Upper‐limb contracture development in children with cerebral palsy: a population‐based study

Abstract

In a population-based sample of 771 children with cerebral palsy, 34% developed an upper-limb contracture. Contracture development started at preschool age. The first affected movements were wrist extension and supination. Passive range of motion decreased with age. High Manual Ability Classification System level was the most important predictor of contractures.

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“…Spasticity of the calf muscles peaks at four years of age and declines thereafter until the age of twelve [53]. However, the reduced passive range of motion (pROM) involving alterations in the visco-elastic properties of muscles, that many children with CP develop worsens continuously throughout childhood and adolescence, becoming more evident during puberty [54,55], a process referred to as contracture development [56,57]. Approximately one third of children with CP develop contractures in the arms [57].…”

“…However, the reduced passive range of motion (pROM) involving alterations in the visco-elastic properties of muscles, that many children with CP develop worsens continuously throughout childhood and adolescence, becoming more evident during puberty [54,55], a process referred to as contracture development [56,57]. Approximately one third of children with CP develop contractures in the arms [57]. The passive stiffnes, secondary to an upper motor neuron lesion [58][59][60] is altered in both plantar flexors and forearm muscles [44].…”

“…One-third of children with CP will develop an arm contracture [57]. Muscle contractures develop continuously throughout childhood and adolescence in these children, although more rapidly during puberty [54,55].…”

“…Muscle contractures develop continuously throughout childhood and adolescence in these children, although more rapidly during puberty [54,55]. The MACS level is the strongest predictor of contracture formation in the arm, with children at MACS level V exhibiting a 17-fold higher risk of such development than those of MACS level I [57]. The various explanations proposed include a mismatch between bone and muscle growth, alterations in neural activation, mechanotransduction, tensional homeostasis, micro-vascularization, genetics and epigenetics [100].…”

Contracture formation in the upper limb in cerebral palsy starts early

“…In a population‐based registry study of 771 children with CP, Hedberg‐Graff et al . investigated longitudinal development of the passive range of motion in the upper limb and correlated it to CP type, and ambulatory (Gross Motor Function Classification System [GMFCS]) and manual ability (Manual Ability Classification System [MACS]).…”