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Cloodt E, Lindgren A, Rodby-Bousquet E. Knee and ankle range of motion and spasticity from childhood into adulthood: a longitudinal cohort study of 3,223 individuals with cerebral palsy. Acta Orthop 2024; 95:200-205. [PMID: 38708569 PMCID: PMC11072397 DOI: 10.2340/17453674.2024.40606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND AND PURPOSE Reduced range of motion (ROM) and spasticity are common secondary findings in cerebral palsy (CP) affecting gait, positioning, and everyday functioning. These impairments can change over time and lead to various needs for intervention. The aim of this study was to analyze the development path of the changes in hamstring length, knee extension, ankle dorsiflexion, and spasticity in hamstrings and gastrosoleus from childhood into adulthood in individuals with CP at the Gross Motor Function Classification System (GMFCS) levels I-V. METHODS A longitudinal cohort study was undertaken of 61,800 measurements in 3,223 individuals with CP, born 1990-2017 and followed for an average of 8.7 years (range 0-26). The age at examination varied between 0 and 30 years. The GMFCS levels I-V, goniometric measurements, and the modified Ashworth scale (MAS) were used for repeated assessments of motor function, ROM, and spasticity. RESULTS Throughout the follow-up period, knee extension and hamstring length exhibited a consistent decline across all individuals, with more pronounced decreases evident in those classified at GMFCS levels III-V. Ankle dorsiflexion demonstrated a gradual reduction from 15° to 5° (GMFCS I-IV) or 10° (GMFCS V). Spasticity levels in the hamstrings and gastrosoleus peaked between ages 5 and 7, showing a propensity to increase with higher GMFCS levels. CONCLUSION Passive ROM continues to decrease to 30 years of age, most pronouncedly for knee extension. Conversely, spasticity reached its peak at a younger age, with a more notable occurrence observed in the gastrosoleus compared with the hamstrings. Less than 50% of individuals had spasticity corresponding to MAS 2-4 at any age.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; Department of Research and Development, Region Kronoberg, Växjö.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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Noten S, Pettersson K, Czuba T, Cloodt E, Casey J, Rodby-Bousquet E. Probability of independent walking and wheeled mobility in individuals with cerebral palsy. Dev Med Child Neurol 2024; 66:326-332. [PMID: 37559231 DOI: 10.1111/dmcn.15731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
AIM To estimate the probability of independent walking and wheeled mobility in individuals with cerebral palsy (CP) at home and in the community in relation to age and gross motor function. METHOD This was a longitudinal cohort study using data reported into the combined Swedish CP follow-up programme and national quality registry from October 2000 to October 2022. Walking, walking with aids, wheeled mobility, and assisted mobility defined independent or assisted mobility at home and in the community, based on the Functional Mobility Scale with additional data on wheelchair performance, were assessed. RESULTS There were 52 858 examinations reported for 6647 individuals with CP (age range 0-32 years, follow-up period 0-22 years). Most children and adults in Gross Motor Function Classification System (GMFCS) levels I or II walked without assistive devices. The probability of dependence on others for mobility in the community was high for both children and adults in GMFCS levels III to V. INTERPRETATION Although independent mobility is vital for participation and social inclusion, many children and adults with CP are dependent on others for mobility. We recommend clinicians, together with families and individuals with CP, explore how to increase access to independent mobility from an early age and continuously throughout the life course. WHAT THIS PAPER ADDS • There is a high probability of independent walking in Gross Motor Function Classification System (GMFCS) levels I to II. • Mobility options vary most at home and in the community in GMFCS level III. • Being dependent on others for mobility is likely in GMFCS levels III to V.
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Affiliation(s)
- Suzie Noten
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
| | - Katina Pettersson
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
| | - Tomasz Czuba
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Erika Cloodt
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Jackie Casey
- Regional Wheelchair: Training, Research & Service Development (NI), Belfast Health & Social Care Trust, Belfast, UK
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
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Cloodt E, Lindgren A, Lauge-Pedersen H, Rodby-Bousquet E. Sequence of flexion contracture development in the lower limb: a longitudinal analysis of 1,071 children with cerebral palsy. BMC Musculoskelet Disord 2022; 23:629. [PMID: 35780097 PMCID: PMC9250270 DOI: 10.1186/s12891-022-05548-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background To prevent severe contractures and their impact on adjacent joints in children with cerebral palsy (CP), it is crucial to treat the reduced range of motion early and to understand the order by which contractures appear. The aim of this study was to determine how a hip–knee or ankle contracture are associated with the time to and sequence of contracture development in adjacent joints. Methods This was a longitudinal cohort study of 1,071 children (636 boys, 435 girls) with CP born 1990 to 2018 who were registered before 5 years of age in the Swedish surveillance program for CP and had a hip, knee or ankle flexion contracture of ≥ 10°. The results were based on 1,636 legs followed for an average of 4.6 years (range 0–17 years). The Cox proportional-hazards model adjusted for Gross Motor Function Classification System (GMFCS) levels I–V was used to compare the percentage of legs with and without more than one contracture. Results A second contracture developed in 44% of the legs. The frequency of multiple contractures increased with higher GMFCS level. Children with a primary hip or foot contracture were more likely to develop a second knee contracture. Children with a primary knee contracture developed either a hip or ankle contracture as a second contracture. Conclusions Multiple contractures were associated with higher GMFCS level. Lower limb contractures appeared in specific patterns where the location of the primary contracture and GMFCS level were associated with contracture development in adjacent joints.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | | | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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Cloodt E, Wagner P, Lauge-Pedersen H, Rodby-Bousquet E. Knee and foot contracture occur earliest in children with cerebral palsy: a longitudinal analysis of 2,693 children. Acta Orthop 2021; 92:222-227. [PMID: 33228441 PMCID: PMC8158222 DOI: 10.1080/17453674.2020.1848154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints, it is crucial to identify children with a reduced range of motion (ROM) early. We examined whether significant hip, knee, or foot contracture occurs earliest in children with CP.Patients and methods - This was a longitudinal study involving 27,230 measurements obtained for 2,693 children (59% boys, 41% girls) with CP born 1990 to 2018 and registered before 5 years of age in the Swedish surveillance program for CP. The analysis was based on 4,751 legs followed up for an average of 5.0 years. Separate Kaplan-Meier (KM) curves were drawn for each ROM to illustrate the proportions of contracture-free legs at a given time during the follow-up. Using a clustered bootstrap method and considering the child as the unit of clustering, 95% pointwise confidence intervals were generated for equally spaced time points every 2.5 years for each KM curve.Results - Contracture developed in 34% of all legs, and the median time to the first contracture was 10 years from the first examination. Contracture was most common in children with a higher Gross Motor Function Classification System (GMFCS) level. The first contracture was a flexion contracture preventing dorsiflexion in children with GMFCS level I or II and preventing knee extension in children with GMFCS level III to V.Interpretation - Early interventions to prevent knee and foot contractures in children with CP should be considered.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; ,Department of Research and Development, Region Kronoberg, Växjö;; ,Correspondence:
| | - Philippe Wagner
- Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
| | | | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund; ,Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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Cloodt E, Krasny J, Jozwiak M, Rodby-Bousquet E. Interrater reliability for unilateral and bilateral tests to measure the popliteal angle in children and youth with cerebral palsy. BMC Musculoskelet Disord 2021; 22:275. [PMID: 33714264 PMCID: PMC7956112 DOI: 10.1186/s12891-021-04135-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Short hamstring muscles can cause several problems for children with cerebral palsy. The results of the clinical measurement of hamstring length are often used in decision-making about treatment of children with cerebral palsy. There are different ways of performing this measurement. The aim of this study was to evaluate the interrater reliability of the unilateral and bilateral measurement of the popliteal angle in children and youth with cerebral palsy. Methods Two methods for estimating hamstring length using unilateral and bilateral measurements of the popliteal angle were applied in children with cerebral palsy. Both tests were applied bilaterally by two independent examiners on the same day for each child. The intraclass correlation coefficient (ICC) was calculated to evaluate the interrater reliability of both measurements. Seventy young people with cerebral palsy (32 females, 38 males, mean age 10 years 8 months, range 5–22 years) at Gross Motor Function Classification System levels I (n = 17), II (n = 31), III (n = 12) and IV (n = 10) were included. Results The interrater reliability was good for both measurements. The ICC values were 0.80 on the right and 0.86 on the left for the unilateral popliteal angle, and 0.82 on the right and 0.83 on the left for the bilateral popliteal angle. Conclusions Both unilateral and bilateral measurement of the popliteal angle is a reliable method for estimating hamstring length in children and youth with cerebral palsy.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Joanna Krasny
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jozwiak
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research, Uppsala University-Region Västmanland, Västerås, Sweden
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Cloodt E, Rosenblad A, Rodby-Bousquet E. Demographic and modifiable factors associated with knee contracture in children with cerebral palsy. Dev Med Child Neurol 2018; 60:391-396. [PMID: 29318610 DOI: 10.1111/dmcn.13659] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Abstract
AIM To identify the prevalence of knee contracture and its association with gross motor function, age, sex, spasticity, and muscle length in children with cerebral palsy (CP). METHOD Cross-sectional data for passive knee extension were analysed in 3 045 children with CP (1 756 males, 1 289 females; mean age 8y 1mo [SD 3.84]). CP was classified using the Gross Motor Function Classification System (GMFCS) levels I (n=1 330), II (n=508), III (n=280), IV (n=449), and V (n=478). Pearson's χ2 test and multiple binary logistic regression were applied to analyse the relationships between knee contracture and GMFCS level, sex, age, spasticity, hamstring length, and gastrocnemius length. RESULTS Knee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Odds ratios (ORs) for knee contracture were significantly higher for children at GMFCS level V (OR=13.17), with short hamstring muscles (OR=9.86), and in the oldest age group, 13 years to 15 years (OR=6.80). INTERPRETATION Knee contracture is associated with higher GMFCS level, older age, and shorter muscle length; spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture. WHAT THIS PAPER ADDS Knee contracture occurs in children with cerebral palsy at all Gross Motor Function Classification System (GMFCS) levels. Knee contracture in children is associated with short hamstring muscles, higher GMFCS level, and older age. Short hamstring muscles present a greater risk for knee contracture than spasticity.
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Affiliation(s)
- Erika Cloodt
- Department of Health Sciences Lund, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Andreas Rosenblad
- Centre for Clinical Research Västerås, Uppsala University, Region Västmanland, Västerås, Sweden
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research Västerås, Uppsala University, Region Västmanland, Västerås, Sweden.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
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