Developmental Trajectories and Reference Percentiles for Range of Motion, Endurance, and Muscle Strength of Children With Cerebral Palsy

Abstract

Background Children with cerebral palsy (CP) frequently present with secondary impairments in spinal alignment and extremity range of motion, endurance for activity, and muscle strength. Creation of developmental trajectories for these impairments will help guide clinical decision-making. Objective For children in each level of the Gross Motor Function Classification System (GMFCS) this study aimed to: (1) create longitudinal developmental trajectories for range of motion (Spinal Alignment and Range of Motion Measures [SAROMM]), endurance (Early Activity Scale for Endurance [EASE]), and functional strength (Functional Strength Assessment [FSA]); and (2) develop age-specific reference percentiles and amount of change typical over 1 year for these outcomes. Design This study used a longitudinal cohort design. Methods Participants comprised 708 children with CP across GMFCS levels, aged 18 months up to the 12th birthday, and their families. In 2 to 5 assessments every 6 months over 2 years, trained therapists performed the SAROMM and FSA, and parents completed the EASE questionnaire. For children in each GMFCS level, longitudinal trajectories using linear and nonlinear mixed-effects models from all visits, and reference percentiles using quantile regression from the first, 12-month, and 24-month visits were created for each measure. Results Longitudinal trajectories and percentile graphs for SAROMM, FSA, and EASE were primarily linear, with different performance scores among GMFCS levels. There was much variability in both longitudinal trajectories and percentiles within GMFCS levels. Limitations Limitations included a convenience sample and varying numbers of participants assessed at each visit. Conclusions The longitudinal trajectories and percentile graphs have application for monitoring how children with CP are performing and changing over time compared with other children with CP. The resources presented allow therapists and families to collaboratively make decisions about intervention activities targeted to children's unique needs.

The external validity of a novel contract‐relax stretching technique on knee flexor range of motion

“…As the field‐based SRC technique was completed without partner assistance and with the muscle contractions performed at shorter muscle lengths, the modified technique can be considered to be a more practical, yet equally effective, stretching paradigm. However, it was decided in the present study to confirm the ecological validity of the technique in a healthy population, prior to use in clinical populations such as those with diabetes, cerebral palsy, stroke, arthritis, or in elderly individuals . Nonetheless, as similar improvements in ROM were achieved as with CR stretching (ie, current clinical “gold standard”) but without the significant practical limitations that restrict the use of CR stretching in clinical and other (eg, athletic) environments, these findings likely have important implications for clinical exercise prescription in populations where ROM is often compromised.…”

“…Lower‐limb joint ranges of motion (ROM) and passive resistance to stretch during joint rotations (indicative of tissue stiffness) are important functional parameters that influence physical function and muscle strain injury risk and are compromised in a range of conditions including diabetes, cerebral palsy, stroke, aging, and arthritis . While static muscle stretching is both easily applied and commonly used in both clinical and athletic environments to increase ROM, proprioceptive neuromuscular facilitation (PNF) stretching techniques are often reported as being more effective for promoting both acute and chronic improvements .…”

Study protocol: functioning curves and trajectories for children and adolescents with cerebral palsy in Brazil – PartiCipa Brazil

“…These motor capacity curves help parents and healthcare professionals to understand patterns of motor development of children with CP, according to their functional level and age, as well as to predict their potential for motor acquisition and functional independence [ 11 ]. Targeting improved clinical applicability, centile reference curves based on the 66-item Gross Motor Function Measure (GMFM-66) were constructed by Hanna et al (2008) [ 12 ]. These curves are widely used to guide clinical decision-making in Brazil, but all these tools were constructed based on the development of children with CP, aged 1 to 13 years, served by 19 publicly-funded children’s rehabilitation services in Ontario, Canada [ 11 , 13 ].…”

“…Subsequently, Hanna et al (2009) followed a sample of the study participants into adolescence and young adulthood [ 14 ]. Longitudinal trajectories and reference centiles were also developed in Canada and United States for several other outcomes, such as range of motion (Spinal Alignment and Range of Motion Measures - SAROMM), endurance (Early Activity Scale for Endurance - EASE), and strength (Functional Strength Assessment - FSA) [ 12 ] in young children with CP.…”

Toward Evaluation of The Subjective Experience of A General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability

“…[3] Current gait-therapeutic options for children with CP are insufficient to provide consistent and adequate stretching and strengthening of the muscles that cause walking disorders. [4,5] Targeting key muscles in the ankle is critical to gait remediation, [6][7][8][9] but treatment best practice often requires extensive bracing or complex constraint mechanisms. [10] As a result, intervening to stretch and strengthen key muscle groups currently requires time-intensive, in-clinic therapies as well as an intensive home exercise regimen to provide an optimal program for improving gait.…”