Related Experiment Video
Updated: Nov 20, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Arm Muscle Strength in Children with Bilateral Spastic CP
Meta N Eek1, Git Lidman1,2
1Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Children with bilateral spastic cerebral palsy and higher motor impairment (Manual Ability Classification Scale level II) had weaker arm muscles and greater side differences compared to level I. Wrist extensor strength decreased with age.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Movement Science
Background:
- Bilateral spastic cerebral palsy (BSCP) significantly impacts motor function in children.
- Arm muscle strength is crucial for fine and gross motor skills in daily activities.
- Understanding strength deficits is key to targeted interventions for children with BSCP.
Purpose of the Study:
- To evaluate arm muscle strength in relation to motor function in children with BSCP.
- To compare muscle strength across different functional levels defined by the Manual Ability Classification Scale (MACS).
Main Methods:
- Muscle strength of shoulder abductors, elbow flexors/extensors, wrist extensors, and grip strength was measured.
- Participants were children aged 5-15 years with bilateral spastic cerebral palsy.
- Children were categorized into MACS levels I and II for comparative analysis.
Main Results:
- Children at MACS level II exhibited lower muscle strength, particularly in shoulder abductors and wrist extensors, compared to MACS level I.
- Greater strength discrepancies between dominant and non-dominant sides were observed in children at MACS level II.
- Grip strength varied, with some children at MACS level II showing higher mean values despite functional limitations.
Conclusions:
- Children with higher levels of motor impairment (MACS II) in BSCP demonstrate reduced arm muscle strength and increased inter-limb asymmetry.
- Wrist extensor strength shows a decline with age in children with BSCP, suggesting a potential developmental trajectory difference.
- Findings highlight the need for tailored strength training programs addressing specific muscle groups and functional levels in pediatric cerebral palsy.
Aims:
To assess arm-muscle strength related to motor function in children with bilateral spastic cerebral palsy, 5-15 years old.
Methods:
Muscle strength was measured for shoulder abductors, elbow extensors and flexors, wrist extensors, and grip strength. The children were grouped according to the Manual Ability Classification Scale (MACS).
Results:
Forty-two children were included. The majority of the children at MACS levels I-II were within the normal range; shoulder abductors were weakest (mean 60-80% of predicted value), and variation was greatest for wrist extensors.Children at MACS level II showed lower values than children at level I, with significant differences for shoulder abductors (p=.028) and wrist extensors (p<.001). Differences between the dominant and non-dominant side was greater in children at MACS level II and statistically significant for wrist extensors (p=.024).Of 15 children tested for grip strength, nine were within the 2 SD range. The three children at MACS level II, all walking with a walker, had a higher mean value than those at MACS level I.
Conclusions:
Muscle strength was lower and differences were greater between sides in children at MACS level II. Wrist extensors showed a decreasing trend with age as compared with normal development.
