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Published on: August 9, 2024
Passive range of motion in a population-based sample of children with spastic cerebral palsy who walk
Brona C McDowell1, Jose J Salazar-Torres, Claire Kerr
1Gait Analysis Laboratory, Belfast Health and Social Care Trust, Musgrave Park Hospital, Belfast, Northern Ireland. brona.mcdowell@belfasttrust.hscni.net
Insights
Children with spastic cerebral palsy (CP) have significantly reduced passive range of motion (PROM) in key joints compared to typically developing peers. Reduced PROM correlates with increased functional limitations across Gross Motor Function Classification System (GMFCS) levels.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Passive range of motion (PROM) is crucial for assessing therapeutic needs in children.
- Limited data exists on PROM in children with spastic cerebral palsy (CP).
Purpose of the Study:
- To investigate and compare PROM in children with spastic CP and typically developing children.
- To examine the relationship between PROM, Gross Motor Function Classification System (GMFCS) levels, and unilateral/bilateral involvement in spastic CP.
Main Methods:
- A population-based sample of 178 children with spastic CP (ages 4-17) and 68 controls were assessed.
- Goniometric measurements of ankle dorsiflexion, knee extension, popliteal angle, hip abduction, and hip rotation were performed.
- Participants with CP were categorized by GMFCS levels (I-IV).
Main Results:
- Children with CP exhibited significantly reduced PROM compared to controls.
- Reduced muscle length was observed in hamstrings, hip adductors, iliopsoas, and gastrocnemius-soleus, with knee contractures noted.
- PROM deficits worsened with higher GMFCS levels and varied between unilateral and bilateral CP involvement.
Conclusions:
- Spastic CP is associated with widespread PROM limitations, particularly affecting hamstrings and hip adductors.
- PROM deficits correlate with functional limitations (GMFCS level) and type of CP involvement.
- Findings highlight the need for targeted interventions addressing PROM in children with CP.
Abstract:
While passive range of motion (PROM) is commonly used to inform decisions on therapeutic management, knowledge of PROM of children with spastic cerebral palsy (CP) is limited. A population-based sample of 178 children with spastic CP (110 male; unilateral, n = 94; bilateral, n = 84; age range 4-17 years) and 68 typically developing children (24 male; age range 4-17 years) were recruited to the study. All children were able to walk a minimum of 10 m over a straight flat course, with or without assistive devices. Gross Motor Function Classification System (GMFCS) levels of participants with CP were: Level I = 55, Level II = 88, Level III = 21, and Level IV = 14. Ankle dorsiflexion, knee extension, popliteal angle, hip abduction, hip internal rotation, and hip external rotation were measured using a goniometer. The results indicate that the children with CP had significantly reduced PROM compared to the children with typical development. Children with CP demonstrated reduced length in the hamstrings, hip adductor, iliopsoas and gastrocnemius-soleus musculature, and contracture at the knee joint. Among children with CP, there were significant reductions in range with increasing functional limitation (higher GMFCS level) and variations based on unilateral or bilateral involvement. This was particularly the case for the hamstrings and hip adductor musculature, where PROM varied considerably across GMFCS Levels I to IV.
