Frontal Plane Motion of the Pelvis and Hip during Gait Stance Discriminates Children with Diplegia Levels I and II of the GMFCS

ISRN Pediatrics ◽

10.5402/2012/163039 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Renata Noce Kirkwood ◽

Rosa de Lourdes Lima Dias Franco ◽

Sheyla Cavalcanti Furtado ◽

Ana Maria Forti Barela ◽

Kevin John Deluzio ◽

...

Keyword(s):

Cerebral Palsy ◽

Stance Phase ◽

Angular Displacement ◽

Frontal Plane ◽

Plane Motion ◽

Pelvic Obliquity ◽

Rehabilitation Programs ◽

Level Ii ◽

Level I ◽

Gmfcs Level

Objective. To determine if gait waveform could discriminate children with diplegic cerebral palsy of the GMFCS levels I and II. Patients. Twenty-two children with diplegia, 11 classified as level I and 11 as level II of the GMFCS, aged 7 to 12 years. Methods. Gait kinematics included angular displacement of the pelvis and lower limb joints during the stance phase. Principal components (PCs) analyses followed by discriminant analysis were conducted. Results. PC1s of the pelvis and hip in the frontal plane differ significantly between groups and captured 80.5% and 86.1% of the variance, respectively. PC1s captured the magnitude of the pelvic obliquity and hip adduction angle during the stance phase. Children GMFCS level II walked with reduced pelvic obliquity and hip adduction angles, and these variables could discriminate the groups with a cross-validation of 95.5%. Conclusion. Reduced pelvic obliquity and hip adduction were observed between children GMFCS level II compared to level I. These results could help the classification process of mild-to-moderate children with diplegia. In addition, it highlights the importance of rehabilitation programs designed to improve pelvic and hip mobility in the frontal plane of diplegic cerebral palsy children level II of the GMFCS.

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Test–Retest Reliability and Construct Validity of the German Translation of the Gait Outcome Assessment List (GOAL) Questionnaire for Children with Ambulatory Cerebral Palsy

Neuropediatrics ◽

10.1055/s-0040-1722688 ◽

2021 ◽

Author(s):

Michaela V. Bonfert ◽

Evelyn Jelesch ◽

A. Sebastian Schroeder ◽

Julia Hartmann ◽

Helene Koenig ◽

...

Keyword(s):

Cerebral Palsy ◽

Children And Adolescents ◽

Motor Function ◽

Related Function ◽

Retest Reliability ◽

Level Ii ◽

Children With Cerebral Palsy ◽

Level I ◽

Test Retest Reliability ◽

Gmfcs Level

AbstractThe Gait Outcome Assessment List (GOAL) is a patient or caregiver-reported assessment of gait-related function across different domains of the International Classification of Functioning, Disability, and Health (ICF) developed for ambulant children with cerebral palsy (CP). So far, the questionnaire is only available in English. The aim of this study was to translate the GOAL into German and to evaluate its reliability and validity by studying the association between GOAL scores and gross motor function as categorized by the gross motor function classification system (GMFCS) in children with cerebral palsy (CP). The GOAL was administered to primary caregivers of n = 91 children and adolescents with CP (n = 32, GMFCS levels I; n = 27, GMFCS level II; and n = 32, GMFCS level III) and n = 15 patients were capable of independently completing the whole questionnaire (GMFCS level I). For assessing test–retest reliability, the questionnaire was completed for a second time 2 weeks after the first by the caregivers of n = 36 patients. Mean total GOAL scores decreased significantly with increasing GMFCS levels with scores of 71 (95% confidence interval [CI]: 66.90–74.77) for GMFCS level I, 56 (95% CI: 50.98–61.86) for GMFCS level II, and 45 (95% CI: 40.58–48.48) for GMFCS level III, respectively. In three out of seven domains, caregivers rated their children significantly lower than children rated themselves. The test–retest reliability was excellent as was internal consistency given the GOAL total score. The German GOAL may serve as a much needed patient-reported outcome measure of gait-related function in ambulant children and adolescents with CP.

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Change in popliteal angle and hamstrings spasticity during childhood in ambulant children with spastic bilateral cerebral palsy. A register-based cohort study

BMC Pediatrics ◽

10.1186/s12887-019-1891-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Merete Aarsland Fosdahl ◽

Reidun Jahnsen ◽

Are Hugo Pripp ◽

Inger Holm

Keyword(s):

Cerebral Palsy ◽

Cohort Study ◽

Level Ii ◽

Modified Ashworth Scale ◽

Significant Difference ◽

Second Year ◽

Level I ◽

Ashworth Scale ◽

Gmfcs Level

Abstract Background Muscle contractures are developing during childhood and may cause extensive problems in gait and every day functioning in children with cerebral palsy (CP). The aim of the present study was to evaluate how the popliteal angle (PA) and hamstrings spasticity change during childhood in walking children with spastic bilateral CP. Methods The present study was a longitudinal register-based cohort study including 419 children (1–15 years of age) with spastic bilateral CP, gross motor function classification system (GMFCS) level I, II and III included in the Norwegian CP Follow-up Program (CPOP). From 2006 to 2018 a total of 2193 tests were performed. The children were tested by trained physiotherapists yearly or every second year, depending on GMFCS level and age. The PA and the hamstrings spasticity (Modified Ashworth scale (MAS)) were measured at every time point. Both legs were included in the analysis. Results There was an increase in PA with age for all three GMFCS levels with significant differences between the levels from 1 up to 8 years of age. At the age of 10 years there was no significant difference between GMFCS level II and III. At the age of 14 years all three GMFCS levels had a mean PA above 40° and there were no significant differences between the groups. The hamstrings spasticity scores for all the three GMFCS levels were at the lower end of the MAS (mean < 1+), however they were significantly different from each other until 8 years of age. The spasticity increased the first four years in all three GMFCS levels, thereafter the level I and II slightly increased, and level III slightly decreased, until the age of 15 years. Conclusion The present study showed an increasing PA during childhood. There were significantly different PAs between GMFCS level I, II and III up to 8 years of age. At the age of 14 years all levels showed a PA above 40°. The spasticity increased up to 4 years of age, but all the spasticity scores were at the lower end of the MAS during childhood.

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Validation of a Model of Gross Motor Function for Children With Cerebral Palsy

Physical Therapy ◽

10.1093/ptj/80.10.974 ◽

2000 ◽

Vol 80 (10) ◽

pp. 974-985 ◽

Cited By ~ 501

Author(s):

Robert J Palisano ◽

Steven E Hanna ◽

Peter L Rosenbaum ◽

Dianne J Russell ◽

Stephen D Walter ◽

...

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Gross Motor ◽

Gross Motor Function ◽

Rehabilitation Centers ◽

Level Ii ◽

Children With Cerebral Palsy ◽

Stratified Sample ◽

Level I ◽

Gmfcs Level

Abstract Background and Purpose. Development of gross motor function in children with cerebral palsy (CP) has not been documented. The purposes of this study were to examine a model of gross motor function in children with CP and to apply the model to construct gross motor function curves for each of the 5 levels of the Gross Motor Function Classification System (GMFCS). Subjects. A stratified sample of 586 children with CP, 1 to 12 years of age, who reside in Ontario, Canada, and are known to rehabilitation centers participated. Methods. Subjects were classified using the GMFCS, and gross motor function was measured with the Gross Motor Function Measure (GMFM). Four models were examined to construct curves that described the nonlinear relationship between age and gross motor function. Results. The model in which both the limit parameter (maximum GMFM score) and the rate parameter (rate at which the maximum GMFM score is approached) vary for each GMFCS level explained 83% of the variation in GMFM scores. The predicted maximum GMFM scores differed among the 5 curves (level I=96.8, level II=89.3, level III=61.3, level IV=36.1, and level V=12.9). The rate at which children at level II approached their maximum GMFM score was slower than the rates for levels I and III. The correlation between GMFCS levels and GMFM scores was −.91. Logistic regression, used to estimate the probability that children with CP are able to achieve gross motor milestones based on their GMFM total scores, suggests that distinctions between GMFCS levels are clinically meaningful. Conclusion and Discussion. Classification of children with CP based on functional abilities and limitations is predictive of gross motor function, whereas age alone is a poor predictor. Evaluation of gross motor function of children with CP by comparison with children of the same age and GMFCS level has implications for decision making and interpretation of intervention outcomes.

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Coactivation During Dynamometry Testing in Adolescents With Spastic Cerebral Palsy

Physical Therapy ◽

10.2522/ptj.20140448 ◽

2016 ◽

Vol 96 (9) ◽

pp. 1438-1447 ◽

Cited By ~ 4

Author(s):

Maaike M. Eken ◽

Annet J. Dallmeijer ◽

Caroline A.M. Doorenbosch ◽

Hurnet Dekkers ◽

Jules G. Becher ◽

...

Keyword(s):

Cerebral Palsy ◽

Muscle Fatigue ◽

Knee Extensor ◽

Load Level ◽

Isometric Contractions ◽

Level Ii ◽

Knee Extensor Strength ◽

Level I ◽

Age Range ◽

Gmfcs Level

Abstract Background Dynamometry has been used extensively to measure knee extensor strength in individuals with cerebral palsy (CP). However, increased coactivation can lead to underestimation of knee extensor strength and, therefore, reduce validity of strength measurements. It is yet unknown to what extent coactivation occurs during dynamometry testing and whether coactivation is influenced by severity of CP, load levels, and muscle fatigue. Objectives The aims of this study were: (1) to investigate coactivation in adolescents with and without CP during dynamometer tests and (2) to assess the effect of Gross Motor Function Classification System (GMFCS) level, load level, and muscle fatigue on coactivation. Design A cross-sectional observational design was used. Method Sixteen adolescents with CP (GMFCS levels I and II: n=10/6; age range=13–19 years) and 15 adolescents without CP (n=15; age range=12–19 years) performed maximal isometric contractions (maximal voluntary torque [MVT]) and a series of submaximal dynamic contractions at low (±65% MVT), medium (±75% MVT), and high (±85% MVT) loads until fatigue. A coactivation index (CAI) was calculated for each contraction from surface electromyography recordings from the quadriceps and hamstring muscles. Results Adolescents with CP classified in GMFCS level II showed significantly higher CAI values than adolescents classified in GMFCS level I and those without CP during maximal and submaximal contractions. No differences were observed among load levels. During the series of fatiguing submaximal contractions, CAI remained constant in both the CP group and the group with typical development (TD), except for adolescents with TD at the low-load condition, which showed a significant decrease. Limitations Electromyography tracings were normalized to amplitudes during maximal isometric contractions, whereas previous studies suggested that these types of contractions could not be reliably determined in the CP population. Conclusion Coactivation was higher in adolescents with CP classified in GMFCS level II than in adolescents with TD and those with CP in GMFCS level I at different load levels. Within all groups, coactivation was independent of load level and fatigue. In individuals with CP, coactivation can lead to an underestimation of agonist muscle strength, which should be taken into account while interpreting the results of both maximal and submaximal dynamometer tests.

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Reliability and Validity of Data for 2 Newly Developed Shuttle Run Tests in Children With Cerebral Palsy

Physical Therapy ◽

10.1093/ptj/86.8.1107 ◽

2006 ◽

Vol 86 (8) ◽

pp. 1107-1117 ◽

Cited By ~ 76

Author(s):

Olaf Verschuren ◽

Tim Takken ◽

Marjolijn Ketelaar ◽

Jan Willem Gorter ◽

Paul JM Helders

Keyword(s):

Cerebral Palsy ◽

Intraclass Correlation ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Treadmill Test ◽

Children With Cerebral Palsy ◽

Level I ◽

Test Retest Reliability ◽

Shuttle Run ◽

Gmfcs Level

Abstract Background and Purpose. The purpose of this study was to examine the reliability and validity of data obtained with 2 newly developed shuttle run tests (SRT-I and SRT-II) to measure aerobic power in children with cerebral palsy (CP) who were classified at level I or II on the Gross Motor Function Classification System (GMFCS). The SRT-I was developed for children at GMFCS level I, and the SRT-II was developed for children at GMFCS level II. Subjects. Twenty-five children and adolescents with CP (10 female, 15 male; mean age=11.9 years, SD=2.9), classified at GMFCS level I (n=14) or level II (n=11), participated in the study. Methods. To assess test-retest reliability of data for the 10-m shuttle run tests, the subjects performed the same test within 2 weeks. To examine validity, the shuttle run tests were compared with a GMFCS level–based treadmill test designed to measure peak oxygen uptake. Results. Statistical analyses revealed test-retest reliability for exercise time (number of levels completed) (intraclass correlation coefficients of .97 for the SRT-I and .99 for the SRT-II) and reliability for peak heart rate attained during the final level (intraclass correlation coefficients of .87 for the SRT-I and .94 for the SRT-II). High correlations were found for the relationship between data for both shuttle run tests and data for the treadmill test (r=.96 for both). Discussion and Conclusion. The results suggest that both 10-m shuttle run tests yield reliable and valid data. Moreover, the shuttle run tests have advantages over a treadmill test for children with CP who are able to walk and run (GMFCS level I or II). [Verschuren O, Takken T, Ketelaar M, et al. Reliability and validity of data for 2 newly developed shuttle run tests in children with cerebral palsy. Phys Ther. 2006;86:1107–1117.]

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Reference Values for Aerobic Fitness in Children, Adolescents, and Young Adults Who Have Cerebral Palsy and Are Ambulatory

Physical Therapy ◽

10.2522/ptj.20090318 ◽

2010 ◽

Vol 90 (8) ◽

pp. 1148-1156 ◽

Cited By ~ 28

Author(s):

Olaf Verschuren ◽

Manon Bloemen ◽

Cas Kruitwagen ◽

Tim Takken

Keyword(s):

Young Adults ◽

Cerebral Palsy ◽

Young People ◽

Reference Values ◽

Aerobic Fitness ◽

Adolescents And Young Adults ◽

Cross Sectional ◽

Level I ◽

Shuttle Run ◽

Gmfcs Level

BackgroundVery few objective data exist regarding aerobic performance in young people with cerebral palsy (CP). The characterization of aerobic fitness could provide baseline and outcome measures for the rehabilitation of young people with CP.ObjectiveThe objective of this study was to provide reference values for aerobic fitness in a group of children, adolescents, and young adults who had CP and who were classified at Gross Motor Function Classification System (GMFCS) level I or II. Data were collected with 10-m shuttle run tests.DesignThis investigation was a cross-sectional observational study conducted between August 2008 and June 2009.MethodsReference values were established using data from a total of 306 children, adolescents, and young adults who had CP, who were 6 to 20 years old, and who were recruited from 26 rehabilitation centers in the Netherlands, Switzerland, Australia, Canada, and the United States. A total of 211 participants were classified at GMFCS level I (mean age=12.2 years, SD=3.0), and 95 were classified at GMFCS level II (mean age=12.4 years, SD=3.2); 181 were male, and 125 were female. Aerobic fitness was reflected by the level achieved on the 10-m shuttle run tests.ResultsOn the basis of a total of 306 assessments from the 10-m shuttle run tests, 4 reference curves were created.LimitationsThe limitation of this study is the cross-sectional nature of the design.ConclusionsThis study provided height-related reference values for aerobic fitness in children, adolescents, and young adults who had CP, who were 6 to 20 years old, and who were classified at GMFCS level I or II. Generalized additive models for location, scale, and shape were used to construct centile curves. These curves are clinically relevant and provide a user-friendly method for the prediction of aerobic fitness in young people with CP.

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Inclusion of children with cerebral palsy in basic education

Fisioterapia e Pesquisa ◽

10.1590/1809-2950/428210114 ◽

2014 ◽

Vol 21 (1) ◽

pp. 40-46

Author(s):

Geovana Sôffa Rézio ◽

Cibelle Kayenne Martins Roberto Formiga

Keyword(s):

Cerebral Palsy ◽

School Environment ◽

Basic Education ◽

Gross Motor ◽

Rehabilitation Centers ◽

School Participation ◽

Children With Cerebral Palsy ◽

Level I ◽

Function Assessment ◽

Gmfcs Level

The aim of the study was to analyze the inclusion of children with cerebral palsy in elementary schools. The sample consisted of 31 children between 1 and 11 years old, with a mean of 5 years and 2 months, coming from 2 rehabilitation centers and their leaders and teachers. As for functionality, 71% are Gross Motor Function Classification System (GMFCS) level I, 51.6% are diplegic and 58.1% had cerebral palsy during the prenatal stage. Regarding economic classification, 54.8% of the families were in class C. A neurological evaluation form was applied. A gross motor evaluation using the GMFCS; a socioeconomic assessment using the Brazilian Criteria for Economic Classification and the School Function Assessment were done. The results revealed that these children perform their activities in all aspects of the school participation, although they require constant supervision, moderate assistance and minimal adaptation. These results may be useful to better adapt the school environment, for a better targeting of assistance provided and to plan clinical interventions with these children.

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Association between Pelvic Obliquity and Scoliosis, Hip Displacement and Asymmetric Hip Abduction in Children with Cerebral Palsy. A Cross-Sectional Registry Study

10.21203/rs.3.rs-24942/v1 ◽

2020 ◽

Author(s):

Gunnar Hägglund

Keyword(s):

Cerebral Palsy ◽

Strong Association ◽

Pelvic Obliquity ◽

Cross Sectional ◽

Hip Displacement ◽

Pelvic Radiographs ◽

High Side ◽

Hip Abduction ◽

Chi Squared ◽

Gmfcs Level

Abstract Background Pelvic obliquity (PO) is common in individuals with cerebral palsy (CP). I analysed the prevalence of PO in a population of children with CP and its associations with scoliosis, hip displacement and asymmetric range of hip abduction.Methods Over a 5-year period all pelvic radiographs from the Swedish surveillance programme for CP and the recorded data for scoliosis and hip abduction in children from southern Sweden at Gross Motor Function Classification System (GMFCS) levels II–V were analysed. PO and hip displacement calculated as migration percentage (MP) were measured on supine pelvic radiographs and compared with side difference in hip abduction. Statistical analyses comprised chi-squared testing and binominal confidence intervals.Results In total, 337 children were analysed, of whom 79 had a PO of ≥5°. The proportion of children with PO increased from 16% in GMFCS level II to 34% in level V. Scoliosis combined with PO was reported in 38 children, of whom 34 (89%, 95% confidence interval [CI] 80–99%) had the convexity opposite the high side of the PO. Asymmetric abduction with PO was reported in 45 children, of whom 40 (89%, CI 79–99%) had reduced abduction on the high side of the PO. Asymmetric MP of ≥5% with PO was seen in 62 children, of whom 50 had higher MP on the high side of the PO (81%, CI 71–90%). Children in GMFCS levels II–IV more often had isolated infra-pelvic association with PO (47% versus 19% in GMFCS V, P = 0.025), while combined supra- and infrapelvic association was more common in GMFCS level V (65% versus 30% in GMFCS II–IV, P = 0.004). Isolated infrapelvic or no association was seen in 74% of children ≤10 years of age while 76% of children ≥11 years old had suprapelvic or combined supra- and infrapelvic association with PO (P = 0.0001).Conclusions There was a strong association between the high side of the PO and the side of scoliosis, highest MP and lowest range of abduction when PO was measured in supine position. PO was more often associated with infrapelvic factors. PO was seen in young children indicating the need for early awareness of this complication.

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Self-versus Proxy-Reported Pain in Children with Cerebral Palsy: A Population-Based Registry Study of 3783 Children

Journal of Primary Care & Community Health ◽

10.1177/2150132720911523 ◽

2020 ◽

Vol 11 ◽

pp. 215013272091152 ◽

Cited By ~ 2

Author(s):

Gunnar Hägglund ◽

Amanda Burman-Rimstedt ◽

Tomasz Czuba ◽

Ann I. Alriksson-Schmidt

Keyword(s):

Logistic Regression ◽

Cerebral Palsy ◽

Classification System ◽

Population Based ◽

Registry Study ◽

Cross Sectional ◽

Marginal Effects ◽

Level I ◽

Average Marginal Effects ◽

Gmfcs Level

Objective: To assess how the prevalence of pain in a population-based sample of children and adolescents with cerebral palsy (CP) differ based on self- or proxy reporting. Methods: This cross-sectional registry study included 3783 children (58% boys), 1 to 18 years old, enrolled in the Swedish follow-up program for CP. Logistic regression was used to regress source of reporting (self or proxy) on the presence of general pain adjusted for age, sex, Gross Motor Function Classification System (GMFCS), and Communication Function Classification System (CFCS) levels, including marginal effects between source of reporting and adjusted covariates. Results: The pain item was self-reported in 45%, proxy-reported in 51%, and information was missing in 3%. Pain was reported in 44% of those who self-reported and in 41% of those who proxy-reported ( P = .04). The logistic regression showed that the average marginal effects of proxy versus self-reported pain were lower among children at GMFCS level IV (−0.14, 95% CI −0.17 to −0.03) and CFCS level I (−0.09, CI −0.16 to −0.01) and higher at CFCS level III (0.11, CI 0.00-0.22). There were no statistically significant differences in average marginal effects related to age, sex, or the other GMFCS and CFCS levels between proxy and self-reporting. Conclusions: Pain was more often reported by those who self-reported. However, after adjusting for age, sex, CFCS level, and GMFCS level, the proportion of reported pain was almost equal between self and proxy-reporting. Assuming that the self- and proxy-reported groups were not significantly different on relevant factors not controlled for the results indicate that presence of pain is equally reported by children and parents.

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