Effect of Tonal Abnormality On Physiological Cost Index In Patients With Cerebral Palsy
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Cerebral Palsy
Resting Heart Rate
Walking Heart Rate
Walking Velocity
Tardieu scale
Pulse oximeter

How to Cite

Ms. Renuka Dhomne, Dr. Suvarna Ganvir, & Dr. Chetana Kunde. (2019). Effect of Tonal Abnormality On Physiological Cost Index In Patients With Cerebral Palsy . VIMS Health Science Journal , 6(2), 47-49. https://doi.org/10.46858/dvvpf.j.


Background:  Children with cerebral palsy (CP) have limited functional level due to primary and secondary functional impairments like movement difficulty, problem with balance and coordination. Physiological Cost Index (PCI) is a reliable clinical tool for measuring energy expenditure during walking. However presence of tonal abnormality may affect the PCI and subsequently the energy expenditure. Aim: To investigate the effect of tonal abnormality in lower limb muscles on PCI patients with CP. Methodology: After obtaining Institutional Ethical Committee approval, ambulatory patients with cerebral palsy were included with their parent consent. Patients were asked to walk a pathway of 50 meters with or without orthosis as a self-selected speed. Along with the demographic data, type of Tonal abnormality, muscles involved, Resting & Walking Heat Rate, Walking Speed & PCI were recorded. Spasticity in lower limb muscles was assessed with the help of Modified Tardieu scale. Result: In the present study, out of 30 patients there were 16 boys and 14 girls in the age group of 6-12 years. Patient were divided into 3 groups on the presence of spasticity in either Tendo Achilles(TA), Hamstring(H), and in both the muscle (TA+H). There was no significant difference among three groups for the parameters – Resting Heart Rate (RHR), Walking Heart Rate (WHR), Walking speed, Physiological Cost Index. (P value for RHR 0.4724, WHR-0.8936, WALKING SPEED-0.3379, PCI -0.4952). Conclusion: It is concluded from study that tonal abnormality in various muscle group does not affect Physiological Cost Index.

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Rethlefsen SA, Ryan DD, Kay RM. Classification systems in cerebral palsy. Orthopaedic Clinics. 2010 Oct 1;41(4):457-67.

Bhise SA, Ban J, Parab S, Ghodey S. Comparison between physiological cost index in healthy normal children as against ambulatory spastic diplegic cerebral palsy (with and without orthosis) in the age group 6 to18 years. International Journal of Physiotherapy. 2016 Aug 7:395-400.

Keenan WN, Rodda J, Wolfe R, Roberts S, Borton DC, Graham HK. The static examination of children and young adults with cerebral palsy in the gait analysis laboratory: technique and observer agreement. Journal of Pediatric Orthopaedics B. 2004 Jan 1;13(1):1-8.

Takaki K, Kusumoto Y. The relationship between the physical cost index and knee extensor strength in children with hemiplegic cerebral palsy. Journal of physical therapy science. 2017;29(10):1784-7.

Ross SA, Engsberg JR. Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Archives of physical medicine and rehabilitation. 2007 Sep 1;88(9):1114-20.

Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003 Jan 1;111(1):e89-97.

Furukawa A, Nii E, Iwatsuki H, Nishiyama M, Uchida A. Factors of influence on the walking ability of children with spastic cerebral palsy. Journal of Physical Therapy Science. 1998;10(1):1-5.

Fritz S, Lusardi M. White paper:“walking speed: the sixth vital sign”. Journal of geriatric physical therapy. 2009 Jan 1;32(2):2-5.

Pirpiris M, Wilkinson AJ, Rodda J, Nguyen TC, Baker RJ, Nattrass GR, Graham HK. Walking speed in children and young adults with neuromuscular disease: comparison between two assessment methods. Journal of Pediatric Orthopaedics. 2003 May 1;23(3):302-7.

Beckung E, Hagberg G. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Developmental medicine and child neurology. 2002 May;44(5):309-16.

Schenker R, Coster W, Parush S. Participation and activity performance of students with cerebral palsy within the school environment. Disability and rehabilitation. 2005 May 20;27(10):539-52.

Duffy CM, Hill AE, Cosgrove AP, Carry IS, Graham HK. Energy consumption in children with spina bifida and cerebral palsy: a comparative study. Developmental Medicine & Child Neurology. 1996 Mar;38(3):238-43.

Damiano DL, Abel MF. Functional outcomes of strength training in spastic cerebral palsy. Archives of physical medicine and rehabilitation. 1998 Feb 1;79(2):119-25.

Papadonikolakis A, Vekris M, Korompilias A, Kostas J, Ristanis S, Soucacos P. Botulinum a toxin for treatment of lower limb spasticity in cerebral palsy gait analysis in 49 patients. Acta Orthopaedica Scandinavica. 2003 Jan 1;74(6):749-55.

Tuzson AE, Granata KP, Abel MF. Spastic velocity threshold constrains functional performance in cerebral palsy. Archives of physical medicine and rehabilitation. 2003 Sep 1;84(9):1363-8.

Dobson F, Morris ME, Baker R, Graham HK. Gait classification in children with cerebral palsy: a systematic review. Gait & posture. 2007 Jan 1;25(1):140-52.

Norman JF, Bossman S, Gardner P, Moen C. 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. Pediatric Physical Therapy. 2004 Dec 1;16(4):206-11.

Raja K, Joseph B, Benjamin S, Minocha V, Rana B. Physiological cost index in cerebral palsy: its role in evaluating the efficiency of ambulation. Journal of pediatric orthopaedics. 2007 Mar 1;27(2):130-6.

Mackey AH, Walt SE, Lobb G, Stott NS. Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia. Developmental medicine and child neurology. 2004 Apr;46(4):267-72.


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