Normalizing lower extremity strength data for children, adolescents, and young adults with cerebral palsy

The traditional method for normalizing quantitative strength data is to divide force or torque by body mass. We have previously shown that this method is not appropriate for able-bodied children and young adults and that normalization using allometric scaling is more effective. The purpose of the current study was to evaluate the effectiveness of applying existing normalization equations for lower extremity strength to children, adolescents, and young adults with cerebral palsy (CP) and, if appropriate, to develop CP-specific normalization equations using allometric scaling. We measured the maximum torque generated during hip abduction/adduction, knee extension/flexion, and ankle dorsiflexion/plantar flexion in 96 subjects with spastic diplegia CP ages 4-23 years. Traditional mass normalization (Torque/Mass1.0) and allometric scaling equations from children without disability (Torque/Mass1.6 for hip and knee; Torque/Mass1.4 for ankle) were not effective in eliminating the influence of body mass. Normalization using CP-specific allometric scaling equations was effective using both muscle-specific and common (Torque/Mass0.8 for ankle plantar flexors; Torque/Mass1.4 for all others) scaling relationships. For the first time, normalization equations have been presented with demonstrated effectiveness in adjusting strength measures for body size in a group of children, adolescents, and young adults with CP.