Related Experiment Video
Updated: Aug 5, 2026
Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Physical and neuromuscular impairment profiles across GMFCS Levels I-III in children with spastic cerebral palsy
Guilherme Auler Brodt1, Lauro Machado Neto2
1Gait Analysis Laboratory, Clinical Center, Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil.
Insights
Muscle strength and selective motor control impairments in the plantar flexors, along with knee flexor spasticity, strength, and SMC, best differentiate functional levels in spastic cerebral palsy (CP) across GMFCS levels I-III.
Area of Science:
- Neurology
- Physical Therapy
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy (CP) is a neurological condition characterized by motor impairments stemming from early brain injury.
- Understanding how physical and neuromuscular deficits vary with functional severity is crucial for effective clinical assessment and targeted interventions.
Purpose of the Study:
- To compare joint range of motion (ROM), muscle strength, spasticity, and selective motor control (SMC) across Gross Motor Function Classification System (GMFCS) levels I to III in individuals with spastic CP.
- To identify key physical and neuromuscular impairments that distinguish functional levels in spastic CP.
Main Methods:
- Retrospective analysis of clinical data from 251 individuals with spastic CP (GMFCS I-III).
- Standardized assessments included passive joint ROM, manual muscle testing, Modified Ashworth Scale for spasticity, and an ordinal SMC scale.
- General linear models were used to analyze outcomes by muscle group, with GMFCS level as a fixed factor and age as a covariate.
Main Results:
- Significant differences in ROM, muscle strength, spasticity, and SMC were observed across GMFCS levels.
- Plantar flexor strength and SMC, followed by knee flexor spasticity, strength, and SMC, showed the largest effect sizes and discriminatory capacity.
- Restricted ROM was noted in higher GMFCS levels, particularly for knee extension and hip abduction.
Conclusions:
- Consistent patterns of neuromuscular impairment correlate with GMFCS levels in spastic CP.
- Plantar flexor and knee flexor impairments are key indicators differentiating functional severity in spastic CP.
- These findings support the use of GMFCS as a framework for understanding and addressing specific functional deficits in spastic CP.
Background:
Spastic cerebral palsy (CP) is a non-progressive neurological condition resulting from early brain injury or maldevelopment, leading to heterogeneous motor impairments that affect functional abilities and daily activities. Describing how physical and neuromuscular impairments vary across functional severity levels may improve characterization of functional impairment profiles relevant to clinical assessment.
Objectives:
To describe between-group differences in joint range of motion (ROM), muscle strength, spasticity, and selective motor control (SMC) across Gross Motor Function Classification System (GMFCS) levels I to III in individuals with spastic CP.
Methods:
A retrospective cross-sectional analysis was conducted using clinical records of 251 participants with CP (GMFCS I-III). Standardized physical examinations included passive joint ROM, manual muscle testing, the Modified Ashworth Scale for spasticity, and an ordinal SMC scale. Physical examination outcomes were analysed by muscle group using general linear models, with GMFCS level as a fixed factor and age as a covariate. Partial eta squared was used to estimate effect sizes.
Results:
ROM measures demonstrating the largest effect were passive knee extension, slow hip abduction, and the Modified Thomas test, with more restricted values observed in GMFCS III. Muscle strength exhibited large effect sizes across all muscle groups, with the greatest discrimination observed for plantar flexors and knee flexors. Spasticity showed predominantly large effect sizes, particularly in knee flexors, knee extensors, hip adductors, and hip flexors. SMC demonstrated large effect sizes for plantar flexors, knee flexors, and dorsiflexors, with lower scores observed in higher GMFCS levels. Age contributed minimally to between-group differences for most outcomes.
Conclusions:
Across GMFCS levels I to III, impairments in plantar flexor strength and SMC, followed by knee flexor spasticity, strength, and SMC, demonstrated the greatest discriminatory capacity between functional levels. These findings describe consistent impairment patterns associated with GMFCS classification in participants with spastic CP.
