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Range of motion in children with spastic diplegia, GMFCS I-II compared to age and gender matched controls
Gaela M Kilgour1, Peter J McNair, N Susan Stott
1Christchurch Polytechnic, Christchurch, New Zealand.
Insights
Children with spastic diplegia show reduced passive range of motion in lower limbs, particularly hamstring length and ankle dorsiflexion, compared to typically developing peers. Individual variability is significant in these measurements.
Area of Science:
- Pediatrics
- Neurology
- Orthopedics
Background:
- Passive range of motion (PROM) measurements are crucial for assessing muscle shortening in pediatric spastic diplegic cerebral palsy.
- Limited data exists on normative PROM values for children with spastic diplegia and their comparison to healthy controls.
Purpose of the Study:
- To compare eight lower limb sagittal plane PROM measurements in children with spastic diplegia (GMFCS I-II) against age and gender-matched controls.
- To establish expected PROM values for children with mild spastic diplegia.
Main Methods:
- A comparative study involving 22 children with spastic diplegia (GMFCS I-II) and 22 matched typically developing children.
- Measurement of eight lower limb sagittal plane passive range of motion parameters.
Main Results:
- Children with spastic diplegia exhibited significantly reduced popliteal angle (average -59.2° vs. -38.8°), SLR (average 52.7° vs. 75.8°), and ankle dorsiflexion with knee extended (average -2.5° vs. 8.6°).
- Minimal hip extension loss was observed, but hamstring length was notably reduced.
- Significant inter-individual variability in PROM measurements was noted within the spastic diplegia group.
Conclusions:
- Children with mild spastic diplegia demonstrate restricted passive range of motion in specific lower limb joints compared to controls.
- These findings highlight the need for individualized assessment due to considerable variability in PROM measurements.
Abstract:
Measurements of passive range of motion are often used to define the degree of muscle shortening in children with spastic diplegic cerebral palsy. However, little is known about the expected values of passive range of motion measurements in children with spastic diplegia and how these might differ from age and gender matched norms taken from the same population. Therefore, the purpose of this study was to compare eight lower limb measurements of sagittal plane passive range of motion in 22 children with spastic diplegia, GMFCS I to II, with 22 matched controls. Children with spastic diplegia had minimal hip extension loss, but reduced hamstring length, with popliteal angle averaging -59.2+/-10.6 degrees (control -38.8+/-13.4 degrees, p < 0.001) and SLR averaging 52.7+/-10.2 degrees (control 75.8+/-11.1 degrees, p < 0.001). Ankle dorsiflexion with knee extension averaged -2.5+/-8.4 degrees in children with spastic diplegia (control 8.6+/-6.8 degrees, p < 0.001). These data confirmed that children with mild spastic diplegia had some restriction in passive range of motion compared to controls but that there was considerable variability between individuals.
