Energy cost of walking: solving the paradox of steady state in the presence of variable walking speed.

Measurement of the energy cost of walking in children with cerebral palsy is used for baseline and outcome assessment. However, such testing relies on the establishment of steady state that is deemed present when oxygen consumption is stable. This is often assumed when walking speed is constant but in practice, speed can and does vary naturally. Whilst constant speed is achievable on a treadmill, this is often impractical clinically, thus rendering an energy cost test to an element of subjectivity. This paper attempts to address this issue by presenting a new method for calculating energy cost of walking that automatically applies a mathematically defined threshold for steady state within a (non-treadmill) walking trial and then strips out all of the non-steady state events within that trial. The method is compared with a generic approach that does not remove non-steady state data but rather uses an average value over a complete walking trial as is often used in the clinical environment. Both methods were applied to the calculation of several energy cost of walking parameters of self-selected walking speed in a cohort of unimpaired subjects and children with cerebral palsy. The results revealed that both methods were strongly correlated for each parameter but showed systematic significant differences. It is suggested that these differences are introduced by the rejection of non-steady state data that would otherwise have incorrectly been incorporated into the calculation of the energy cost of walking indices during self-selected walking with its inherent speed variation.