scholarly journals Muscle strength does not explain standing ability in children with bilateral spastic cerebral palsy: a cross sectional descriptive study

BMC Neurology ◽  
2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Cecilia Lidbeck ◽  
Kristina Tedroff ◽  
Åsa Bartonek
Keyword(s):  
Cerebral Palsy ◽  
Muscle Strength ◽  
Descriptive Study ◽  
Spastic Cerebral Palsy ◽  
Cross Sectional

scholarly journals Upper Extremity Muscle Strength in Children With Unilateral Spastic Cerebral Palsy: A Bilateral Problem?

2020 ◽  
Vol 100 (12) ◽  
pp. 2205-2216
Author(s):  
Koen J F M Dekkers ◽  
Eugene A A Rameckers ◽  
Rob J E M Smeets ◽  
Andrew M Gordon ◽  
Lucianne A W M Speth ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Muscle Strength ◽  
Elbow Flexion ◽  
Cross Sectional Study ◽  
Spastic Cerebral Palsy ◽  
Pinch Strength ◽  
Wrist Flexion ◽  
Cross Sectional ◽  
Flexion Extension ◽  
Arm Strength

Abstract Objective The objective was to investigate whether muscle strength in the nonaffected and affected upper extremities (UEs) in children (7–12 years) with unilateral spastic cerebral palsy (USCP) differs from that in children with typical development (TD). Methods A cross-sectional study design was used. Isometric arm strength (wrist flexion, wrist extension with flexed and extended fingers, elbow flexion/extension) was assessed in 72 children (mean age = 9.3 [SD = 1.9] years) with USCP, and isometric grip/pinch strength was assessed in 86 children (mean age = 9.3 [SD = 1.8] years) with USCP. Arm/grip/pinch strength was assessed in 120 children (mean age = 9.5 [SD = 1.7] years) with TD. Arm strength was measured with a hand-held dynamometer, and grip/pinch strength was measured with a calibrated, modified (digitized) grip dynamometer and a pinch meter. The nonaffected UE of children with USCP was compared with the preferred UE of children with TD because both sides represent the preferred UE. The affected UE was compared with the nonpreferred UE of children with TD, as both sides represent the nonpreferred UE. Results In all measurements except for grip strength of the preferred UE, children with USCP were weaker than children with TD. Conclusions In children with USCP, muscle strength weakness exists in both UEs. Impact When unimanual or bimanual ability limitations are present in children with unilateral cerebral palsy, investigation of the muscle strength of the nonaffected UE should be part of the assessment.

scholarly journals Development of Lower Extremity Strength in Ambulatory Children With Bilateral Spastic Cerebral Palsy in Comparison With Typically Developing Controls Using Absolute and Normalized to Body Weight Force Values

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicolaos Darras ◽  
Eirini Nikaina ◽  
Magda Tziomaki ◽  
Georgios Gkrimas ◽  
Antigone Papavasiliou ◽  
...  
Keyword(s):  
Body Weight ◽  
Cerebral Palsy ◽  
Muscle Strength ◽  
Lower Limb ◽  
Age Groups ◽  
Knee Extensors ◽  
Spastic Cerebral Palsy ◽  
Typically Developing ◽  
Antagonist Muscles ◽  
Muscle Groups

This cross-sectional study aimed to examine the development of lower limb voluntary strength in 160 ambulatory patients with bilateral spastic cerebral palsy (CP) (106 diplegics/54 quadriplegics) and 86 typically developing (TD) controls, aged 7–16 years. Handheld dynamometry was used to measure isometric strength of seven muscle groups (hip adductors and abductors, hip extensors and flexors, knee extensors and flexors, and ankle dorsiflexors); absolute force (AF) values in pounds were collected, which were then normalized to body weight (NF). AF values increased with increasing age (p < 0.001 for all muscle groups), whereas NF values decreased through adolescence (p < 0.001 for all muscle groups except for hip abduction where p = 0.022), indicating that increases in weight through adolescence led to decreases in relative force. Both AF and NF values were significantly greater in TD subjects when compared with children with CP in all muscle and all age groups (p < 0.001). Diplegics and quadriplegics demonstrated consistently lower force values than TD subjects for all muscle groups, except for the hip extensors where TD children had similar values with diplegics (p = 0.726) but higher than quadriplegics (p = 0.001). Diplegic patients also exhibited higher values than quadriplegics in all muscles, except for the knee extensors where their difference was only indicative (p = 0.056). The conversion of CP subjects' force values as a percentage of the TD subjects' mean value revealed a pattern of significant muscle strength imbalance between the CP antagonist muscles, documented from the following deficit differences for the CP muscle couples: (hip extensors 13%) / (hip flexors 32%), (adductors 27%) / (abductors 52%), and (knee extensors 37%) / (knee flexors 53%). This pattern was evident in all age groups. Similarly, significant force deficiencies were identified in GMFCS III/IV patients when compared with TD children and GMFCS I/II patients. In this study, we demonstrated that children and adolescents with bilateral CP exhibited lower strength values in lower limb muscles when compared with their TD counterparts. This difference was more prevalent in quadriplegic patients and those with a more severe impairment. An important pattern of muscle strength imbalance between the antagonist muscles of the CP subjects was revealed.

Effect of floor reaction ankle–foot orthosis on crouch gait in patients with cerebral palsy: What can be expected?

2017 ◽  
Vol 42 (3) ◽  
pp. 245-253 ◽  
Author(s):  
Harald Böhm ◽  
Hösl Matthias ◽  
Frank Braatz ◽  
Leonhard Döderlein
Keyword(s):  
Cerebral Palsy ◽  
Standard Deviation ◽  
Knee Extension ◽  
Spastic Cerebral Palsy ◽  
Foot Orthoses ◽  
Cross Sectional ◽  
Positive Effects ◽  
Foot Progression Angle ◽  
Ankle Foot Orthoses ◽  
Crouch Gait

Background: Floor reaction ankle–foot orthoses are commonly prescribed to improve knee extension of children with cerebral palsy having crouch gait. Their effectiveness is debated. Therefore, the objective of this study is to optimize current prescription criteria for the improvement of crouch gait. Study design: Cross-sectional interventional study. Methods: A total of 22 patients with bilateral spastic cerebral palsy, between 6 and 17 years, Gross Motor Function Classification System II–IV participated in this study. Instrumented gait analysis was done under three conditions: barefoot, shoed, and with orthotics. Patients were divided into two groups: good and non-responders with more and less than 8.8° improvement of knee extension during walking, respectively. A multiple predictor analysis was done on parameters that were different between groups. Results: In total, 12 of 22 patients showed good response in knee extension with a mean change of 17° (standard deviation = 5°). Good responders showed a significantly smaller walking velocity, knee extension strength, ankle plantarflexion strength, and greater external foot progression angle compared to non-responders. Foot progression angle together with ankle plantarflexion strength explained 37% of the variance in improvement of knee extension. Conclusion: With appropriate patient selection, an improvement of crouch gait by ankle–foot orthoses of 17° (standard deviation = 5°) can be expected. Patients with slow velocity, weak plantarflexors, and external foot progression benefit most. Joint contractures were no contraindications. Clinical relevance This study showed that gait in patients with low functional level benefit most from ankle–foot orthoses. Unlike in patients with higher functional status, contractures of hip, knee, and ankle did not reduce the positive effects on gait. The suggested prescription criteria may help to better select appropriate patients for orthotics.

scholarly journals The Contribution of Decreased Muscle Size to Muscle Weakness in Children With Spastic Cerebral Palsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Britta Hanssen ◽  
Nicky Peeters ◽  
Ines Vandekerckhove ◽  
Nathalie De Beukelaer ◽  
Lynn Bar-On ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Muscle Weakness ◽  
Plantar Flexion ◽  
Joint Torque ◽  
Muscle Size ◽  
Spastic Cerebral Palsy ◽  
Regression Equations ◽  
Plantar Flexors ◽  
Cross Sectional ◽  
Large Variability

Muscle weakness is a common clinical symptom in children with spastic cerebral palsy (SCP). It is caused by impaired neural ability and altered intrinsic capacity of the muscles. To define the contribution of decreased muscle size to muscle weakness, two cohorts were recruited in this cross-sectional investigation: 53 children with SCP [median age, 8.2 (IQR, 4.1) years, 19/34 uni/bilateral] and 31 children with a typical development (TD) [median age, 9.7 (IQR, 2.9) years]. Muscle volume (MV) and muscle belly length for m. rectus femoris, semitendinosus, gastrocnemius medialis, and tibialis anterior were defined from three-dimensional freehand ultrasound acquisitions. A fixed dynamometer was used to assess maximal voluntary isometric contractions for knee extension, knee flexion, plantar flexion, and dorsiflexion from which maximal joint torque (MJT) was calculated. Selective motor control (SMC) was assessed on a 5-point scale for the children with SCP. First, the anthropometrics, strength, and muscle size parameters were compared between the cohorts. Significant differences for all muscle size and strength parameters were found (p ≤ 0.003), except for joint torque per MV for the plantar flexors. Secondly, the associations of anthropometrics, muscle size, gross motor function classification system (GMFCS) level, and SMC with MJT were investigated using univariate and stepwise multiple linear regressions. The associations of MJT with growth-related parameters like age, weight, and height appeared strongest in the TD cohort, whereas for the SCP cohort, these associations were accompanied by associations with SMC and GMFCS. The stepwise regression models resulted in ranges of explained variance in MJT from 29.3 to 66.3% in the TD cohort and from 16.8 to 60.1% in the SCP cohort. Finally, the MJT deficit observed in the SCP cohort was further investigated using the TD regression equations to estimate norm MJT based on height and potential MJT based on MV. From the total MJT deficit, 22.6–57.3% could be explained by deficits in MV. This investigation confirmed the disproportional decrease in muscle size and muscle strength around the knee and ankle joint in children with SCP, but also highlighted the large variability in the contribution of muscle size to muscle weakness.

scholarly journals Detection of body postures and movements in ambulatory adults with cerebral palsy: a novel and valid measure of physical behaviour

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Everett A. Claridge ◽  
Rita J. G. van den Berg-Emons ◽  
Herwin L. D. Horemans ◽  
Wilma M. A. van der Slot ◽  
Nick van der Stam ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Objective Measure ◽  
Correlation Coefficients ◽  
Criterion Validity ◽  
Spastic Cerebral Palsy ◽  
Relative Time ◽  
Primary Position ◽  
Cross Sectional ◽  
Body Postures ◽  
Physical Behaviour

Abstract Background Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM’s positioning affects validity. Methods In this cross-sectional study, 14 ambulatory adults with CP [9 men; mean (SD) age, 35.4 (13.1) years] performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative [(video time–AM time)/mean time, %] time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng’s tests. Results Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all). Conclusions The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid measurement.

scholarly journals CEREBRAL PALSY;

2014 ◽  
Vol 21 (06) ◽  
pp. 1166-1170
Author(s):  
Naeem Mohammad Mansha ◽  
Sumair Anwar ◽  
Itaat Ullah Khan Afridi ◽  
Shazia Maqbool
Keyword(s):  
Cerebral Palsy ◽  
Developmental Delay ◽  
Postural Balance ◽  
Cross Sectional Study ◽  
Spastic Cerebral Palsy ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Different Types ◽  
The Brain

Background: Cerebral Palsy is a disorder of movement and postural balance due to insult to the brain. The injury to the developing brain may be prenatal, natal or postnatal. The diagnosis is clinical mainly. The spastic Cerebral Palsy is classified into monoplegic, hemiplegic, diplegic, and quadriplegic types. There is a difference in the frequency of these types of Cerebral Palsy in different studies. The patterns of various forms of Cerebral Palsy emerge gradually with a delay in developmental milestones. A spectrum of associated developmental disabilities has been found to be common in these children. Management is through a multi-disciplinary approach. Objectives: To find out the frequency of different types of Cerebral Palsy and degree of associated developmental delay. Methodology: A cross sectional study was carried out for a period of six months (October 1, 2006 to March 31, 2007) at The Children’s Hospital & Institute of Child Health Lahore. 100 Cases diagnosed as Cerebral Palsy on clinical basis were assessed for the type of cerebral palsy and the degree of associated developmental delay. Results: Out of the total 100 patients 54% had quadriplegia, 32% had diplegia, 10% had himiplegia and 4% had monoplegia. The total fifty-four cases of quadriplegic cerebral palsy 54 had developmental delay and amongst them 4 (7%) had mild delay, 16 (30%) had moderate delay while 34 (63%) had severe delay. Amongst the total forty-six other three types of cerebral palsy 12 (26%) had mild delay, 6 (13%) had moderate delay and 28 (61%) had severe delay. The P-value was >0.05. Conclusions: Quadriplegic is the commonest type of CP, associated with the factors (peri-natal more than socio-demographic) and had significant effect on the developmental parameters.

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