Marsico Petra, Tal-Akabi Amir, Van Hedel Hubertus J A
Paediatric Rehab Research Group, Rehabilitation Centre for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.
Department of Health, Bern University of Applied Sciences, Bern, Switzerland.
Dev Med Child Neurol. 2016 Feb;58(2):173-9. doi: 10.1111/dmcn.12797. Epub 2015 May 11.
Preventing restrictions to lower limb movement is part of the treatment given to children with cerebral palsy (CP). Such restrictions can be assessed using the 'straight leg raise' (SLR) test. This study investigated the interrater reliability and practicability of the SLR test in children with CP.
Experienced physiotherapists examined 23 children with CP (6-18y; eight females, 15 males) twice. The SLR hip range of motion (ROM) was measured using an electrogoniometer, and the test was rated based on sensitizing manoeuvres and biceps femoris muscle activity. Practicability was investigated by evaluating children's subjective feedback on the tolerable ROM.
Intraclass correlation coefficients for the SLR hip ROM varied, ranging from 0.84 (95% CI 0.61-0.93) to 0.93 (95% CI 0.87-0.96). Physiotherapists substantially agreed on SLR ratings (Cohen's kappa=0.73). Biceps femoris muscle activity decreased significantly with the release of tension on the sciatic nerve. All children were able to communicate the location and sensation of the maximally tolerated position.
The SLR test proved to be reliable and practicable in children with CP and might improve clinical reasoning processes. Lower limb movement restrictions in these children may partly be related to limitations in sciatic nerve mobility. Further studies should investigate if the SLR test could estimate activities in children with CP.
预防下肢运动受限是脑瘫（CP）患儿治疗的一部分。这种受限情况可通过“直腿抬高”（SLR）测试进行评估。本研究调查了SLR测试在CP患儿中的评分者间信度和实用性。
经验丰富的物理治疗师对23名CP患儿（6 - 18岁；8名女性，15名男性）进行了两次检查。使用电子角度计测量SLR时髋关节活动范围（ROM），并根据激发动作和股二头肌活动对测试进行评分。通过评估患儿对可耐受ROM的主观反馈来研究实用性。
SLR时髋关节ROM的组内相关系数有所不同，范围从0.84（95%CI 0.61 - 0.93）到0.93（95%CI 0.87 - 0.96）。物理治疗师对SLR评分基本达成一致（Cohen's kappa = 0.73）。随着坐骨神经张力的释放，股二头肌活动显著降低。所有患儿都能够传达最大耐受位置的部位和感觉。
SLR测试在CP患儿中被证明是可靠且实用的，可能会改善临床推理过程。这些患儿的下肢运动受限可能部分与坐骨神经活动度受限有关。进一步的研究应调查SLR测试是否可以评估CP患儿的活动情况。
