Purpose: To compare energy expenditure of ambulation with and without walker on outdoor uneven surface and indoor even surface in children with spastic diplegia. Methods: Twenty fi ve children (13boys, 12 girls) with spastic diplegia, between 5-17 years walked for 50 meters on an indoor even surface and outdoor uneven surface with and without walker. Their energy expenditure was measured by Physiological Cost Index (PCI). Results: Independent t-test and paired t-test were used for analysis. There was a statistically signifi cant difference between children who walked either with hand support or independently and with walker. Indoor performance was better than outdoor performance under both conditions. Children walking independently or using hand support consumed less energy than children who used walker on both surfaces (p <0.05). Conclusions: Children with spastic diplegia require more energy when ambulating with walker than when ambulating with hand holding assistance or independently.

Key words: spastic diplegia, walker, energy expenditure, physiological cost index.