Related Experiment Video
Updated: Oct 11, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Predictors of range of motion restrictions in children with spastic cerebral palsy: A registry-based study
Nihad A Almasri1, Ed J Gracely2, Maysoun Saleh1
1Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan.
Insights
Children with spastic cerebral palsy (CP) often develop restricted passive range of motion (PROM). Older age, male gender, and bilateral CP increase PROM restrictions, particularly in hip abduction, knee extension, and ankle dorsiflexion.
Area of Science:
- Pediatrics
- Orthopedics
- Neurology
Background:
- Spastic cerebral palsy (CP) frequently leads to restricted passive range of motion (PROM) and contractures in children.
- Limited knowledge exists regarding specific child characteristics that heighten the risk for developing restricted PROM.
- Early identification of children at risk is crucial for timely medical intervention and management.
Purpose of the Study:
- To identify the most common PROM limitations in children with spastic CP.
- To investigate the influence of a child's age, gender, Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) level, and CP subtype on restricted PROM.
Main Methods:
- Retrospective analysis of PROM data from 233 children with CP using the CPUP-Jordan national registry.
- Data included child's age, gender, GMFCS-E&R level, and CP subtype.
- Statistical analyses included point biserial correlations and multiple binary logistic regressions to identify PROM predictors.
Main Results:
- Hip abduction was the most frequently restricted PROM (57.9%).
- Older age correlated with increased restrictions in knee extension and ankle dorsiflexion.
- Male gender, lower GMFCS-E&R levels, and bilateral CP were associated with specific PROM restrictions, notably hip abduction.
Conclusions:
- Child characteristics significantly predict PROM limitations in hip, knee, and ankle joints of children with spastic CP.
- Findings offer insights for healthcare professionals managing children with CP.
- Highlights the importance of comprehensive assessments and targeted interventions based on individual risk factors.
Background:
Although children with spastic cerebral palsy (CP) commonly present with restricted passive range of motion (PROM) and contractures, knowledge about the child's characteristics that increase the risk of development of restricted PROM is limited. Identifying children who are more likely to develop contractures is important for early detection and the provision of appropriate medical management. This study aims to identify the most commonly restricted PROM of children with spastic CP and (2) to examine the combined effect of a child's age, gender, gross motor functional classification level and CP subtype on the development of restricted PROM in children with spastic CP.
Methods:
The PROM of 233 children diagnosed with CP was extracted from the national registry of CP in Jordan (CPUP-Jordan) in addition to information about children's age, gender, level of Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) and subtype of CP. The mean age of the participants was 3.73 years (SD = 3.14), 57.5% were males and 80.3% had bilateral spastic CP. Point biserial correlations were calculated between the PROM and the child's variables. Multiple binary logistic regressions were conducted to identify the predictors of PROM.
Results:
Hip abduction was the most common restricted PROM (57.9%), whereas the hip extension was the least (2.1%). Children with older ages demonstrated more restrictions in knee extension and ankle dorsiflexion; males demonstrated more restriction in hip abduction than females; children with lower GMFCS-E&R levels had more restrictions in hip internal rotation but fewer restrictions in hip abduction and ankle dorsiflexion; and children with bilateral spastic CP had more restrictions in hip abduction than children with unilateral spastic CP.
Conclusions:
PROM of the hip, knee and ankle joints of children with spastic CP was predicted by different sets of child characteristics. Implications for health professionals and follow-up registries of children with CP are provided.
