Comparison of Reliability between a Ten-metre and a One-minute Walking Test in Children and Adolescents with Cerebral Palsy at Mean Velocity

Special Article – Gait Rehabilitation

Phys Med Rehabil Int. 2017; 4(2): 1116.

Comparison of Reliability between a Ten-metre and a One-minute Walking Test in Children and Adolescents with Cerebral Palsy at Mean Velocity

Volpini Lana MR, da Cruz dos Anjos DM*, Moura Batista AC, Martins E, Oliveira de Souza KC and Leocadio RM

Centro Universitário Estácio, Physical Therapy Course, Minas Gerais, Belo Horizonte, Brazil

*Corresponding author: Daniela Maria da Cruz dos Anjos, Centro Universitário Estácio, Physical Therapy Course, Minas Gerais, Belo Horizonte, Brazil

Received: May 06, 2017; Accepted: May 30, 2017; Published: June 06, 2017


Cerebral palsy (CP) is a non-progressive neurological syndrome, but with frequent adaptation to abnormal patterns of posture and movement. The gait of children with CP follows an abnormal pattern and their persistence results in many damages and even a loss of ambulatory capability over the years. The gait analysis allows the management of possibilities for therapeutic intervention. A good, low-cost option for gait assessment of PC patients is the 10-meter walk test (10MWT) and the 1-minute walk test (1MWT) that demonstrate validity and reliability. However, not all gait tests can be performed by the various levels of motor function present in the PC. Thus, the purpose of this study was to compare the reliability for the mean velocity between the 10MWT and 1MWT in children and adolescents with CP. 30 children and adolescents (aged 7-18 years) with CP, levels I, II and III of the Gross Motor Function Classification System (GMFCS) were included. The Graph Pad Prism® program was used for statistical calculations and t-test for comparison between walking tests. The difference in mean velocity was not significant between 10MWT and 1MWT gait tests at p <0.05. However, both groups presented high CV due to the nature of the sample, presenting three different motor levels (GMFCSI, GMFCSII and GMFCSIII). The 10MWT and 1MWT with 30 participants with CP revealed efficacy to extract reliable values about mean velocity. Although the 10MWT is shorter than the 1MWT, it can be used as a valid medium speed analysis tool.

Keywords: Gait; Cerebral palsy; Reliability; Gait test


Cerebral palsy (CP) is a non-progressive neurological disorder that causes abnormal patterns of movement and posture [1]. The etiology of cerebral palsy is heterogeneous, but knowing the exact cause does not considerably change the direction of treatment. Gait in CP has a pattern different than normal, with deficits in spatiotemporal parameters such as speed, and quality of performance on such tasks [2].

Children with cerebral palsy that show impairments in ability and performance of gait have limitations in their participation in activities of daily living and, consequently, in social interaction [3]. Therefore, appropriate assessment and gait training are essential for the rehabilitation of children with CP.

Assessment of gait has been widely used in the treatment of individuals with neuromuscular disability, especially cerebral palsy. This evaluation may find specific motor alterations in patients, which allows for a more accurate physical functional diagnosis and better treatment options. Alterations in gait are observed by health professionals and allow them to implement per-case appropriate interventions, such as prostheses, injection of botulinum toxin, conservative treatment such as physical therapy, and others [4].

The spatiotemporal parameters of gait, especially the speed variables, are often used to assess the development of gait in children, and identify possible disorders. Not only does the analysis of these parameters evaluate aspects of pathological gait, it quantifies its evolution after surgical interventions or rehabilitation [5].

Although assessing gait deviation is essential for treatment planning, of the necessary equipment, such as the gait laboratory and surface electromyography (EMG), is often costly. Consequently, this limits its availability at rehabilitation clinics.

A viable low-cost alternative for gait assessment in patients with CP is walking tests that show validity and reliability [6-8]. For instance, there is a ten-metre walking test (10MWT) and the oneminute walking test (1MWT).

Studies have demonstrated that the severity of functional impairment is quite variable. Furthermore, it is associated with the severity of neurological injury [9]. Thus, whilst some children are able to walk long distances, other children need auxiliary devices even for short routes [10].

Hence, not all tests for the assessment of gait may be performed by the various levels of motor function found in CP. For some children, walking for one minute is an easy task, whereas it is a strenuous activity for others. However, it may be more easily executed over ten metres.

This study aimed at comparing the reliability of the mean velocity between the ten-metre and one-minute walking test in ambulatory children and adolescents with CP, which correspond to the levels I, II, and III of the Gross Motor Function Classification System (GMFCS).


Clinical methodology

After the Ethics and Research Committee of Estácio de Sá University (UNESA/RJ) under opinion 1.385.724/16 approved this study, and the Free Informed Consent and the Free and Clarified Assentment Term forms were signed, testing was performed.

We compared the medical speed values of children with CP acquired from two different gait tests and determined the influence of the duration of the test (longer or shorter), and the severity of neurological impairment in the value found.

The results were obtained from the analysis of data collected by a 10MWT, and a 1MWT.

Selection of sample

Thirty children and adolescents (aged seven to 18 years) with CP were included in this study. Participants were randomly selected and agreed to participate. The criteria of selection were that they had good vision, ability to understand instructions, ability to walk continuously for 14 metres and for one minute with or without walking aids, and classification of gross motor function at levels I, II, or III in accordance with the GMFCS for cerebral palsy. Individuals who had been administered botulinum toxin, had undergone orthopedic surgery within the previous 6 months, or had orthopedic conditions (shortenings, contractures) that could negatively alter gait were excluded from the study.

According to this classification, GMFCS I (n=17), GMFCS II (n=8), and GMFCS III (n=8) children with CP participated in this study.

Gait analysis

Gait analysis was performed with a 10MWT and a 1MWT. Both were performed on the same day. There were three repetitions for each test, with a rest period of three to five minutes. After each test, the mean velocity was calculated. The tests were performed on a flat surface, without distracting factors. The children were instructed to walk at their preferred speeds. They were allowed their own clothes and shoes, and the use of their lower limb orthoses.

The 10MWT was performed with a “flying” method, i.e. while the individual walked for approximately 14 metres, time was recorded during the intermediate ten metres. The initial two acceleration metres and the finial two deceleration metres were discarded [11]. The ten-metre walking times were measured using a digital timer [12].

During the one-minute walking test, participants were instructed that when instruction to start walking was given, they should continue walking around a track with markings at meters for one minute. The distance was measured with a manual tape measure using the markings on the track.

Statistical analysis

The Graph Pad Prism® software, version 6.0 Trial was used for statistical calculations. The t-test was applied to compare two groups, and a one-way ANOVA was applied for multiple comparisons. Newman Keuls was the post-test.


The demographic characteristics of the sample are described below. The sample consisted of 30 children with CP. Of these, 15 were boys and 15 were girls. The average age was 7.4 ± 0.69. Seventeen children were classified as GMFCS level I, eight children were classified as GMFCS level II, and eight children were classified as GMFCS level III.

Data (mean ± SD) of Vm and (mean ± SD) of gait were analyzed within each group (each test) and between groups (between tests).

To verify the correlation and efficacy of pairing between tests, the Pearson’s correlation coefficient (r) was calculated, whose value was above 0.90. This value indicated a very strong correlation (Table 1).