Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study

Nordmark, Eva; Hägglund, Gunnar; Lauge-Pedersen, Henrik; Wagner, Philippe; Westbom, Lena

doi:10.1186/1741-7015-7-65

Cited by 121 publications

(186 citation statements)

References 27 publications

(20 reference statements)

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“…However, no change can sometimes be positive, when deterioration is usually to be expected, which is often the case in CP. 22 Reduced muscle tone may decrease the risk of further development of contractures, but other interventions are needed to deal with muscle contractures such as positioning, orthoses, and orthopaedic surgery. As development of contractures is a slow process, there is also a need for a long-term follow-up after ITB for this aspect.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity

Eek

Olsson

Lindh

et al. 2017

Develop Med Child Neuro

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ITBIntrathecal baclofen ROM Range of motion AIM To investigate the effect of intrathecal baclofen (ITB) on function and activity in dyskinetic cerebral palsy (CP).METHOD A retrospective cohort study of records from 25 children (15 males, 10 females; mean age 10y 11mo, SD 4y 9mo). Five were classified in Gross Motor Function Classification level IV and 20 in level V. Parents were interviewed about activities in daily life, sitting, communication, pain, sleep, and gross and fine motor function. Differences before and 1 year after ITB were graded as positive, no change, or negative. Assessments of dystonia (using the Barry-Albright Dystonia Scale) and muscle tone (Ashworth Scale) were made. Joint range of motion (ROM) was measured.RESULTS Both dystonia and increased muscle tone, present in all participants before ITB, decreased after (p<0.001). Passive ROM was restricted, with no difference after. Parents reported improvements in activities in daily life (p<0.001), sitting (p<0.001), communication (p<0.001), and fine motor function (p=0.013), but no change in gross motor function. Before ITB, pain and disturbed sleep were reported. There was a reduction in pain (p=0.002) and sleep improved (p=0.004) after ITB.INTERPRETATION After ITB in individuals with dyskinetic CP, improvements were found in sitting, communication, and fine motor skills. There was a reduction in dystonia and muscle tone, and pain and sleep improved.Dyskinetic cerebral palsy (CP) is characterized by involuntary, uncontrolled, recurring, occasionally stereotyped movements. Primitive reflex patterns predominate and muscle tone varies. 1 There are two major patterns of movement disorder: dystonia and choreoathetosis. In a populationbased study of children born between 1991 and 1998 with dyskinetic CP in western Sweden, 39 out of 48 children were predominantly dystonic and there were also signs of spasticity in 33 out of 48.2 Primitive reflexes were found in 43 out of 48, with the asymmetric tonic neck reflex being the most prevalent. Most children with dyskinetic CP have a severe motor impairment, often accompanied by other problems, such as intellectual impairment and epilepsy, with increasing occurrence by severity of motor impairment.2 Communication is often hampered: most are without speech and rely on augmentative and alternative communication. However, in a recent study by Monbaliu et al., 3 almost half of the participants were able to communicate with unknown partners. Involuntary movement and primitive reflexes may disturb the use of augmentative and alternative communication, and optimal medical treatment and positioning is consequently vital to facilitate communication.Baclofen, a c-aminobutyric acid agonist, can be used orally and intrathecally to reduce dystonia and spasticity in children with CP, and has been shown to improve ease of care, reduce pain, and to be cost-effective. [4][5][6] The effect on choreoathetosis is seldom described. The continuous administration of baclofen directly into the intrathecal space requires the implant...

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Section: Discussionmentioning

confidence: 99%

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity

Eek

Olsson

Lindh

et al. 2017

Develop Med Child Neuro

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“…10,34,35 Goniometric measurement was selected as it is the most commonly used method to assess hip flexibility in children with CP. The protocol included measuring the child in the supine position.…”

Section: Measurement Protocolmentioning

confidence: 99%

“…A decrease in mean ROM with age may result in decreased mobility. 10 Decreased locomotion has been shown to limit activities of the child and restrict participation in the community. [11][12][13] Stretching is widely used for the treatment and prevention of contractures.…”

Section: Introductionmentioning

confidence: 99%

“…22 These, combined with decreased voluntary muscle strength, balance deficits, and impaired motor control, lead to considerable deterioration of functional skills such as walking, standing, sitting, and transfers. 10 During standing and walking, the adductor muscles and hip flexors tend to adopt a preferential pattern of hip flexion, adduction, and internal rotation, whereas the abductors, extensors, and external rotators are globally weak, poorly controlled, and finally elongated as the opposing musculature becomes contracted. 23 This lower limb walking pattern increases energy expenditure leading to less efficient walking.…”

Section: Introductionmentioning

confidence: 99%

“…These contractures can also be related to progressive changes in the femur and the acetabulum. 10,23,[25][26][27] Hip adduction contractures in children with spastic diplegia GMFCS level III decreases the base of support in standing, and the children require assistance to stand and walk, and demonstrate a scissoring pattern causing problems with foot clearance. 4 Therapists who used standers in their supported standing programs reported benefits on weight-bearing, pressure relief, ROM, muscle strength, psychological wellbeing, and other positive effects.…”

Section: Introductionmentioning

confidence: 99%

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

Macias-Merlo

Bagur-Calafat

Girabent-Farrés

et al. 2015

Pediatric Physical Therapy

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Reliability and validity of assessing lower‐limb muscle architecture of patients with cerebral palsy (CP) using ultrasound: A systematic review

Liu

Ling

et al. 2023

J of Clinical Ultrasound

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AimsTo investigate the reliability, validity, and level of evidence of applying ultrasound in assessing the lower‐limb muscles of patients with cerebral palsy (CP).MethodPublications in Medline, PubMed, Web of Science, and Embase were searched on May 10, 2023, to identify and examine relevant studies investigating the reliability/validity of ultrasound in evaluating the architecture of CP lower‐limb muscles systematically, following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis 2020 guidelines.ResultsOut of 897 records, 9 publications with 111 CP participants aged 3.8–17.0 years were included (8 focused on intra‐rater and inter‐rater reliability, 2 focused on validity, and 4 were with high quality). The ultrasound‐based measurements of muscle thickness (intra‐rater only), muscle length, cross‐sectional area, muscle volume, fascicle length, and pennation angle showed high reliability, with the majority of intraclass correlation coefficient (ICC) values being larger than 0.9. Moderate‐to‐good correlations between ultrasound and magnetic resonance imaging measurements existed in muscle thickness and cross‐sectional area (0.62 ≤ ICC ≤ 0.82).InterpretationGenerally, ultrasound has high reliability and validity in evaluating the CP muscle architecture, but this is mainly supported by moderate and limited levels of evidence. More high‐quality future studies are needed.

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Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study

Cited by 121 publications

References 27 publications

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity

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

Reliability and validity of assessing lower‐limb muscle architecture of patients with cerebral palsy (CP) using ultrasound: A systematic review

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