们发现，一个孩子的步态模式，总结的GDI，影响代谢功率约两倍的第二大贡献者。选择性运动控制、动态运动控制和痉挛状态的影响次之。在我们考虑的因素中，力量对代谢功率的影响最小。我们的研究结果表明，与改善痉挛状态或力量相比，CP儿童可能从改善其步态模式和运动控制的治疗中获益更多。
Metabolic power (net energy consumed while walking per unit time) is, on average, two-to-three times greater in children with cerebral palsy (CP) than their typically developing peers, contributing to greater physical fatigue, lower levels of physical activity and greater risk of cardiovascular disease. The goal of this study was to identify the causal effects of clinical factors that may contribute to high metabolic power demand in children with CP. We included children who 1) visited Gillette Children’s Specialty Healthcare for a quantitative gait assessment after the year 2000, 2) were formally diagnosed with CP, 3) were classified as level I-III under the Gross Motor Function Classification System and 4) were 18 years old or younger. We created a structural causal model that specified the assumed relationships of a child’s gait pattern (i.e., gait deviation index, GDI) and common impairments (i.e., dynamic and selective motor control, strength, and spasticity) with metabolic power. We estimated causal effects using Bayesian additive regression trees, adjusting for factors identified by the causal model. There were 2157 children who met our criteria. We found that a child’s gait pattern, as summarized by the GDI, affected metabolic power approximately twice as much as the next largest contributor. Selective motor control, dynamic motor control, and spasticity had the next largest effects. Among the factors we considered, strength had the smallest effect on metabolic power. Our results suggest that children with CP may benefit more from treatments that improve their gait pattern and motor control than treatments that improve spasticity or strength.
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影响因子：
3.8
作者：
Jahnsen, R;Villien, L;Holm, I
通讯作者：
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DOI：
10.1002/cjs.11248
发表时间：
2015-06-01
影响因子：
0.6
作者：
Kapelner, Adam;Bleich, Justin
通讯作者：
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