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Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children
Lynn M Jeffries1, Alyssa LaForme Fiss2, Sarah Westcott McCoy3
1Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117 (USA).
Insights
This study developed developmental trajectories and reference percentiles for range of motion, endurance, and strength in children with cerebral palsy (CP). These tools help monitor CP progression and guide personalized interventions for better clinical decision-making.
Area of Science:
- Pediatric Rehabilitation
- Developmental Pediatrics
- Biomedical Engineering
Background:
- Children with cerebral palsy (CP) often experience secondary impairments affecting spinal alignment, range of motion, endurance, and muscle strength.
- Understanding the developmental trajectories of these impairments is crucial for effective clinical decision-making and intervention planning.
Purpose of the Study:
- To create longitudinal developmental trajectories for range of motion (SAROMM), endurance (EASE), and functional strength (FSA) in children with CP, stratified by Gross Motor Function Classification System (GMFCS) level.
- To develop age-specific reference percentiles and typical 1-year change amounts for these key functional outcomes.
Main Methods:
- A longitudinal cohort study involving 708 children with CP across GMFCS levels (18 months to 12 years).
- Data collected through therapist-administered SAROMM and FSA, and parent-reported EASE, over 2 years with assessments every 6 months.
- Longitudinal trajectories modeled using mixed-effects models, and reference percentiles derived from quantile regression.
Main Results:
- Longitudinal trajectories and percentile graphs for SAROMM, EASE, and FSA were predominantly linear, showing distinct performance levels across GMFCS classifications.
- Significant variability was observed within GMFCS levels for both longitudinal trajectories and percentile data.
Conclusions:
- The developed longitudinal trajectories and percentile graphs serve as valuable resources for monitoring the performance and changes in children with CP over time.
- These tools facilitate collaborative decision-making between therapists and families, enabling targeted interventions based on individual needs.
Background:
Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making.
Objective:
For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes.
Design:
This study used a longitudinal cohort design.
Methods:
Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure.
Results:
Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels.
Limitations:
Limitations included a convenience sample and varying numbers of participants assessed at each visit.
Conclusions:
The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.
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