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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.

Developmental Medicine and Child Neurology
|September 12, 2018
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Summary

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.

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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.