# Quantifying the energetic cost of support and stabilization during walking in children with cerebral palsy

> **NIH NIH R21** · UNIVERSITY OF WASHINGTON · 2021 · $242,199

## Abstract

Project Summary
Walking promotes independence, participation, fitness, and exploration in daily life. Like other activities,
walking requires metabolic energy from the food we eat, which is ultimately used by our muscles to power
movement. Experimentally, we can measure this energy using indirect calorimetry, which monitors oxygen and
carbon dioxide as the body converts stored energy into the form used by muscles during activities of daily
living. Decades of energetics research has demonstrated that human walking is incredibly efficient. However,
for people with cerebral palsy the energetic cost of walking is significantly increased, on average over two times
higher than typically-developing individuals. This means that for people with cerebral palsy, walking is as tiring
as jogging or climbing stairs. An energetic cost of this magnitude restricts activities of daily living and causes
exhaustion. While our team and many others have sought to reduce these costs through surgical interventions,
rehabilitation, orthotics, or other assistive devices, these strategies have failed to result in meaningful
reductions in energy. To design strategies that successfully reduce walking costs, we must first understand the
underlying mechanisms contributing to elevated cost in people with cerebral palsy. The proposed research
seeks to fill this knowledge gap by examining biomechanical factors that contribute to elevated energy for
people with cerebral palsy. Specifically, we will evaluate the energetic cost of supporting the body (Aim-1) and
stabilizing the body (Aim-2) during walking for children with cerebral palsy, and compare these costs to
typically-developing peers. These tasks require very little energy during unimpaired walking (e.g., <10% of
total walking cost), but their costs remain unknown for people with cerebral palsy and have direct implications
for treatment decisions and assistive device design. Building upon decades of energetics research of
unimpaired walking, this research will use a mechatronic device to precisely provide support and stabilization
assistance during walking and quantify the impact of this assistance on walking cost. In unimpaired adults,
similar methods have led to the design of exoskeletons and training programs that effectively reduce walking
and running energy. This research will provide the foundation to create evidence-based strategies to decrease
energy costs, minimize fatigue, and increase quality of life for people with cerebral palsy and other neurologic
injuries.

## Key facts

- **NIH application ID:** 10301594
- **Project number:** 1R21HD104112-01A1
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Max Donelan
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $242,199
- **Award type:** 1
- **Project period:** 2021-08-15 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10301594

## Citation

> US National Institutes of Health, RePORTER application 10301594, Quantifying the energetic cost of support and stabilization during walking in children with cerebral palsy (1R21HD104112-01A1). Retrieved via AI Analytics 2026-06-02 from https://api.ai-analytics.org/grant/nih/10301594. Licensed CC0.

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