Upper-limb contracture development in children with cerebral palsy: a population-based study
Jenny Hedberg-Graff1,2, Fredrik Granström2, Marianne Arner3,4
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Thirty-four percent of children with cerebral palsy develop upper-limb contractures, with decreased passive range of motion (ROM) appearing by preschool age. Higher Manual Ability Classification System (MACS) levels significantly predict contracture development.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting motor function.
- Contractures and reduced passive range of motion (ROM) are significant complications in children with CP, impacting function and quality of life.
- Understanding the longitudinal development of these issues is crucial for timely intervention.
Purpose of the Study:
- To investigate the longitudinal development of passive upper limb ROM in children with CP.
- To identify predictors of contracture development, including functional level (Manual Ability Classification System - MACS), CP subtype, and age.
Main Methods:
- Analysis of annual passive ROM measurements from a population-based sample of 771 children with CP (aged 1-18 years).
- Utilized mixed-effects models to determine the age of decreased passive ROM onset.
- Employed logistic regression and odds ratios to assess risk factors and predict contracture development, with a focus on MACS levels.
Main Results:
- 34% of children with CP developed upper-limb contractures.
- Decreased passive ROM was observed by mean ages of 4 years (wrist extension) and 7 years (shoulder flexion, elbow extension, supination).
- Children at MACS level V had a 17-fold higher risk of contractures compared to MACS level I.
Conclusions:
- Upper-limb contractures affect one-third of children with CP, with onset in early childhood.
- Passive ROM decreases longitudinally with age in this population.
- MACS level is the most significant predictor of contracture development, highlighting the importance of functional assessment in management.
Aim:
The aim of this study was to investigate the longitudinal development of passive range of motion (ROM) in the upper limbs in a population-based sample of children with cerebral palsy (CP), and to investigate which children are more likely to develop contractures related to functional level, CP subtype, and age.
Method:
Registry data of annual passive ROM measurements of the upper limbs from 771 children with CP (417 males, 354 females; mean age 11y 8mo, [SD 5mo] range 1-18y) were analysed. Mixed models were used to investigate at what age decreased passive ROM occurs. Odds ratios were calculated to compare risks and logistic regression analysis was used to predict contracture development.
Results:
Thirty-four per cent of the children had developed contractures. Among these children, decreased passive ROM was significant at a mean age of 4 years for wrist extension and 7 years for shoulder flexion, elbow extension, and supination. Children at Manual Ability Classification System (MACS) level V had a 17-times greater risk of contractures than children at MACS level I.
Interpretation:
One-third of the children in the total population developed upper-limb contractures while passive ROM decreased with age. MACS level was the strongest predictor of contracture development.
What This Paper Adds:
In a population-based sample of 771 children with cerebral palsy, 34% developed an upper-limb contracture. Contracture development started at preschool age. The first affected movements were wrist extension and supination. Passive range of motion decreased with age. High Manual Ability Classification System level was the most important predictor of contractures.
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