Passive Range of Motion in a Population-Based Sample of Children with Spastic Cerebral Palsy Who Walk

Abstract

While passive range of motion (PROM) is commonly used to inform decisions on therapeutic management, knowledge of PROM of children with spastic cerebral palsy (CP) is limited. A population-based sample of 178 children with spastic CP (110 male; unilateral, n = 94; bilateral, n = 84; age range 4-17 years) and 68 typically developing children (24 male; age range 4-17 years) were recruited to the study. All children were able to walk a minimum of 10 m over a straight flat course, with or without assistive devices. Gross Motor Function Classification System (GMFCS) levels of participants with CP were: Level I = 55, Level II = 88, Level III = 21, and Level IV = 14. Ankle dorsiflexion, knee extension, popliteal angle, hip abduction, hip internal rotation, and hip external rotation were measured using a goniometer. The results indicate that the children with CP had significantly reduced PROM compared to the children with typical development. Children with CP demonstrated reduced length in the hamstrings, hip adductor, iliopsoas and gastrocnemius-soleus musculature, and contracture at the knee joint. Among children with CP, there were significant reductions in range with increasing functional limitation (higher GMFCS level) and variations based on unilateral or bilateral involvement. This was particularly the case for the hamstrings and hip adductor musculature, where PROM varied considerably across GMFCS Levels I to IV.

Muscle-specific changes in length-force characteristics of the calf muscles in the spastic Han-Wistar rat

“…Previously, this mutant rat model has been used for neural studies exclusively (7,39,44). The mechanical properties of the spastic rat calf muscles found in the present study are consistent with the reduced functional range of motion and increased stiffness reported clinically in human limbs affected by spasticity (17,31,32,40), and the narrower active lengthforce curves estimated in in vivo studies on human GA (2,15,16). Thus the spastic rat model used in the present study mimics several important features of spasticity in human patients, and may be used to elucidate the mechanisms responsible for changes in muscle and limb mechanical properties observed in patients with spasticity.…”

“…muscle spasticity; mechanical properties; myofascial force transmission; muscle stiffness MUSCLE SPASTICITY HAS BEEN defined as a "velocity-depended resistance to stretch" (24) and arises secondary to upper motoneuron lesions with cerebral palsy and stroke as the most common examples (12). Individuals suffering from spasticity typically experience muscle weakness, enhanced joint stiffness, increased muscle tone, reduced range of joint motion, increased antagonistic co-contraction, and exaggerated reflexes (1,3,6,12,13,32,41,48). These effects severely impair the ability to perform daily activities, and treatment is often needed.…”

Reported outcomes of lower limb orthopaedic surgery in children and adolescents with cerebral palsy: a mapping review

“…This is despite the developers' original paper describing it as a classification system . The GMFCS is an important predictor of the risk of scoliosis and hip dysplasia in CP and may be linked to success of some surgeries, reduction in muscle strength, and changes in range of motion over time . Given the importance of the GMFCS for many surgical outcomes, the authors believe that its use to classify study participants should become a requirement for publication of orthopaedic outcomes of lower limb surgery.…”

Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy

“…However, the adductor muscles did not lose ROM with age, which is common in children with spastic diplegic CP. 10,38 The longitudinal data published by Nordmark et al 10 show that for measurements such as hip abduction and the popliteal angle, there can be a considerable change during the early years, with the mean ROM of hip abduction decreasing from 43 • to 34 • , between age 2 and 14 years. McDowell et al 38 found significant reductions in passive ROM for the hamstrings and hip adductor musculature in children with spastic CP.…”

“…The mean of hip abduction in children of 4 to 10 years at GMFCS level III was 25.9 • ± 9.5 • . 38 These children also had no history of lower limb surgery.…”