Cost of walking in adults with Cerebral palsy (COWAC) – a study protocol and case presentation

Exhaustion, tiredness or a lack of energy and a reduced capacity to perform tasks over time, is often described as fatigue [1]. Fatigue is a widespread problem, reported in about half of adults with cerebral palsy (CP) [2]. Children and adolescents with CP have high oxygen consumption relative to their maximum capacity (physical strain) when walking at preferred speed [3]. The knowledge on level and impact of physical strain during walking and the relation to walking deterioration in adults with CP is largely unknown, as we lack studies with objective measures of walking function over adult life span for this group [4]. What are the main predictors of physical strain during walking in adults with CP, and what are the relationship between physical strain and fatigue? Partcipants will be 100 adults (18-65 years) with CP with functional walking ability. Data collection will be done over 1 year at Sunnaas Rehabilitation Hospital, Norway from summer 2023. Descriptive statistics consists of demographic variables, 6-minute walk test, Timed-up-and-go test, perceived change in walking function and pain. The possible predictors of physical strain in the regression analysis will be age, sex, gait deviations (GDI), joint moments (GDI kinetic), spasticity, selective motor control, VO2max, Gross Motor Function Classification System and type of CP. The relationship between physical strain and fatigue will be investigated with correlation analysis. Data collection will commence in the spring of 2023. Preliminary results from two representative cases will be presented at the conference with kinematic and kinetic data coupled with cardiorespiratory data (VO2max and physical strain) and fatigue. The scope of this study is to raise the need to improve the understanding of factors that influence fatigue in individuals with neurological impairments. By establishing objective and valid measurement protocols for assessing the total physical burden of functional activities, such as walking, we can bring this field forwards. The study results may lead to information of what factors predicts physical strain, and knowledge of the natural development of walking, walking capacity, fatigue, and pain through adulthood. This can improve individually tailored treatment plans based on the role of the predictors.