Age‐related changes in energy efficiency of gait,activity, and participation in children with cerebral palsy

Aim The aim of this study was to use a prospective longitudinal study to describe age‐related trends in energy efficiency during gait, activity, and participation in ambulatory children with cerebral palsy (CP). Method Gross Motor Function Measure (GMFM), Paediatric Evaluation of Disability Inventory (PEDI), and Lifestyle Assessment Questionnaire‐Cerebral Palsy (LAQ‐CP) scores, and energy efficiency (oxygen cost) during gait were assessed in representative sample of 184 children (112 male; 72 female; mean age 10y 9mo; range 4–16y) with CP. Ninety‐four children had unilateral spastic CP, 84 bilateral spastic CP, and six had other forms of CP. Fifty‐seven were classified as Gross Motor Function Classification System (GMFCS) level I, 91 as level II, 22 as level III, and 14 as level IV). Assessments were carried out on two occasions (visit 1 and visit 2) separated by an interval of 2 years and 7 months. A total of 157 participants returned for reassessment. Results Significant improvements in mean raw scores for GMFM, PEDI, and LAQ‐CP were recorded; however, mean raw oxygen cost deteriorated over time. Age‐related trends revealed gait to be most inefficient at the age of 12 years, but GMFM scores continued to improve until the age of 13 years, and two PEDI subscales to age 14 years, before deteriorating (p<0.05). Baseline score was consistently the single greatest predictor of visit 2 score. Substantial agreement in GMFCS ratings over time was achieved (κ_lw=0.74–0.76). Interpretation These findings have implications in terms of optimal provision and delivery of services for young people with CP to maximize physical capabilities and maintain functional skills into adulthood.     

Self‐care and mobility skills in children with cerebral palsy,related to their manual ability and gross motor function classifications

Aim The aim of this study was to investigate the acquisition of self‐care and mobility skills in children with cerebral palsy (CP) in relation to their manual ability and gross motor function. Method Data from the Pediatric Evaluation of Disability Inventory (PEDI) self‐care and mobility functional skill scales, the Manual Ability Classification System (MACS), and the Gross Motor Function Classification System (GMFCS) were collected from 195 children with CP (73 females, 122 males; mean age 8y 1mo; SD 3y 11mo; range 3–15y); 51% had spastic bilateral CP, 36% spastic unilateral CP, 8% dyskinetic CP, and 3% ataxic CP. The percentage of children classified as MACS levels I to V was 28%, 34%, 17%, 7%, and 14% respectively, and classified as GMFCS levels I to V was 46%, 16%, 15%, 11%, and 12% respectively. Results Children classified as MACS and GMFCS levels I or II scored higher than children in MACS and GMFCS levels III to V on both the self‐care and mobility domains of the PEDI, with significant differences between all classification levels (p<0.001). The stepwise multiple regression analysis verified that MACS was the strongest predictor of self‐care skills (66%) and that GMFCS was the strongest predictor of mobility skills (76%). A strong correlation between age and self‐care ability was found among children classified as MACS level I or II and between age and mobility among children classified as GMFCS level I. Many of these children achieved independence, but at a later age than typically developing children. Children at other MACS and GMFCS levels demonstrated minimal progress with age. Interpretation Knowledge of a child’s MACS and GMFCS level can be useful when discussing expectations of, and goals for, the development of functional skills.     

Development and validation of item sets to improve efficiency of administration of the 66‐item Gross Motor Function Measure in children with cerebral palsy

Aim To develop an algorithmic approach to identify item sets of the 66‐item version of the Gross Motor Function Measure (GMFM‐66) to be administered to individual children, and to examine the validity of the algorithm for obtaining a GMFM‐66 score. Method An algorithmic approach was used to identify item sets of the GMFM‐66 (GMFM‐66‐IS) using data from 95 males and 79 females with cerebral palsy (CP; mean age 14y 7mo, SD 1y 8mo, range 12y 7mo to 17y 8mo). The GMFM‐66‐IS scores were then validated using combined data from three Dutch studies involving 134 males and 92 females with CP (mean age 7y, SD 4y 6mo, range 1y 4mo to 13y 8mo), representing all levels of the Gross Motor Function Classification System. Results The final algorithm contains three decision items from the GMFM‐66 that determine which one of four item sets to administer. The GMFM‐66‐IS has excellent agreement with the full GMFM‐66 both at a single assessment (intraclass correlation coefficient [ICC]=0.994, 95% confidence intervals [CI] 0.993–0.996) and across repeat assessments (ICC=0.92, 95% CI 0.89–0.95). Interpretation The GMFM‐66‐IS is a promising alternative to the full GMFM‐66. Users should be consistent in their choice of measure (GMFM‐66 or GMFM‐66‐IS) on repeat testing and clearly identify which method was used.     

Criterion validity of the GMFM‐66 item set and the GMFM‐66 basal and ceiling approaches for estimating GMFM‐66 scores

Aim

The aim of this study was to compare the accuracy of two abbreviated approaches for estimating Gross Motor Function Measure 66 (GMFM‐66) scores against the full GMFM‐66 and to explore their strengths and limitations.

Method

An existing dataset (n=224) comprising children aged 1 to 13 years (mean age 6y 11mo, SD 4y 6mo; 132 males, 92 females) with cerebral palsy (CP) of all Gross Motor Function Classification System (GMFCS) levels was used to compare the validity of the item set version (GMFM‐66‐IS) and the basal and ceiling version (GMFM‐66‐B&C) with the full GMFM‐66 scores. Follow‐up assessment at 1 year (n=109) allowed evaluation of change scores and accuracy at a single point in time.

Results

The cross‐sectional agreement was excellent for both abbreviated measures (all intraclass correlation coefficients [ICCs] >0.98). When measuring change over time, both the GMFM‐66‐IS and the GMFM‐66‐B&C showed good agreement for children with bilateral CP (ICCs >0.9). However, the GMFM‐66‐IS assessed change over 1 year more accurately than the GMFM‐66‐B&C in children with unilateral CP (ICC=0.89 vs ICC=0.58; 95% confidence intervals do not overlap).

Interpretation

Both approaches for estimating GMFM‐66 scores are accurate at a single point in time. If the primary goal of assessment is to measure change, the full GMFM‐66 should still be regarded as the criterion standard. The GMFM‐66‐IS should be the preferred shortened measure for children with unilateral CP.     

Relation between physical fitness and gross motor capacity in children and adolescents with cerebral palsy

Aim  To examine the relation between physical fitness and gross motor capacity in children with cerebral palsy (CP) who were classified in Gross Motor Function Classification System levels I or II.
Method  In total, 68 children with CP (mean age 12y 1mo, SD 2y 8mo; 44 males, 24 females; 45 classified as having spastic unilateral CP, 23 as having spastic bilateral CP) participated in this study. All participants performed a maximal aerobic exercise test (10m Shuttle Run Test), a short-term muscle power test (Muscle Power Sprint Test), an agility test (10×5m sprint test), and a functional muscle strength test (30s repetition maximum) within 2 weeks. Gross motor capacity was concurrently assessed using dimensions D (standing) and E (walking, running, and jumping) of the 88-item version of the Gross Motor Function Measure (GMFM).
Results  No relation between aerobic capacity, body mass index, and dimensions D and E of the GMFM was found. The correlations between short-term muscle power, agility, functional muscle strength, and dimensions D and E of the GMFM were moderate to high ( r ∼0.6–0.7).
Interpretation  The relations found between short-term muscle power, agility, functional muscle strength, and gross motor capacity indicate the importance of these components of physical fitness, and may direct specific interventions to maximize gross motor capacity in children and adolescents with CP.     

Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: a preliminary study

This study aimed to evaluate functional effects of Bobath therapy in children with cerebral palsy (CP). Fifteen children with a diagnosis of CP were recruited (9 males, 6 females; mean age 7 years 4 months, SD 2 years 8 months; age range 2 to 12 years). Types of motor disorder were as follows: spastic quadriplegia (n=9); spastic diplegia (n=4); athetoid quadriplegia (n=1), and ataxia (n=1). Participants were distributed across the following Gross Motor Function Classification levels: level I, n=1; level II, n=4; level III, n=5; level IV, n=4; and level V, n=1. Children awaiting orthopaedic intervention were excluded. A repeated measures design was used with participants tested with the Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) at 6-weekly intervals (baseline, before and after Bobath therapy, and follow-up). As the data were of ordinal type, non-parametric statistics were used, i.e. Wilcoxon's test. Participants showed a significant improvement in scores in the following areas following Bobath therapy compared with the periods before and after Bobath therapy: GMFM total score (p=0.009); GMFM goal total (p=0.001); PEDI self care skills (p=0.036); and PEDI caregiver assistance total score (p=0.012). This demonstrates that in this population, gains were made in motor function and self care following a course of Bobath therapy.     

Comparison of the Gross Motor Function Measure and Paediatric Evaluation of Disability Inventory in assessing motor function in children undergoing selective dorsal rhizotomy

This study was designed to compare assessment with the functional outcome measures Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) over time, in children with cerebral palsy (CP) undergoing selective dorsal rhizotomy combined with individualised physiotherapeutic interventions. Using the Gross Motor Function Classification System (GMFCS), 18 children with spastic diplegia were divided into two groups according to age-related severity of motor function impairment. Data were collected preoperatively, and at 6 and 12 months postoperatively. Both instruments were sensitive to changes in function over time in the series as a whole and in the group with milder impairment, although the PEDI detected significant changes earlier. In the group with more severe impairment, changes in function were detected only with the PEDI, not with the GMFM. Thus, the instruments are to be considered complementary tests, because they measure different aspects of function.     

The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years

The aim of this study was to explore motor development in children with cerebral palsy (CP) using developmental curves for CP, subtypes, and the five severity levels of the Gross Motor Function Classification System (GMFCS). The Gross Motor Function Measure (GMFM) and the GMFCS were applied to 317 children (145 females, 172 males) with CP, aged between 1 and 15 years. The CP type distribution was spastic diplegia in 157 (49%), spastic hemiplegia in 101 (33%), spastic tetraplegia in 11 (3%), dyskinesia in 38 (12%), and ataxia in 10 (3%). Forty-five physiotherapists were trained in the GMFM and intra- and interrater reliability was tested. The GMFM was measured prospectively every 6 months up to the age of 4 years and once a year thereafter. Developmental curves were constructed for 258 children with spastic CP. About three-quarters of the children at GMFCS Level I reached 90% of the maximum GMFM score at 5 years of age. The performance peaked at 7 years of age. Children at GMFCS Level II reached 90% at a median age of 5 years, which was also the upper limit, reached by about three-quarters at 7 years of age. The majority of children at GMFCS Level III reached 80% of the GMFM by 7 years of age and most of the children at GMFCS Level IV reached 30% at 5 years and remained there. The median score for children at GMFCS Level V was 20%. The intra- and interrater reliability for the GMFM 88 among physiotherapists were Spearman's rank correlation coefficient 0.91 and 0.99 respectively. There were 931 measurements with a median of 2 (1-11) per child. The gross motor development was demonstrated for the five GMFCS levels in children with spastic CP. These kind of curves may be useful for monitoring and predicting motor development, for planning treatment, and for evaluating outcome after interventions.     

Measuring mobility limitations in children with cerebral palsy: content and construct validity of a mobility questionnaire (MobQues)

Aim The objective of this study was to assess the validity of a mobility questionnaire (MobQues) that was developed to measure parent‐reported mobility limitations in children with cerebral palsy (CP). Method The parents of 439 children with CP (256 males and 183 females; age range 2–18y; Gross Motor Function Classification System [GMFCS] levels I–IV) completed the mobility questionnaire (MobQues). To assess content validity, we linked all meaningful concepts of the MobQues items to the International Classification of Functioning, Disability and Health (ICF). To assess construct validity, we compared the total scores of the two versions of the MobQues (MobQues47 and MobQues28) according to GMFCS level, and determined Pearson’s correlation coefficient (r) with the Gross Motor Function Measure‐66 (GMFM‐66). Results Content validity was demonstrated by the fact that 46 of the 47 MobQues items were linked to categories in the ‘Mobility’ chapter of the ICF. Construct validity was demonstrated by the finding that MobQues scores decreased with increasing GMFCS levels (p<0.001). In a subgroup of 162 children, positive correlations were found between total scores and the GMFM‐66 (MobQues47, r=0.75; MobQues28, r=0.67, p<0.001). Interpretation The results of this study provide evidence supporting the content and construct validity of the MobQues as a measure of mobility limitation in children with CP.     

Comparing reliability and validity of pediatric instruments for measuring health and well-being of children with spastic cerebral palsy

This study sought to examine the reliability and validity of three generic instruments for measuring the health of children with cerebral palsy (CP) and to compare them with a disease-specific measure, the Gross Motor Function Measure (GMFM). The Pediatric Evaluation and Disability Inventory (PEDI), the Pediatric Outcomes Data Collection Instrument (PODCI), and the Child Health Questionnaire (CHQ) were completed by the primary caregivers of 115 young children with spastic CP. The GMFM was administered to the children. The mean age of the sample was 5 years 8 months (range 3:1 to 10:4) and consisted of more males (58%) than females. The PEDI scales demonstrated higher internal consistency than the PODCI and CHQ scales. In comparison with the GMFM, the PODCI transfer and mobility scale (relative validity, 62%) and the PEDI mobility scale (relative validity, 53%) detected the most significant health differences between children with hemiplegia, diplegia, and quadriplegia. The PEDI social function scale detected the largest differences in cognitive function between children with an IQ of less than 70 compared with those with an IQ of 70 or greater. The reliability and validity of these different instruments varied significantly in this patient population.     

A randomized controlled trial of the impact of therapeutic horse riding on the quality of life, health, and function of children with cerebral palsy

This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP). Ninety-nine children aged 4 to 12 years with no prior horse riding experience and various levels of impairment (Gross Motor Function Classification System Levels I−III) were randomized to intervention (10wks therapeutic programme; 26 males, 24 females; mean age 7y 8mo [SD 2y 5mo] or control (usual activities, 27 males, 22 females; mean age 8y 2mo [SD 2y 6mo]). Pre- and post-measures were completed by 72 families (35 intervention and 37 control). Children's gross motor function (Gross Motor Function Measure [GMFM]), health status (Child Health Questionnaire [CHQ]), and QoL (CP QoL-Child, KIDSCREEN) were assessed by parents and QoL was assessed by children before and after the 10-week study period. On analysis of covariance, there was no statistically significant difference in GMFM, CP QoL-Child (parent report and child self-report), and CHQ scores (except family cohesion) between the intervention and control group after the 10-week study period, but there was weak evidence of a difference for KIDSCREEN (parent report). This study suggests that therapeutic horse riding does not have a clinically significant impact on children with CP. However, a smaller effect cannot be ruled out and the absence of evidence might be explained by a lack of sensitivity of the instruments since the QoL and health measures have not yet been demonstrated to be sensitive to change for children with CP.     

Everyday functioning in young children with cerebral palsy: functional skills,caregiver assistance,and modifications of the environment

Everyday functioning is described in 95 children with cerebral palsy (CP; 55 males and 40 females; mean age 58 months, SD 18 months, range 25 to 87 months) using the three scales of the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills, Caregiver Assistance, and Modifications of the Environment. Types of CP in the children were hemiplegia, (n=19), spastic/ataxic diplegia, (n=44), spastic quadriplegia, (n=16), dyskinetic, (n=9), and mixed (n=7). Symptoms were grouped by severity according to the Gross Motor Function Classification System (GMFCS): 23% were classified at level I, 21% at level II, 10% at level III, 23% at level IV, and 23% level V. A large variability in functioning in mobility, self-care, and social function was seen because of the heterogeneity of children with CP. Limitations in achievement of activities, need for assistance, and use of assistive devices increased progressively with GMFCS level. Furthermore, these children differed to a great extent from the normative sample of the PEDI. Stepwise regression analysis showed that the GMFCS was a good predictor of everyday functioning with age and learning problems as significantly contributing factors, particularly in self-care and social function. In conclusion, the three scales of the PEDI represent different but strongly related aspects of everyday functioning in young children with CP.     

Effects of a supported speed treadmill training exercise program on impairment and function for children with cerebral palsy

Aim To compare the effects of a supported speed treadmill training exercise program (SSTTEP) with exercise on spasticity, strength, motor control, gait spatiotemporal parameters, gross motor skills, and physical function. Method Twenty‐six children (14 males, 12 females; mean age 9y 6mo, SD 2y 2mo) with spastic cerebral palsy (CP; diplegia, n=12; triplegia, n=2; quadriplegia n=12; Gross Motor Function Classification System levels II–IV) were randomly assigned to the SSTTEP or exercise (strengthening) group. After a twice daily, 2‐week induction, children continued the intervention at home 5 days a week for 10 weeks. Data collected at baseline, after 12‐weeks’ intervention, and 4 weeks after the intervention stopped included spasticity, motor control, and strength; gait spatiotemporal parameters; Gross Motor Function Measure (GMFM); and Pediatric Outcomes Data Collection Instrument (PODCI). Results Gait speed, cadence, and PODCI global scores improved, with no difference between groups. No significant changes were seen in spasticity, strength, motor control, GMFM scores, or PODCI transfers and mobility. Post‐hoc testing showed that gains in gait speed and PODCI global scores were maintained in the SSTTEP group after withdrawal of the intervention. Interpretation Although our hypothesis that the SSTTEP group would have better outcomes was not supported, results are encouraging as children in both groups showed changes in function and gait. Only the SSTTEP group maintained gains after withdrawal of intervention.     

Quantitative diffusion tensor tractography of the motor and sensory tract in children with cerebral palsy

Aim The aim of this study was to compare the findings of quantitative diffusion tensor tractography of the motor and sensory tracts in children with cerebral palsy (CP) and typically developed comparison individuals, and also to evaluate the correlation with gross motor function. Method Thirty‐four children with CP (mean age 2y 2.mo, SD 2y 0mo; 19 with spastic diplegia, eight with hemiplegia, six with spastic quadriplegia, and one with spastic triplegia) and 21 healthy comparison children (mean 2y 1.68mo, SD 2y 8.64mo) were evaluated. The distribution of Gross Motor Function Classification System (GMFCS) levels in the CP group was as follows: level I, 7; level II, 14; level III, 5; level IV, 3; and level V, 5. The following three diffusion tensor imaging (DTI) parameters including tractography were evaluated for each tract (corticospinal tract [CST] and posterior thalamic radiation [PTR]): number of fibres, tract‐based fractional anisotropy, and region of interest (ROI)‐based fractional anisotropy. We compared each value between the two groups, and correlated each value with the GMFCS level. Results The number of fibres and ROI‐based fractional anisotropy values of both tracts were significantly lower in children with CP than in the comparison group (p<0.05–0.001). Additionally, there was significant negative correlation between GMFCS level and motor–sensory parameters (p<0.001–0.05). Interpretation DTI parameters of the CST and PTR in children with CP were significantly lower than in comparison children. In addition, these parameters were significantly correlated with GMFCS level.     

Anisotropy of transcallosal motor fibres indicates functional impairment in children with periventricular leukomalacia

Aim In children with bilateral spastic cerebral palsy (CP), periventricular leukomalacia (PVL) is commonly identified on magnetic resonance imaging. We characterized this white matter condition by examining callosal microstructure, interhemispheric inhibitory competence (IIC), and mirror movements. Method We examined seven children (age range 11y 9mo–17y 9mo, median age 15y 10mo, four females, three males) with bilateral spastic CP/PVL (Gross Motor Function Classification System level I or II, Manual Ability Classification System level I) and 12 age‐matched controls (age range 11y 7mo–17y 1mo, median age 15y 6mo, seven females, five males). Fractional anisotropy of the transcallosal motor fibres (TCMF) and the corticospinal tract (CST) of both sides were calculated. The parameters of IIC (transcranial magnetic stimulation) and mirror movements were measured using a standardized clinical examination and a computer‐based hand motor test. Results Fractional anisotropy was lower in children with bilateral spastic CP/PVL regarding the TCMF, but not the left or right CST. Resting motor threshold was elevated in children with bilateral spastic CP/PVL whereas measures of IIC tended to be lower. Mirror movements were markedly elevated in bilateral spastic CP/PVL. Interpretation This study provides new information on different aspects of motor function in children with bilateral spastic CP/PVL. Decreased fractional anisotropy of TCMF is consistent with impairment of hand motor function in children with bilateral spastic CP/PVL. The previously overlooked microstructure of the TCMF may serve as a potential indicator for hand motor function in patients with bilateral spastic CP/PVL.     

Effects of a static bicycling programme on the functional ability of young people with cerebral palsy who are non-ambulant

This study investigated the effects of exercise on the motor function of 11 young people (10 females, one male; age range 11-15y; mean age 12y 7mo [SD 1y 4mo]) with cerebral palsy (CP) who were non-ambulant (Gross Motor Function Classification System Levels IV or V), using an adapted static bicycle. Three participants had dyskinetic quadriplegia, seven had spastic quadriplegia, had spastic quadriplegia, and one had spastic diplegia. The study used an ABA design with participants acting as their own controls with 6-week baseline, 6-week exercise (three sessions a week), and 6-week follow-up periods. Outcomes were assessed with the Gross Motor Function Measure (GMFM)-66 and GMFM-88. A "graded exercise test" determined pedalling resistance, and "overload" was ensured by increasing the duration and speed of pedalling. Results showed significant improvements in GMFM-66 (p=0.010) and in GMFM-88 dimensions D (Standing; P=0.012) and E (Walking, Running, and Jumping; p=0.011) over the intervention period, but not over the baseline or follow-up periods. Significant improvements were found in "cycling" ability for duration of pedalling (p<0.001), speed (p=0.01), and resistance (p=0.001). This study demonstrates that a relatively short, clinically feasible training programme on a static bicycle can lead to valuable improvements in functional ability in young people with CP. The static bicycle provided a safe, effective means of exercise to a population with very limited opportunities for activity.     

Horseback riding in children with cerebral palsy: effect on gross motor function

The effects of recreational horseback riding therapy (HBRT) on gross motor function in children with cerebral palsy (CP: spastic diplegia, spastic quadriplegia, and spastic hemiplegia) were determined in a blinded study using the Gross Motor Function Measure (GMFM). Seventeen participants (nine females, eight males; mean age 9 years 10 months, SE 10 months) served as their own control. Their mean Gross Motor Function Classification System score was 2.7 (SD 0.4; range 1 to 5). HBRT was 1 hour per week for three riding sessions of 6 weeks per session (18 weeks). GMFM was determined every 6 weeks: pre-riding control period, onset of HBRT, every 6 weeks during HBRT for 18 weeks, and 6 weeks following HBRT. GMFM did not change during pre-riding control period. GMFM Total Score (Dimensions A-E) increased 7.6% (p<0.04) after 18 weeks, returning to control level 6 weeks following HBRT. GMFM Dimension E (Walking, Running, and Jumping) increased 8.7% after 12 weeks (p<0.02), 8.5% after 18 weeks (p<0.03), and remained elevated at 1.8% 6 weeks following HBRT (p<0.03). This suggests that HBRT may improve gross motor function in children with CP, which may reduce the degree of motor disability. Larger studies are needed to investigate this further, especially in children. with more severe disabilities. Horseback riding should be considered for sports therapy in children with CP.     

Neuroimpairments, activity performance, and participation in children with cerebral palsy mainstreamed in elementary schools

Participation and activity performance (motor and cognitive or behavioural) were examined in 148 children with cerebral palsy (CP; 87 males, 61 females; mean age 9y 8mo, SD 1y 11mo; range 6y 1mo to 13y 7mo), mainstreamed in fully inclusive (n=100) and in self-contained classes (n=48) within general schools in Israel, using the School Function Assessment. Differences in participation within these groups were analyzed in relation to the type of CP (mainly spastic hemiplegia, spastic diplegia, and spastic tetraplegia), the level of impairment according to the Gross Motor Function Classification System (GMFCS; level II 55%, level III 37%, and level IV 8%), and additional neuroimpairments. Univariate analyses of variance revealed significant differences in levels of participation and levels of activity performance between different types of CP and GMFCS levels. With regard to additional neuroimpairments, significant differences in participation were found for fully included children with speech and language impairments and those with learning disability within the self-contained group. Physical activity performance partly accounted for differences in participation between children with different types of CP and different levels of motor impairment. These findings suggest that within the mainstreamed environment, participation and activity performance increase as motor disability and/or additional neuroimpairments (speech and language impairments and learning disability) decrease.     

Correlates of decline in gross motor capacity in adolescents with cerebral palsy in Gross Motor Function Classification System levels III to V: an exploratory study

Aim To explore associations between clinical variables and decline in motor capacity in adolescents with cerebral palsy (CP). Method Participants included 76 males and 59 females, whose mean age at the beginning of the study was 14 years 6 months (SD 2.4, range 11.6–17.9); 51 at Gross Motor Function Classification System (GMFCS) level III, 47 at level IV, and 37 at level V. Ninety‐six participants had tetraplegia, 32 had diplegia, and one had hemiplegia. Types of motor disorder were spastic n=98; mixed, n=11; dystonic, n=9; hypotonic, n=7; and ataxic n=3 (seven participants were not classified). Reliable raters collected data annually for 4 years on anthropometric characteristics, the Spinal Alignment and Range of Motion Measure, as well as the Gross Motor Function Measure, 66 items (GMFM‐66); participants or their parents reported on health status (using the Health Utilities Questionnaire), pain, and exercise participation (using measures developed for this study). The predicted drop in GMFM‐66 scores after childhood was calculated using data on the same children from an earlier study. Correlations were calculated between the drop in GMFM‐66 scores and the average and change scores of the clinical variables (the alpha level for statistical significance of this exploratory study was 0.10). Results The drop in GMFM‐66 score was significantly correlated with limitations in range of motion (r=0.42) and spinal alignment (r=0.28), and pain (r=0.16). Increases in triceps skinfold (r=?0.19), mid‐arm circumference (r=?0.23), and the ratio of mid‐arm circumference to knee height (r=?0.23) were associated with less decline. Interpretation Preventing range‐of‐motion limitations and pain experiences and optimizing nutrition might contribute to less decline in the gross motor capacity of adolescents with CP. Further investigation is required to clarify the role other factors that contribute to maintained function over time.     

Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy: a randomized controlled trial

Aim To evaluate the effectiveness of functional progressive resistance exercise (PRE) strength training on muscle strength and mobility in children with cerebral palsy (CP). Method Fifty‐one children with spastic uni‐ and bilateral CP; (29 males, 22 females; mean age 10y 5mo, SD 1y 10mo, range 6y 0mo–13y 10mo; Gross Motor Function Classification System levels I–III) were randomized to the intervention group (n=26) or the control group (n=25, receiving usual care). The intervention group trained for 12 weeks, three times a week, on a five‐exercise circuit, which included a leg‐press and functional exercises. The training load progressively increased based on the child’s maximum level of strength, determined by the eight‐repetition maximum. Muscle strength (measured with hand‐held dynamometry and a six‐repetition maximum leg‐press test), mobility (measured with the Gross Motor Function Measure, two functional tests, and a mobility questionnaire), and spasticity (measured by the appearance of a catch) were evaluated before, during, directly after, and 6 weeks after the end of training by two blinded research assistants. Results Directly after training, there was a statistically significant effect (p<0.05) on muscle strength (knee extensors +12% [0.56N/kg; 95% confidence interval {CI} 0.13–0.99]; hip abductors +11% [0.27N/kg; 95% CI 0.00–0.54]; total +8% [1.30N/kg; 95% CI 0.56–2.54]; six‐repetition maximum +14% [14%; 95% CI 1.99–26.35]), but not on mobility or spasticity. A detraining effect was seen after 6 weeks. Interpretation Twelve weeks of functional PRE strength training increases muscle strength up to 14%. This strength gain did not lead to improved mobility.